Renal failure is a condition where kidneys lose their ability to filter waste and maintain balance of fluids and electrolytes, classified into acute renal failure (ARF) and chronic renal failure (CRF). ARF can be reversible and is caused by prerenal, intrinsic, or postrenal factors, while CRF leads to permanent damage and is often due to conditions like diabetes and hypertension. Management includes treating underlying causes, dietary modifications, and monitoring, with potential dialysis for severe cases.

1. .
Renal failure
Renal failure
10/04/202
PRESENTED
BY
MUTEGEKI ADOLF
KSHS

2. DEFINITION
Renal Failure refers to the condition in which the
kidneys lose their ability to adequately filter waste
products from the blood, regulate fluid and
electrolyte balance, and maintain blood pressure.
• It can be classified into two main types:
a) acute renal failure (ARF) and
b) chronic renal failure (CRF).

3. •Acute Renal Failure (ARF) occurs suddenly
and is usually reversible.
•Chronic Renal Failure (CRF) develops
gradually over months or years and is often
irreversible.

4. 1.Acute Renal Failure
ARF is an acute and
potentially reversible
irritability of the kidneys to
perform their normal
functions to maintain
homeostasis.

5. ACUTE RENAL FAILURE (ARF) CAUSES:
•Prerenal causes: Reduced blood flow to the kidneys due to
dehydration, heart failure, shock, or severe blood loss.
•Intrinsic (renal) causes: Direct damage to the kidneys from
conditions such as acute tubular necrosis,
glomerulonephritis, toxins, or drugs (e.g., NSAIDs,
antibiotics).
•Postrenal causes: Obstruction of the urinary tract (e.g.,
kidney stones, tumors, prostate enlargement) that
prevents urine flow.

6. PHASES
1. Initial
-Renal damage is occurring, the patient may be
-Asymptomatic
2. Oliguric
-<1ml/kg/hr of urine
-Impaired glomerular filtration
-Waste cannot be remove
-Uremia develops
-Neurotoxicity
-CCF, HTN, anemia

7. 3. Diuretic
- lasts 2 weeks
- cellular regeneration and healing
- gradual return to normal
- dehydration and electrolyte imbalance due to excess
urination
4. Recovery
- it takes months
- if left untreated it result in fluid overload, electrolyte
imbalance, uremia, coma

8. PATHOPHYSIOLOGY
• In renal failure, the kidneys fail to filter blood effectively,
leading to:
• Accumulation of waste products like urea and creatinine.
• Imbalance of electrolytes, such as sodium, potassium, and
calcium.
• Dysregulation of fluid volume, leading to fluid overload,
edema, and hypertension.
• Inadequate production of hormones (e.g., erythropoietin),
leading to anemia.

9. PATHOPHYSILOGY

10. CLINICAL PRESENTATIONS OF ARF
•Sudden reduction in urine output (oliguria) or no
urine output (anuria).
•Fluid overload: swelling (edema) in the legs, ankles,
or face.
•Shortness of breath.
•Fatigue and weakness.
•Nausea and vomiting.
•Confusion, lethargy, or seizures in severe cases.

11. DIFFERENTIAL DIAGNOSIS
•Other renal disorders
•Biventricular heart failure

12. INVESTIGATIONS
•Blood tests:
•Elevated levels of urea (BUN) and creatinine
(indicative of impaired kidney function).
•Electrolyte imbalances (e.g., high potassium, low
calcium).
•Complete blood count (CBC) to check for anemia.
•Urine tests:
•Urinalysis for protein, blood, or casts in urine.
•Urine output measurement.

13. •Imaging:
•Ultrasound: To detect kidney size, structural
abnormalities, or obstruction.
•CT scan/MRI: For detailed imaging of renal vasculature,
masses, or stones.
•Biopsy: Renal biopsy may be required to determine
the underlying cause, especially in
glomerulonephritis.
•Glomerular Filtration Rate (GFR): Estimates kidney
function and helps stage chronic kidney disease.

14. MANAGEMENT
•Treat underlying conditions e.g. dehydration
•Monitor fluid input and output
•Daily fluid requirements = 10 ml/kg + total of
losses through urine, vomitus and diarrhoea
•Monitor BP twice daily
•Daily weighing
•Restrict salt intake (<2 g or half teaspoonful daily)

15. •Restrict potassium intake e.g. oranges, bananas,
vegetables, meat, fizzy drinks
•Moderate protein intake
•Ensure adequate calories in diet, Check urine and
electrolytes frequently
•Treat any complications (e.g. infections,
hypertension, convulsions), adjusting drug dosages
according to the clinical response where
appropriate

16. •If oliguria, furosemide IV according to
response (high doses may be necessary)
•If no response to above general measures,
worsening kidney function or anuria (urine
output less than 100 ml/24 hours)
•Refer for specialist management including
possible dialysis as soon as possible and
before the patient’s ondition becomes
critical

17. NOTE: Do not give any drugs which may
make kidney damage worse e.g. use
gentamicin with caution

18. PROGNOSIS
Mortality rate of ARF is about 20 to 40%
which is influenced by the cause and
duration of renal failure with severity of
pathological changes.
Poor prognosis is related to associated
sepsis, prolonged anemia, cardiac failure,
hepatic failure and respiratory failure with
delayed initiation of treatment.

19. CHRONIC KIDNEY DISEASE
•Chronic renal failure
•End stage renal failure

20. 2. Chronic Renal Failure
It is a permanent irreversible
destruction of nephron
leading to severe
deterioration of renal
function, finally resulting to
end stage renal disease.

21. ETIOLOGY
•Cause below 5 years of age is mostly
congenital anomalies
•After 5 that is acquired glomerular disease,
hereditary disease
Glomerular disease
Congenital anomalies
Obstructive uropathy
Miscellaneous

22. •Diabetes mellitus: Leading cause due to diabetic
nephropathy.
•Hypertension: Causes damage to blood vessels in the
kidneys.
•Glomerulonephritis: Chronic inflammation of the kidney's
filtering units (glomeruli).
•Polycystic kidney disease: Genetic condition causing cysts
to develop in the kidneys.
•Prolonged use of nephrotoxic drugs (e.g., analgesics,
chemotherapy agents).
•Obstructive uropathy: Chronic obstruction of urine flow due
to stones, tumors, or prostate issues.

23. CLINICAL PRESENTATIONS OF CRF
• Fatigue and weakness.
• Loss of appetite, nausea, and vomiting.
• Swelling (edema) in the legs, face, or hands.
• High blood pressure (hypertension).
• Persistent itching (pruritus).
• Decreased urine output or frequent urination.
• Muscle cramps and bone pain due to calcium imbalances.
• Anemia leading to paleness, shortness of breath, and lethargy.
• Uremic symptoms in late stages, such as confusion, lethargy, and
pericarditis

24. PATHOPHYSIOLOGY
• In the early stage of disease child remains asymptomatic. Advance
renal damage will occur only in late stages.
• Increased numbers of nephrons are destructed at various degrees and
a few remain intact but hypertrophied and functional.
• This leads to insufficient adjustments in fluid and electrolyte balance.
• As the disease progress to end stage severe reduction in number of
nephrons occur and the kidney will not b able to maintain fliud and
electrolyte balance.
• The accumulation of various substances in blood result in
complications

25. Stages of Chronic Renal Failure
1. Diminished Renal Reserve
Normal BUN ( Blood Urea Nitrogen), and serum creatinine absence
of symptoms
2. Renal Insufficiency
GFR is about 25% of normal, BUN Creatinine levels increased
3. Renal Failure
GFR <25% of normal increasing symptoms
4. ESRD (End stage Renal Disease) or Uremia
GFR < 5-10% normal, creatinine clearance
<5-10ml/min resulting in a cumulative effect

26. COMPLICATIONS
• Azotemia (Uremia)
• Metabolic acidosis
• Electrolyte imbalance
• CCF
• HTN
• Severe anemia
• Growth retardation
• Delayed or absent sexual maturation

27. Differential diagnosis
•Other causes of chronic anaemia
•Heart failure
•Protein-energy malnutrition
•Chronic liver disease

28. MANAGEMENT
• Conservative management
Correction of reversible component of renal
dysfunction
Preservation of renal function
Treatment of metabolic and psycho-social problems
Optimization of growth
Preparation for treatment of ESRD
Treat for infection, accelerated hypertension, CCF,
obstruction of urine flow - to improve renal function

29. Dietary therapy
•Low protein diet
•Severe protein restriction may produce
protein calorie malnutrition
•Diet should consist of 100 percent RDA
(Recommended Dietary Allowance) for
calories
•Protein should be of high biological value
and should comprise 6 – 10 % of all
calories

30. •Avoid nephrotoxic medicines, e.g. NSAIDs,
celecoxibs, aminoglycosides, contrast agents
•Prevention of complications
•Anaemia: due to multiple causes. Consider
iron and folic supplements. Target Hb 11-12
gr/dL
•Bone mineral disease: consider adding
calcium Treatment of symptoms

31. •Blood pressure control: Target 130/80 mmHg
(lower in children). Use ACE inhibitors as first
line antihypertensives for diabetics and
patients with proteinuria, plus low salt diet
•In diabetics: BP control is paramount Optimal
blood sugar control (HbA1C <7%)
•Proteinuria: Reduce using ACE inhibitors
and/or ARBs; target < 1 g/day

32. •Salt restriction in patients with hypertension and
fluid overload
•Patients with salt losing nephropathy should take
a liberal amount of salt and water
•If the GFR falls <10ml/min/1.73m2
, potassium
intake should be restricted.(hyperkalemia may
develop)
•Vit D is essential to raise the serum calcium and
suppress parathormone secretion.

33. •If fluid retention/oliguria, furosemide
tablet according to response (high doses
may be necessary)
•Dialysis for end stage cases

34. •Dialysis

35. •Renal transplatation

36. ,
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