pathophysiological changes in ckd patients for anaesthetic concern

1. PATHOPHYSIOLOGICAL
CHANGES IN CRF PATIENTS FOR
RENAL TRANSPLANTATION
DR SHOWKET AHMAD DAR

2. HISTORY
• Dr. Joseph Murray in 1954.
• Noble price in Medicine in 1990.
• India started its kidney transplant program in
1970.
• In 1994 Indian Parliament passed the
transplantation of human organ act (THO).
DR SHOWKET AHMAD DAR

3. DR SHOWKET AHMAD DAR

4. CRD
• When GFR is less than 60 ml / mint / 1.73 m2
for more than 3 months---CRD
DR SHOWKET AHMAD DAR

5. DR SHOWKET AHMAD DAR

6. DR SHOWKET AHMAD DAR

7. INDICATIONS FOR RENAL
TRANSPLANTATION
• ESRD caused by
-D.M (40%)
-Hypertension
-glomerular disease
-PCKD
-Tubulointerstitial disease
-other familial and congenital diseases.
DR SHOWKET AHMAD DAR

8. PATHOPHSIOLOGICAL CHANGES ---
ANAESTHESIOLOGIST
DR SHOWKET AHMAD DAR

9. CONTI
CARDIOVASCULAR SYSTEM
SYSTEMIC HYPERTENSION
•SODIUM AND WATER RETENSION
•ALTERED RENIN-ANGIOTENSIN SECREATION
CHF
•PRIMARY: UREMIC CARDIOMYOPATHY
•SECONDARY: FLUID OVERLOAD
CAD
• ACELERATED ATHEROSCLEROSIS
UREMIC PERICARDITIS
CARDIAC TEMPONADE
CARDIAC DYSARRYTEMIAS
•HYPERKALEMIA
•HYPOCALCEMIA
DR SHOWKET AHMAD DAR

10. DR SHOWKET AHMAD DAR

11. CONTI
PULMONARY ABNORMALITIES
PULMONARY EDEMA, PLEURAL
EFFUSION, ATELECTASIS AND INFECTION
•FLUID OVERLOAD
•MALNUTRITION
•ANEMIA
•IMPAIRED HUMORAL AND CELLULAR
IMMUNITY
•DECREASED SURFACTANT
DR SHOWKET AHMAD DAR

12. CONTI
OXYGEN CARRYING CAPACITY
•RIGHT WARD SHIFT OF OXYGEN
DISSOCIATION CURVE
•INCREASED CARDIAC OUT PUT
•DECREASED BLOOD VISCOSITY
DR SHOWKET AHMAD DAR

13. CONTI
FLUID AND ELECTROLYTE IMBALANCE
HYPERVOLUMIA
•CHF
•PULMONARY EDEMA
•PLEURAL EFFUSION
•HYPERTENSION
HYPERKALEMIA
•CARDIAC DYSARRHYMIAS
HYPOCALCEMIA
•OSTEODYSTROPHIC ABNORMALITIES
•OSTEOPOROSIS
•PATHOLOGICAL BONE FRACTURE
HYPERMAGNESEMIA
•HYPOTENSION
•POTENTIATION OF NON DEPOLARIZING
MUSCLE RELAXANTS
•COMA
DR SHOWKET AHMAD DAR

14. CONTI
HEMATOLOGICAL
ABNORMALITIES
ANEMIA
DECREASED ERYTHOPOITIN PRODUCTION
REDUCED LIFE SPAN
•NORMO CHROMIC NORMOCYTIC ANEMIA
DEMINISHED ERYTHROCYTE PRODUCTION
•FIBROSIS OF BONE MARROW
DIETARY DEFICIENCY
•IRON
•FOLIC ACID
BLOOD LOSS
•HEMATEMESIS
•DIALYSIS
PLATELET
DYSFUNCTION
QUALITATIVE DYSFUCTION
BLEEDING DIATHESIS
DR SHOWKET AHMAD DAR

15. CONTI
GASTROINTESTINAL SYSTEM
DELAYED GASTRIC EMPTYING
NAUSEA AND VOMITING
PEPTIC ULCER DISEASE
GASROINTESTINAL BLEEDING
UREMIC GASTROENTRITIS
DR SHOWKET AHMAD DAR

16. CONTI
CENTRAL NERVOUS SYSTEM
DYSFUNCTION
BEHAVOIRAL CHANGES
LOSS OF MEMORY
NEUROMUSCULAR IRRITABILITY
LETHARGY
COMA
MYOCLONUS
CONVULSIONS
DR SHOWKET AHMAD DAR

17. CONTI
PERIPHERAL NEUROPATHY
MUSCLE WEAKNESS
•PERIPHERAL NERVE PALSY WITH FOOT
DROP
AUTONOMIC NEUROPATHY
ACID BASE ABNORMALITIES METABOLIC ACIDOSIS
DR SHOWKET AHMAD DAR

18. CONTI
ENDOCRINE DISTURBANCES
ALTERED TEMPERATURE REGULATION
ALTERED EXOGENOUS INSULIN REQUIREMENT
REDUCED / IMPAIRED ERYTHROPOITIN
PRODUCTION
SECONDARY HYPERPARATHYROIDISM
RENAL OSTEODYSTROPHY
•BONE PAIN
•FRACTURES
OSTEOMALASIA
DR SHOWKET AHMAD DAR

19. DR SHOWKET AHMAD DAR

20. DR SHOWKET AHMAD DAR

21. CONTI
DIALYSIS RELATED PROBLEMS
DIALYSIS DEMENTIA
DIALYSIS DISEQUILIBRIUM SYNDROME
HYPOVOLUMIA
PERITONITIS
SYSTEMIC ANTICOUGULATION
DR SHOWKET AHMAD DAR

22. TREATMENT OPTIONS FOR ESRD
• DIALYSIS
• RENAL TRANSPLANT
DR SHOWKET AHMAD DAR

23. TAKE HOME MASSAGE
DR SHOWKET AHMAD DAR

24. THANK YOU
DR SHOWKET AHMAD DAR
LOVE YOUR KIDNEY’S