Groups 18, 19, 20Batch 2007/08Faculty of MedicineUniversity of PeradeniyaSri Lanka

Renal failure or kidney failure is a situation in which the kidneys fail to function adequately

Renal failure can broadly be divided into two categories:

•Acute renal failure•Chronic renal failure

• The type of renal failure is determined by the trend in the serum creatinine.

• Other factors which may help differentiate acute and chronic kidney disease include the presence of anemia and the kidney size on ultrasound.

• Chronic kidney disease generally leads to anemia and small kidney size.

ACUTE RENAL FAILURE

Acute renal failure (ARF) is a rapidly progressive loss of renal function, generally characterized by oliguria (decreased urine production);body water and body fluids disturbances;and electrolyte derangement. ARF can result from a large number of causes.

Decrease urine output (70%)Decrease urine output (70%) Edema, esp. lower extremityEdema, esp. lower extremity Mental changesMental changes Heart failureHeart failure Nausea, vomitingNausea, vomiting PruritusPruritus AnemiaAnemia TachypeniaTachypenia Cool, pale, moist skinCool, pale, moist skin

Symptoms of ARF

Causes of acute renal failure

• Sudden interruption in the blood supply to the kidney,

• Toxic overload of the kidneys.

• Accidents, injuries or complications from surgery (where the kidneys are deprived of normal blood flow for an extended period of time.) e.g.- heart-bypass surgery.

• Drug overdoses, such as antibiotics or chemotherapy,

Chronic kidney disease

Chronic Kidney Disease (CKD) can develop slowly and show few initial symptoms, be the long term result of irreversible acute disease or be part of a disease progression

CRF SymptomsCRF Symptoms

MalaiseMalaise WeaknessWeakness FatigueFatigue NeuropathyNeuropathy AnorexiaAnorexia NauseaNausea VomitingVomiting

SeizureSeizure ConstipationConstipation Peptic ulcerationPeptic ulceration DiverticulosisDiverticulosis AnemiaAnemia PruritusPruritus JaundiceJaundice Abnormal hemostasisAbnormal hemostasis

CHRONIC RENAL FAILURE CAUSESCHRONIC RENAL FAILURE CAUSES

•Diabetes mellitus (main cause)•Hypertension•Polycystic kidney disease•Overuse of some common drugs, such as aspirin, ibuprofen, cocaine and acetaminophen

•Glomerulonephritis•HIV nephropathy•Reflux nephropathy in children•Kidney infections & obstructions

Polycystic kidney disease

Polycystic kidney disease

Hematuria

INVESTIGATION

Chronic kidney failure is measured in five stages, which are calculated using a patient’s GFR, or glomerular filtration rate

MEDICATIONS• Unlike in chronic kidney disease, the kidneys can often recover from acute failure, allowing the patient to resume a normal life.

• People suffering from acute failure require supportive treatment until their kidneys recover function, and often remain at an increased risk of developing future kidney failure

Medications used in acute or chronic kidney failure may include

• Diuretics – to flush out the kidneys, increase urine flow, and rid the body of excess sodium (eg, furosemide , mannitol )

• Dopamine, atrial natriuretic peptide (ANP) – to dilate blood vessels in the kidneys,

increase urine flow, flush out sodium

• Blood pressure medications (eg, ACE inhibitors)

• Sodium polystyrene sulfonate or insulin in dextrose –

to control high potassium levels

• Calcium acetate – to control high phosphorus levels

Peritoneal dialysis uses the peritoneal membrane, the lining of the abdomen, to remove excess water, wastes, and chemicals from the body.10 A dialysate passes through the abdomen via a surgically placed catheter. Fluid, wastes, and chemicals pass from capillaries in the peritoneal membrane into the dialysate. After several hours, the waste-carrying dialysate is drained from the abdomen.

Kidney transplant

REFERENCE

Davidson’s Clinical Medicine – 20th Edition (pg.491 – 496)http://www.wikipedia.comhttp://www.kidney.orghttp://www.umm.edu/ency/article/000471.htmhttp://www.fpnotebook.com/REN38.htmhttp://www.paems.org/eWebquiz/renal%20failure/Dialysis%20CEU.pdfhttp://www.loyolaems.com/sop/4med.htm#med8 http://www.chpnet.org/BIEM_Res/lectures.asp http://www.emedicine.com/emerg/topic501.htm http://http://www.medonline.com.br/med_ed/med1/iranejm.htm www.auburn.edu/~deruija/renal_part3/sld001.htm