Chronic renal failre

Chronic kidney disease

Definition:
Irreversile permanent kidney damage with ddecreased glomerular filtration rate.
It occurs over months or years. May be nort diagnosed for long time.
Stages of chronic kidney disease:

Stage 1 2 3 4 5
N  GFR Mild  GFR Moderate  GFR Severe  GFR Kidney failure
GFR(ml/min/ 1.73 m2) < 90 60-89 30-59 15-29 < 15
Causes:

< 5 years old > 5 years old

Congenital anomalies: Glomerular disease:
 Hypoplastic kidney  Focal segmental glomerulosclerosis
 Vesicouretral reflux  Hemolytic uremic syndrome
 Obstructive uropathy  Chronic glomerulonephritis
Genetic disorders:  Alport’s syndrome
 Congenital nephrotic syndrome Tubular disease:
 Polycystic kidney disease  Chronic tubulointerstitial nephritis
 Wilm’s tumor  Nephrotoxic drugs
 Oxalate  Cystinosis

Clinical picture:
It is vague& needs high index of suspicion:
System Symptoms
General Weakness, fatigue& failure to thrive
CVS Hypertension, pericarditis, cardiomyopathy& heart failure
RS Shortness of breath
GIT Anorexia, nausea, vomiting& gastritis
GUS Polyuria, polydipsia& nocturia
CNS Drowsiness& polyneuropathy
MSS Renal osteodystrophy
Blood Anemia, bleeding tendency& infection
Endocrine Growth failure& delayed puberty
Metabolic Hyperuremia, hyperlipidemia, hyperkalemia& hyponatremia
Investigations:
Hematology: CBC: anemia of chronic illness +/- infection
Biochemistry:  urea,  creatinine,  K,  Ph, Na,  Ca,  PTH,  Cholesterol

Head of P.W. Dr. Noura Noraddeen

Urine exam: protein, RBCs
Radiology: CXR: cardiomegaly
Bone X-ray: renal osteodystrophy
Abdominal U/S: atrophic kidneys or enlarge due to tumor or cysts
Others: ABG analysis, Echo& DMSA
Management:
 Stage 1: diagnosis& management of the cause.
 Stage 2&3: improve prognosis& treat complications
 Stage 4: prepare for renal replacement therapy
 Stage 5: renal replacement
Regular OPD visits for:
1- Vital signs& growth parameters
2- Investigations: GUE, CBC, S. electrolytes, KFT, lipid profile
OPD management:
System Treatment
Proteinuria Angiotensin converting enzyme inhibitor captopril or enalapril or lisinopril
Angiotensin receptor blocker: losartan.
HTN Control HTN by: diuretics, ACEI, Ca. channel blockers and/or beta blockers.
GIT Ranitidine, balanced diet, high calories, low salt& special formula
GUT Control edema by: fluid& electrolyte balance.
Osteodystrophy Ph binders, calcium carbonate& vitamin D1.
Blood Erythropoietin, iron& MVT. RBCs if needed.
Metabolic Control hyperlipidemia by: statin group.
Endocrine Growth hormone.
Immunity Vaccination.
Others Avoid NSAID.
Renal replacement therapy:
Indications of dialysis as mentioned in AKI
Types of dialysis:
 Hemodialysis
 Peritoneal dialysis that is preferred in children
Renal transplantation:
Is the preferred method in children that gives good outcome& near normal life.

Head of P.W. Dr. Noura Noraddeen

Head of P.W. Dr. Noura Noraddeen