Chronic Renal failure

Prepared By:

Alaa Mohamed Ali

Under Supervision:

DR/ Shereen
Outlines:

• Definition

• Signs and symptoms

• Stages of Chronic Renal Disease

• Pathophysiology

• Causes of Chronic Renal Disease

• Diagnosis

• Complications

• Management

• References
Definition:

Chronic renal failure is a condition involving a decrease in the kidneys' ability to filter
waste and fluid from the blood. It is chronic, meaning that the condition develops over a
long period of time and is not reversible. The condition is also commonly known as
chronic kidney disease (CKD).

Signs and symptoms:

Many people living with CKD do not have any symptoms until the more advanced stages
and/or complications develop. If symptoms do happen, they may include:

• Foamy urine.
• Urinating (peeing) more often or less often than usual.
• Itchy and/or dry skin.
• Feeling tired.
• Nausea.
• Loss of appetite.
• Weight loss without trying to lose weight.

People who have more advanced stages of CKD may also notice:
• Trouble concentrating.
• Numbness or swelling in your arms, legs, ankles, or feet.
• Achy muscles or cramping.
• Shortness of breath.
• Vomiting.
• Trouble sleeping.
• Breath smells like ammonia.

Stages of Chronic Renal Disease:

Stage 1 Stage 2 Stage 3 Stage 4 Stage 5

Slight kidney Mild Moderate Severe Kidney failure
damage with decrease in decrease in decrease in (ESRD)
normal or kidney kidney kidney requiring
increased function with function with function with dialysis or
filtration: a a GFR of GFR of GFR of transplantati
glomerular
60–89 30–59 15–29 on with GFR
filtration rate
less than 15
(GFR) of more
than 90.
Pathophysiology:

Chronic renal failure is caused by a progressive decline in all kidney functions,

ending with terminal kidney damage. During this time, there is modulation and
adaptation in the still-functional glomeruli, which keeps the kidneys functioning
normally for as long as possible. The remaining glomeruli, therefore, experience a
rise in pressure through hyperfiltration.The release of various cytokines and growth
factors leads to hypertophy and hyperplasia. At the same time, the function of the
glomeruli suffers due to the excessive demands on them, leading to Increased
permeability and proteinuria.Increased protein Concentrations in the proximal tube
system are direct nephrotoxins and can further impair kidney function.There are 4
phases of chronic renal failure:

• Reduction in Excretory Function :

• Reduction in Incretory Renal Function:
• Over-Hydration and the Disruption of Electrolyte Balance:
• Toxic Organ Damage as a Result of Retention of Urinary
• Excreted Metabolites.

Causes of Chronic Renal Disease

Chronic kidney disease occurs when a disease or condition impairs kidney function,
causing kidney damage to worsen over several months or years.i
Diseases and conditions that cause chronic kidney disease include:i

• Type 1 or type 2 diabetesi

• High blood pressurei
• Glomerulonephritis, an inflammation of the kidney's filtering units
Interstitial nephritis, an inflammation of the kidney's tubules and surrounding structures
• Polycystic kidney disease
Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate
kidney stones and some cancers
•Vesicoureteral reflux, a condition that causes urine to back up into your kidneys
Diagnosis:

Physical Exam:
At your appointment, your doctor will examine you thoroughly. Kidney failure
may be causing fluids to back up in your lungs or heart. Your doctor will examine
these organs by listening to them with a stethoscope. This can give your doctor
important clinical information.

Blood and Urine Tests:

• Blood tests for kidney function measure the levels of electrolytes and waste in your
blood. They measure waste products such as creatinine and blood urea. Creatinine is a
byproduct of muscle metabolism. Blood urea is leftover when your body breaks down
proteins. When your kidneys are working properly, they excrete both
substances.

• Urine tests will be performed to check for abnormalities. For example,

protein is normally only present in trace amounts in your urine. An elevated
protein level might indicate kidney problems months or even years before
other symptoms appear. Your urine sediment and cells found in your urine
will also be examined in a laboratory.

Imaging Tests:

Imaging tests can provide structural details of your kidneys. These include an
ultrasound, MRI scan, or CT scan.

Biopsy:

If your doctor is still unsure about the cause of your symptoms, they may do a
biopsy. This can be performed as a needle biopsy or an open biopsy.

Complications:

Chronic kidney disease can affect almost every part of your body. Potential complications
may include:

1-Fluid retention, which could lead to swelling in your arms and legs, high blood pressure,
or Fluid in your lungs (Pulmonary edema)
2-A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your
heart’s ability to function and may be life-threatening.
3-Heart and blood vessel disease (cardiovascular disease) Weak bones and an increased
risk of bone fractures.
4-Anemia.
5-Decreased sex drive or impotence.
6-Damage to your central nervous system, which can cause difficulty concentrating,
personality changes or seizures.
7-Decreased immune response, which makes you more vulnerable to infection.
8-Pericarditis, an inflammation of the sac-like membrane that envelops your heart
(pericardium).
9-Pregnancy complications that carry risks for the mother and the developing fetus.
10-Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring
either dialysis or a kidney transplant for survival.

Management:

Most patients with chronic renal failure can be managed successfully with:

• diet and fluid therapy

• long-term dialysis
• kidney transplantation is unnecessary until the GFR falls to 10% to 15% of the normal
rate.
• Strict adherence to a low-protein diet can delay progression to end-stage renal disease.

• For adult patients, a protein intake of about 50 g daily appears to have a therapeutic
effect without contributing to malnutrition; most of the protein must be of high biological
value to supply sufficient essential amino acids; protein of low biological value increases
the waste load to the kidneys.

• Depending on the stage of the disease and on fluid and electrolyte alterations, fluid
intake may need to be restricted.

• If urine output is decreased, and fluid overload becomes a problem, fluid intake typically
is restricted to the previous day’s urine output plus 500 mL for insensible loss.

• If excessive fluid is lost for example, because of fever, vomiting, or diarrhea fluid
requirements may increase.

• Sodium, potassium, and phosphorus also may be restricted.

– Sodium restriction may be warranted if the patientdevelops hypertension, edema, or
heart failure.
– Dietary potassium generally isn’t restricted if theurine output exceeds 1,000 mL daily;
it’s restricted if the serum potassium level exceeds 5.5 mEq/L.

• Supplements of B-complex vitamins, folic acid, and vitamin C may be needed to

compensate for deficiencies that result from a restrictive diet or dialysis; iron and zinc
supplements also may be prescribed.

• Once long-term dialysis begins, a more liberal protein intake is allowed, and the fluid
intake is controlled to allow a weight gain of 2 to 2.5 lb (0.9 to 1.1 kg) between dialysis
treatments.

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