CHRONIC RENAL FAILURE.

• Chronic renal failure, or chronic kidney

disease (CKD), is a slow and progressive
decline of kidney function. It's usually a result
of a complication from another serious
medical condition such as diabetes, high blood
pressure or cardiovascular disease.
 ETIOLOGY OF CRF.

1. CONGENITAL CAUSES include

obstructive uropathy,reflux
nephropathy,renal hypoplasia or
dysplasia,polycystic kidneys,hereditary
diseases such as Alport’s syndrome and
horse horse shoe kidneys.
 CAUSES OF CRF.
ACQUIRED CAUSES are obstructive
Uropathy reflux
nephropathy,glomerulonephritis,bila
teralWilm’s tumor,hemolytic
uremic
syndrome,nephrotoxins,HTN,nephri
tis etc.
CLINICAL MANIFESTATIONS OF CRF.
Signs of fluid overload.
Hyperkalemia.
Metabolic acidosis.
Hypertension.
Facial edema.
Cardio vascular disease.
Cardiac abnormalities.(LVH,PERICARDITIS).
If untreated it goes in to uremic syndrome.sssss
a. SYMPTOMS OF UREMIC SYNDROME.

• Anaemia.
• Bone disease.
• Peripheral neuropathy.
• CNS abnormalities.
• Muscle cramps.
• Wt loss,growth retardation,failure to thrive.
• Bone or joint pain.
• Amenorrhoea in adolescent girls.
SYMPTOMS OF UREMIC SYNDROME CNTD.

• Dental defects.
• Anorexia nausea,vomiting.
• Bleeding tendencies.
• Uremic frost(urea crystals get deposited on
the skin)
• Pruritis .
 DIAGNOSTIC EVALUATION.
• Renal function test.It shows gradual increase
in creatinine,uric acid and BUN.
• Blood studies shows decreased
hematocrit,hemoglobin,Na+,Ca+,bicarbonate
level,protein and albumine.
 DIGNOSTIC EVALUATION CNTD.
• Urinalysis-changes in specific gravity with
increased creatinine in urine.
• ECG.
• Detect vesicoureteral reflux.
• Retrograde or anterograde pyelography.
• Skeletal survey.
• Renal biopsy.
• Assessment of GFR.
 DIGNOSTIC EVALUATION CNTD.
• Urinalysis-changes in specific gravity with
increased creatinine in urine.
• ECG.
• Detect vesicoureteral reflux.
• Retrograde or anterograde pyelography.
• Skeletal survey.
• Renal biopsy.
• Assessment of GFR.
 MEDICAL MANAGEMENT.
 Specific therapy based on diagnosis.
 Evaluation and management of reversible causes
of renal dysfunction
 Prevention and treatment of complications of
decreased kidney function(anaemia,bone
disease,cardiovascular manifestations,HTN and
growth failure.
 Evaluation and management of comorbid
conditions.
 MEDICAL MANAGEMENT,CNTD.
• Slowing the loss of kidney function.
• Preparation for kidney failure therapy.
• Replacement of kidney function with dialysis
and transplantation if signs and symptoms of
uremia are present.
 MANAGEMENT OF COMPLICATIONS.
• Metabolic acidosis.-Alkalizing agents such as sodium
bicarbonate is administered to treat acidosis.
• Hypertension-commonly used drugs are Beta
adrenergic
• blockers(atenelol,propanalol),calciumchannel
antagonists(nifedipine,amlodipine) .
• Loop diuretics alsomy used in case of fluid
overload.Sodium and fluid restriction are also
needed in advanced renal diseases.
 MANAGEMENT OF COMPLICATIONS.
• Anemia--,To correct this Packed red cell transfusion
maybe given if Hb level falls below 6gm/dl.Iron and
folic acid suppliments also should be
given.Recombinant human erythropoietin is
administeredS/C to increse Hblevel.
• Growth failure.---,Ensure adequate calorie and
protein intake according to age.Osseous deformities
may need correction.Regular dental care is required
because dental defects are common in these
children.
 MANAGEMENT OF COMPLICATIONS.

• Infections----,UTI or any other infectons

should be treated promptly with appropriate
antibiotics.Avoid nephrotoxic drug.
• Symptomatic treatment---,administer anti
emetics for nausea and antiepileptics for
seizures.
• Renal ReplacementTherapy----,It includes
Dialysis and renal transplantation.
 MANAGEMENT OF COMPLICATIONS.
• Dialysis--,It is started when the child develops
symptoms such as severe fluid overload,high
potassium levels,acidosis,pericarditis lethargy
symptoms of uremia etc.Dialysis involves
movement and diffusion of particles from an area of
high con.to an area of low concentration through a
semi permeable membrane.Substances from the
blood move through semi permeable membrane in
to the dialysate (the solution used for dialysis).
 DIALYSIS.
• Types of chronic dialysis therapy are
• Chronic peritonial dialysis(PD)
• Chronic hemodialysis.