WEEEK 1: KIDNEY DISEASE: PATHOGENESISI AND RENAL FAILURE Flashcards
What is chronic renal failure?
Chronic Renal Failure refers to as an irreversible deterioration in renal function which classically develops over a period of years.
Describe the progress of Chronic kidney failure.
What is uremia?
It starts as a biochemical abnormality, eventually loss of excretory, metabolic and endocrine functions of the kidney leading to the development of the clinical signs and symptoms of renal failure which are referred to as UREMIA.
Uremia is a medical condition that occurs when there is an excess of urea and other waste products in the blood due to the impaired function of the kidneys.
Uremia can lead to a range of symptoms affecting multiple organ systems. Common symptoms include fatigue, weakness, nausea, vomiting, loss of appetite, weight loss, changes in mental status, itching, and fluid retention leading to swelling (edema).
What is end stage renal failure (ESRF)?
When death is likely without renal replacement it is referred to as end-stage renal failure (ESRF).
What is acute renal failure?
Sudden loss of renal function
Prerenal (dehydration, poor cardiac output sepsis)
Renal intrinsic (GN, IN, drug induced)
Post renal obstructive
State the stages of Chronic renal failure.
STAGE 1: Kidney damage with normal or high GFR (> 90).
STAGE 2: Kidney damage with slightly low GFR (60-89).
STAGE 3A & 3B: Moderately low GFR (30-59).
STAGE 4: Severe low GFR (15-29)
STAGE 5: Kidney Failure: < 15 or dialysis
State some of the causes of chronic renal failure.
Glomerulonephritis.
Pyelonephritis:
Interstitial nephritis
DM.
Hypertensive nephropathy
Polycystic disease
Analgesic nephropathy
Renal vascular disease
Nephrolithiasis
Prostatic hypertrophy
Glomerulonephritis:
Definition: Inflammation of the glomeruli, the small blood vessels in the kidneys responsible for filtering waste and excess fluids.
Causes: Infections, autoimmune diseases, and other factors can lead to glomerulonephritis.
Pyelonephritis:
Definition: Inflammation of the kidney tissue, usually caused by bacterial infection. It often starts as a urinary tract infection that progresses to involve the kidneys.
Causes: Bacterial infections, commonly Escherichia coli (E. coli).
Interstitial Nephritis:
Definition: Inflammation of the renal interstitium, the tissue between the kidney tubules.
Causes: Drug reactions, infections, autoimmune disorders, and other factors can lead to interstitial nephritis.
Diabetes Mellitus (DM):
Definition: A chronic metabolic disorder characterized by elevated blood sugar levels.
Kidney Involvement: Diabetes is a common cause of kidney disease (diabetic nephropathy) and can lead to progressive damage to the kidneys.
Hypertensive Nephropathy:
Definition: Kidney damage caused by long-term high blood pressure.
Consequence: Chronic hypertension can damage the small blood vessels in the kidneys, leading to kidney dysfunction.
Polycystic Kidney Disease (PKD):
Definition: Genetic disorder leading to the formation of fluid-filled cysts in the kidneys, affecting their structure and function.
Inheritance: Autosomal dominant or autosomal recessive.
Analgesic Nephropathy:
Definition: Kidney damage resulting from the long-term use of certain analgesic medications, especially those containing phenacetin or combinations of aspirin, acetaminophen, and codeine.
Risk: Decreased with the reduction in use of such medications.
Renal Vascular Disease:
Definition: Conditions affecting the blood vessels supplying the kidneys, potentially leading to impaired blood flow.
Causes: Atherosclerosis, renal artery stenosis, and other vascular disorders.
Nephrolithiasis:
Definition: Formation of kidney stones (renal calculi) in the urinary system.
Causes: Various factors, including dehydration, metabolic disorders, and certain medical conditions.
Prostatic Hypertrophy:
Definition: Enlargement of the prostate gland, which can obstruct the flow of urine from the bladder.
Impact: Can lead to urinary retention and, in severe cases, affect kidney function.
State some rare causes of Chronic renal failure.
Myeloma
Amylodosis
SLE
Sceloroderma
Vasculitis
Heamolytic Uraemic Syndrome
Nephrocalcinosis.
Gout.
Renal Tumour
Cystinosis.
Oxalosis
Myeloma:
Definition: Multiple myeloma is a cancer of plasma cells that can affect the kidneys, leading to the production of abnormal proteins that may harm kidney function.
Amyloidosis:
Definition: A group of disorders where abnormal proteins (amyloids) build up in tissues and organs, including the kidneys, affecting their structure and function.
SLE (Systemic Lupus Erythematosus):
Definition: An autoimmune disease where the immune system attacks various tissues, including the kidneys. Lupus nephritis is kidney inflammation associated with SLE.
Scleroderma:
Definition: An autoimmune disease causing thickening and hardening of the skin and connective tissues. Renal involvement, known as scleroderma renal crisis, can lead to severe hypertension and kidney damage.
Vasculitis:
Definition: Inflammation of blood vessels, including those in the kidneys. Various forms of vasculitis can affect the kidneys and lead to impaired blood flow.
Hemolytic Uremic Syndrome (HUS):
Definition: A condition involving the breakdown of red blood cells, kidney failure, and low platelet count. Often associated with bacterial infections, especially E. coli.
Nephrocalcinosis:
Definition: Calcium deposits forming in the renal parenchyma, potentially leading to impaired kidney function.
Gout:
Definition: A type of arthritis caused by the buildup of uric acid crystals in the joints. In some cases, uric acid crystals can accumulate in the kidneys, leading to kidney stones and impairment.
Renal Tumor:
Definition: The development of tumors in the kidneys, which can be either benign (non-cancerous) or malignant (cancerous). Renal cell carcinoma is a common type of kidney cancer.
Cystinosis:
Definition: A genetic disorder resulting in the accumulation of cystine crystals in various organs, including the kidneys, leading to kidney dysfunction.
Oxalosis:
Definition: Excessive accumulation of oxalate in the kidneys, often leading to the formation of kidney stones and potential kidney damage.
State the signs of chronic renal failure.
Pallor.
Yellow skin pigmentation.
Brown nails.
Purpura.
Bruising.
Excoriation.
Elevated BP
Cardiomegaly.
Pericarditis.
Pleural effusion.
Pulmonary or peripheral edema.
Retinopathy.
Proximal myopathy.
Peripheral neuropathy.
Arrythmias.
Encephalopathy.
Seizures.
Coma
acidosis
State blood investigations in Chronic renal failure.
BLOOD:
Decreased Hb( normochromic normocytic).
Increased ESR.
U and E: increased Urea and Creatinine.
Increased glucose in DM.
Decreased calcium, Increased phosphate.
Increased alkaline phosphate ( renal osteodystrophy)
Increased parathyroid hormone.
Increased Uric acid.
State urine investigation in Chronic renal failure.
Urine MCS.
24 hour urinary protein.
Creatinine clearance.
What is the need for renal ultrasound?
To rule out obstruction( in obstructive uropathy), also to look at renal size. Kidney size is usually small but normal or large in DM, polycystic kidney disease., amyloidosis, myeloma , systemic sclerosis, and asymmetric renal vascular disease.
State other investigation for Kidney failure.
CT KUB
CXR: may show Cardiomegaly, pleural effusion/pericardial effusions or pulmonary edema.
Bone x-rays may show renal oestodystrophy.
Renal biopsy
Renal osteodystrophy is a term used to describe a group of bone disorders that occur as a result of chronic kidney disease (CKD). The kidneys play a crucial role in maintaining the balance of minerals in the body, including calcium and phosphorus. When the kidneys are not functioning properly, it can lead to imbalances in these minerals, affecting bone health.
Describe the management of chronic renal failure.
Several aspects are considered in management of CRF. These include:
Identifying the underlying renal disease.
Looking for reversible factors which worsen renal function.
Preventing further renal damage
State some of the reversible factors in CRF.
- Hypertension
- Reduced renal perfusion:
renal artery stenosis
Hypotension due to drug treatment
Sodium and water depletion
Poor cardiac function - Urinary tract obstruction.
- Urinary tract infection.
- Other infections: increased catabolism and urea production.
- Nephrotoxic medications
Describe how we can retard the progression of CRF.
CONTROLLING BP: even a small drop in BP can save significant renal function. ACE inhibitors can decrease the rate of loss of function even if BP is normal. Aim for BP of <130/80.
DIET: match dietary and fluid intake with excretory capacity. Protein restriction is sometimes necessary. Na+ restriction may be helpful in controlling BP and prevent edema while K+ restriction is required only in Hyperkaliemia and acidosis. Acidosis can be treated with HCO-3 supplements.
IN DIABETICS ADEQUATE SUGAR CONTROL