Acute and chronic renal failure Dr. S. Parasuraman Faculty of Pharmacy, AIMST.Renal failure Renal failure is defined as a significant loss of renal function in both kidneys to the point where less than 10 to 20% of normal GFR remains. Renal failure may occur as an acute and rapidly progressing process or may present as a chronic form in which there is a progressive loss of renal function over a number of years. Acute renal failure has an abrupt onset and is potentially reversible. Chronic failure progresses slowly over at least three months and can lead to permanent renal failure.Pathophysiology of Renal Failure * In renal failure there is either glomerular or tubular dysfunction eg. - glomerulonephritis primarily causes of glomerular damage — aminoglycoside nephrotoxicity is mainly in tubular * Glomerular dysfunction- As the main function of glomeruli is filtration, glomerular dysfunction leads to fall in GFR with retention of those substances usually cleared by filtration, including water. * Tubular Dysfunction- As the main function of tubules is reabsorption tubular failure results in the voiding of large volumes of dilute urine (polyuria) of low specific gravity, along with electrolytes and nutrients.Acute renal failure Sudden decrease in renal function. Acute renal failure may be pre-renal, intra-renal or post-renal in nature. Acute renal failure is often reversible so long as permanent injury to the kidney has not occurred. Manifestations =— Oliguria (reduced urine output) — Possible edema and fluid retention = Elevated blood urea nitrogen levels (BUN) and serum creatinine — Alterations in serum electrolytesCauses of Acute Renal Failure * Myocardial infarction, rhabdomyolysis, decreased blood flow, obstruction, hemolytic uremic syndrome, Glomerulonephritis are common causes of acute renal failure. + Acute Renal Failure classified as pre-renal failure, intra-renal failure and post-renal failure * Pre-renal failure — Results from impaired or reduced blood flow to the kidney — Possible causes: shock, hypotension, anaphylaxis, ischemic formationCauses of Acute Renal Failure * Intra-renal failure — Results from acute damage to renal structures — Possible causes: * acute glomerulonephritis, pyelonephritis * May also result from acute tubular necrosis (ATN) * damage of kidney structure from exposure to toxins, solvents, drugs and heavy metals; ATN is the most common cause of acute renal failure * Post-renal failure — Results from conditions block of urine outflow — Possible causes: obstruction of urine outflow by calculi, tumors, prostatic hypertrophySymptoms of acute renal Failure Decreased kidney function (electrolyte imbalance) Obstruction in the urinary tract Blood in urine Reduced urine output Dehydration Detectable abnormal mass Pale skin Poor appetite Diagnosis Routine laboratory test (creatinine and blood urea nitrogen) Ultrasound of the kidney helps to determine whether kidney problem is acute or chronic. kidney biopsy computed tomography scanTreatment of acute renal failure * Treatment — Prevention of acute renal failure through support of blood pressure and blood volume — Correction of fluid and electrolyte imbalances — Dialysis, which may be employed while the kidneys are in the recovery phase — Low protein, high carbohydrate diet to minimize the formation of nitrogenous wastesChronic renal failure * Chronic renal failure is the end result of progressive kidney damage and loss of function. Chronic renal failure is often classified into four progressive stages based on the loss of GFR. Stages of Chronic Renal Failure Diminished renal reserve — GFR decreased to 35 to 50% of normal Renal insufficiency — GFR decreased to 20 to 35% of normal Renal failure — GFR reduced to less than 20% of normal End-Stage Renal Disease — GFR is less than 5% of normalCauses of chronic renal failure — Chronic glomerulonephritis — Chronic infections — Renal obstruction (prolonged) — Exposure to toxic chemicals, toxins or drugs (aminoglycoside antibiotics and nephrotoxicity) — Diabetes — Hypertension — Nephrosclerosis (atherosclerosis of the renal artery) — Diabetic nephropathy — Alport syndrome (inherited disorder causes deafness, progressive kidney damage and eye defects) — Polycystic kidney disease — Interstitial nephritis or pyelonephritisSymptoms of chronic renal failure — Until very kidney function remains, chronic renal failure may not developed — Anemia, increased levels of phosphates (in blood) are complications of kidney failure — Malaise — Dry skin — Poor appetite — Vomiting — Bone pain — metallic taste in mouth — detectable abdominal massManifestations of chronic renal failure — Renal failure is a multisystem disease sen ee ee Body fluids Hematologic Cardiovascular Gastrointestinal tract Neurologic Musculoskeletal Polyuria Metabolic acidosis Abnormal levels of Na*, K*, Ca®*, POF Anemia, excess bleeding Hypertension, edema Anorexia, nausea Uremic encephalopathy Muscle and bone weakness (“Renal Osteodystrophy”) Metabolic acidosis Reduced H’* excretion Loss of tubular function: Impaired erythropoietin Activation of renin-angiotensin system Accumulation of metabolic wastes Accumulation of ammonia and nitrogenous waste Loss of calcium and mineralsTreatment of chronic renal failure Careful management of fluids and electrolytes Prudent use of diuretics Careful dietary management; restriction of dietary protein intake Recombinant erythropoietin to treat anemia Renal dialysis Renal transplantationDisorders of the bladder and urethera — Urine reflux: abnormal movement of urine from the bladder into ureters or kidneys. — Neurogenic bladder: disease of the central nervous system or peripheral nerves involved in the control of micturition. — overactive bladder: chronic condition of the bladder in the urinary tract that causes sudden urges to urinate.Thank youAminoglycoside antibiotics and nephrotoxicity * Aminoglycoside (streptomycin, gentamicin and kanamycin) toxicity is most likely to occur in elderly people, those with renal insufficiency or with chronic use. * Concurrent use of loop diuretics may also compound the adverse renal effects of the aminoglycosides.Dialysis Venous pressure monitor Type of Dialysis: dekeeasied . Hemodia| lysis (primary) rien * Peritoneal dialysis (primary) * Others * Hemofiltration Mente —x i + Hemodiafiltration * Intestinal dialysisaun en aahPractice | teaching oF on Glomerulonephritis . Presented by: Ms. Hari singh nagar M. Sc Nursing 1st year Aa \COPD Chronic Obstructive Pulmonary Disease Mr. ANILKUMAR BR, Lecturer Medical-Surgical nursingAwiteD i Acute Renal Failure aACirrhosis OF liverCOLLEGE OF MEDICINE AND SURGERY SY: 2009-2010 ATHEROSCLEROSI S ASLAM, SHUMAYLALivery Ci eapleysiisi-: Ma. Tosca Cypbil A. Toffes, RN, MAN