Acute and Chronic Renal

Failure

BY
Ayman Salem M.D.
Lecturer of internal Medicine
Faculty of medicine
 Renal Failure
Impaired Kidney functions
Elevation of S.CR and BUN
and loss of other Kidney
functions
 Etiology :
Acute Renal Failure:
- Rapid Loss of Kidney functions :
Rapid elevation of S. creatinine &
BUN within days to weeks
Chronic Renal Failure (CKD):
- Gradual Loss of Kidney functions :
Gradual elevation of S. creatinine & BUN
over months and years.
Chronic Renal Failure
(CRF)
Gradual decline of kidney
functions over long time --
Impaired kidney functions ------
CKD ------ ESRD ------ uremia
 Uremia

Uremia is the clinical and

laboratory syndrome, reflecting
dysfunction of all organs as a
result of untreated acute or
chronic renal failure.
ESRD (End Stage Renal Disease)
It is a clinical state in which
there has been an irreversible
loss of renal functions of a
degree sufficient to render the
patient permanently dependant
upon renal replacement therapy
(Dialysis or renal transplantation)
 Pathophysiology of uremia
Azotemia :
Retention of nitrogenous waste
products as renal insufficiency
develops.
Uremia :-
More advanced stages of progressive
renal insufficiency when the
multiorgan system derangements
become clinically manifest
Pathophysiology of uremia
Fluid ,Electrolyte Disorder
V- Retention of Na and water ---
edema weight gain and hypertension
and pulmonary edema.
Pathophysiology of uremia
Fluid ,Electrolyte Disorder
VI- Hyperkalemia in CRF may be precipitated by
:
1- Augmented dietary intake
2- Protein catabolism
3- Hemolysis or hemorrhage
4- Transfusion of stored blood
5- Metabolic acidosis
6- Drugs as Beta-blockers, ACE inhibitors, K-sparing
diuretics, NSAIDs
Pathophysiology of uremia
Metabolic Acidosis

VII- Metabolic Acidosis :

In advanced CRF ---- accumulation of orgaic
acids ----large anion gap acidosis ( 20
mmol/l )
Anion gap = Na+(Cl + HCO3)-
( normal = 8-12 mmol/l)
Pathophysiology of uremia
IX- Cardiovascular & pulmonary Disorders
Congestive Heart Failure
Hypertension and LVH
Atherosclerosis coronary & peripheral
Pericarditis
Recurrent Chest Infections
Pathophysiology of uremia
X_ Hematological Abnormalities

Anemia of CRF
Normocytic normochromic anemia

Abnormal Hemostasis

Enhanced susceptibility to infection

 Pathophysiology of uremia
:-XI- Neuromuscular Abnormalities
Insomnia
Loss of memory
Convulsions, Muscle twitching , astraxis
Coma
Restless leg syndrome
Dialysis Dementia
Dialysis Disequilibrium
Pathophysiology of uremia
XII_Gastrointestinal Abnormalities
Anorexia
Nausea
Vomiting
Uremic Fetor
Hepatitis B & C
 Pathophysiology of uremia
XIII- Dermatological Disorders
Pruritis
Ecchymosis and hematomas
Pallor
Dry skin
Skin necrosis (Calciphylaxis syndrome)
Pathophysiology of uremia
Endocrine Metabolic Disturbance
Glucose metabolism is impaired
Amenorrhea and inability to carry
pregnancy to term due to low estrogen
Loss of Libido & Impotence
 Diagnosis of CRF
History :
Asymptomatic
Genearl fatigue syndrome
Pallor
Peripheral edema & overload
Ecchymosis and hematomas
Dry skin
Skin necrosis (Calciphylaxis syndrome)
 Diagnosis of CRF
Signs :
Pallor and dusty color
Dry skin, ecchymotic patches
Skin necrosis (Calciphylaxis syndrome)
Urineferous odour
Pericardial rub
Peripheral edema and signs of overload
Hypertension
Bilateral fine basal crepetations (overload)
Uremic Facies
 Diagnosis of CRF
Investigations :
Lab :-
- High S.creatinine , BUN & Urea
- Low Hb
- Low PH, Low bicarbonate
- Low S. calcium, High S. phosphate
- High S. potasium
Radiology:
Abdominal sonography :
Small bilateral Echogenic Kidneys (ESRD)
Osteoporosis
 Stages of Chronic Kidney Disease (CKD)

Stage Description GFR

(Ml/Min/ 1.73m2 )

1 Kidney damage with > 90

Normal or increased GFR

2 Kidney damage with 60-89

mild decrease in GFR

3 Moderate decrease in GFR 30-59

4 Severe decrease in GFR 15-29

5 Kidney failure (ESRD) < 15

 Treatment of CRF
Diet control :-
Avoid nephrotoxic drugs
Control of anemia
Control of Hypertension
Control of Proteinureia
Control of calcium and phosphate
Preparation for Replacement therapy
AV Fistula
Dialysis
Transplantation