chronic renal failure r.manoj kumar. definition crf refers to an irreversible deterioation in renal...
TRANSCRIPT
DefinitionCRF refers to an irreversible deterioation in renal function which classically develops over a period of years.
CRF corresponds to CKD stages 3-5
CAUSES of CRF
Congenital and Inherited- Polycystic Kidney Disease, Alport’s syndrome
Renal artery stenosis Hypertension Glomerular diseases- IgA Nephropathy most
common Interstitial diseases Systemic Inflammatory diseases- SLE,
Vasculitis Diabetes Mellitus Unknown causes
PATHOGENESIS Disturbances in water, electrolyte and Acid-Base
balance contribute to the clinical picture in Patient with CRF;But the exact Pathogenesis of the clinical syndrome of Uremia is unknown.
Many substances present in Abnormal concentrations in the Plasma have been suspected as being Uremic toxins and uremia is probably caused by the accumulation of various intermediate products of metabolism like Nitrogenous excretory products such as Guanido compounds,Urates,Hippurates,products of nucleic acid metabolism,polyamines,Myoinositol,Phenols and Indoles.
CLINICAL FEATURES Fluid & Electrolyte disturbance – Volume expansion Hyponatremia Hyperkalemia Hyperphosphatemia Endocrine-metabolic disturbance – Sec
hyperparathyroidism Adynamic Bone Carbohydrate
resistance Hyperuricemia Decreased HDL levels PEM Impaired growth Amenorrhea
Neuromuscular disturbances- Fatigue Sleep
disorders Headache Lethargy Muscular
irritability Myoclonus Seizures Coma Myopathy
CVS & Pulmonary disturbances- Arterial Htn CHF Pulmonary
edema Pericarditis Cardiomyopathy Uremic Lung Atherosclerosis Hypotension Arrhythmias Vascular
calcifications
Skin disturbances- Pallor
Hyperpigmentation Pruritus Ecchymoses Uremic frost GIT- Anorexia Nausea &
vomiting Gastroenteritis GI bleeding Idiopathic
ascites Peritonitis
Hematologic & Immunologic disturbance-
Anemia Lymphocytopenia Bleeding diathesis Inc susp to
infection Leucopenia Thrombocytopenia
INVESTIGATIONS Hematology- Full blood count Hematinics Biochemistry Urea,electrolytes,creatinine Calcium,phosphate,albumin Parathyroid hormone Lipids, Glucose
Microbiology- Hepatitis and HIV
serology Imaging- Renal Ultrasound Chest X-ray Renal artery imaging E.C.G Immunology- Grouping Tissue typing CMV,EBV,VZV
If diagnosis is not Known.
Consider Immunoglobulin and Protein
electrophoresis Urinary BenceJones proteins Compliment Rheumatoid factor ANCA Anti-GBM Cryoglobulins
Problems with Haemodialysis
Hypotension during Dialysis Cardiac Arrhythmias Hemorrhage Air Embolism Dialyser Hypersensitivity Emergencies between treatments- Pulmonary
edema Systemic
sepsis
Problems with Peritoneal dialysis
Peritonitis Catheter exit site infection Ultra filtration failure Peritoneal membrane failure
Management after Transplantation
Immunosuppressive therapy- Prednisolone,ciclosporine
and Azathioprine Rejection is treated by short course of very
high dose corticosteroids and more potent therapies such as anti-lymphocyte antibodies or plasma exchange
Immunosuppression leads to Increased incidence of infection such as CMV & Pneumocystis
PROGNOSIS
Cadaver donors- 96% patient survival 92% graft survival at 1 year 84% patient survival 76% graft survival at 5 years Living donors- 92% patient survival 86% graft survival at 5 years Renal transplantation offers the best hope of
complete rehabilitation and is the most cost effective treatment for end stage CRF