renal failure
DESCRIPTION
RENAL FAILURE. DR..M.H.MUMTAZ. TYPES. 1, REVERSIBLE DYSFUNTION (acute R.failure) 2, IRREVERSIBLE DYSFUNTION (Chronic R failure). ACUTE RENAL FAILURE. 1, PRE RENAL 2, RENAL - PowerPoint PPT PresentationTRANSCRIPT
-
RENAL FAILURE
DR..M.H.MUMTAZ
-
TYPES1, REVERSIBLE DYSFUNTION (acute R.failure)2, IRREVERSIBLE DYSFUNTION (Chronic R failure)
-
ACUTE RENAL FAILURE 1, PRE RENAL 2, RENAL 3, POST RENAL
-
PRE RENAL FAILURECAUSES a,total body water depletion b,water redistribution ivs--------iss vasodilation,sepsis,anaphy. c,low CO--------low BP (S,M.D)
-
RENAL a, Interstitial nephritis b, A.T.N. hypoperfusion chemical trauma , toxins sepsis
-
PATHOLOGY T.obstruction T.damage
T.backleakage
-
DIAGNOSIS a,History oligurea,concentrated U b,Tests lab. Serum,urine radiodiagnostics C.T. MRI. Ultrasount
-
ALTERNATIVE CLASS. Filteration failure Tubular dysfuntion
Oliguric/non oliguric
-
RISK FACTORSAcute diseases sepsis SIRS jaundice I.A.P. renal trauma transfusion DIC
Anaphylaxis muscle injury thermal burn electrocution
-
RISK FACTORS CHRONIC DISEASES advancing age diabetes mellitis renal disease vascular disease hyperuricaemia
-
RISK FACTORS Physiological changes 1. ^ age 2. ^ HR hypotension ^ CVP, lowRVPP high or low co,svr abnormal OER olig/polyurea
3. Fluid balance Oedaema high/low protein intake
-
RISK FACTORS Chronic drug therapy NSAIDS Diuretics Cyclosporins
-
RISK FACTORSAcute drug therapyA. ATN aminoglycosides cephalosporins diuretics contra. rifampicin lithium cisplatin
B. Interstitial nephritis cephalosporins diuretics aspirin,NSAIDS cemetidine captopril
-
RISK FACTORS Proceedures a. Aortic/renal cross clamping b.Transfusion c. Major surgery
-
RISK FACTORS IMPAIRED RBF hypotension/m.hypertension renal art. Occlosion hepatorenal failure endotoxaemia renal vein thrombosis renal venous hypertansion
-
RISK FACTORS Metaboic causes 1. Electrilytes hyper-cal hypo-k hyper-phosphate 2. High oncotic P.
3. Metabolites Pigments bilirubin myoglobin haemoglobin
-
RISK FACTORS Post-renal urethral/blader obs. bil.ureter obs. stones/clot/tumur papillary necrosis
Retroperitoneal fibrosisSurgical ligationBlader ruptureRenal pelvic traumaUrethral trauma
-
ACUTE TUBULAR NECROSIS PHASES
a,Initiation phase
b,Maintenance phase
-
INITIATION PHASEISCHAEMIA ^ symp.stimulation ^ renin activity PGE2 ANH inhibition ^ ADH ^ adenosine ^ endothelinNEPHROTOXINS
Ischaemia increases the
susceptibility to
nephrotoxic agents
-
MANTENANCE PHASEFactors acting to maintain filteration failure 1,tubular obstruction 2,tubular backleak 3,vasodilatation of efferent art. 4,decreased GMP
-
Mechanism of oligurea a,glomerulo-tubular balance
b,decreased GMP
c,itratubular obstruction d,interstitial oedema e,cortical ischaemia
-
Complications of ARF/ATNA,oligurea
absolute
relativeB, azotaemia normal solute load maximum in catabolic states in ARF ^ urea/d ^ cr/d
-
ComplicationsC,Biochamical ^NaCl/water ^ K ^ HPO4 hypocalcaemia ^ Mg ^ uric acid M.acidosisD,Haematological Anaemia Thrombocytopaenia
Leukocyte dysf.
-
ComplicationsE,Immunosupression Lumphopaenia Reduced IgG Reduced comple. Impaired PMN R.I.response Drug effects Infections
F,C.V.S. CCF Hypertention Arrhythmias Pericarditis Effusion
-
ComplicationsG, G.I.T.
Anorexia,Nausea, Ileus,Hmge.
H,Neurological Lethargy,somnolance Confusion, Convulsions ^ sensitivity to anaesthetics
-
ComplicationsI,causes of pulmonary infilterates in ARF 1,LVF/CCF 2,bacterial pmeumonia 3,Atypical pneumonia 4,Septicaemia 5,ARDS 6,Autoammune diseases
-
Causes of Acidosis in ARFA,Tubular dysfuntion
B,Glomerular dysfuntion
C,Other causes low C.O. Resp.F Starvation
Rhabdomyolysis Hyperkalaemia Organic acids
-
INVESTIGATIONS IN ARFBiochemistry
-
INVESTIGATIONS
-
Investigations-1, Biochemistry
-
Definitions RFI=RENA FAILURE INDEX =urine(Na)/(U/P creatinine)
FEna=%fractional excretio Na
=(U/P Na).100/(U/P creatinine)
-
Abnormal urea/creatinine ratio
Normal U:C ratio 100:1( R;70-150)
Pre-renal disease >200:1
-
Abnormal urea/creatinine ratio
High Ratio ^ urea .dehydration/hypovol. .GIT.bleeding .Catabolic state .Hyperalimentation .Drugs low creatinie .elderly,low m. mass
-
Abnormal urea/creatinine ratioLow Ratio low urea. Liver failure hepato-renal synd Malnutrition High creatinie rhabdomyolysis acute m.disease ketones,drugs
-
CREATININE CLEARANCE1, clearance(ml/min=(N-age[years])*BW(kg)/serum creat. N = 150 foe female N = 160 for male > 70 N = 170 for male < 70 2, clearance(ml/min)=UV*1000 /p*420 U=urine creatinine level V=urine volume (midnight &7 am) P= plasma creatinine level
-
2. Urinary sediment.Cast types i,hyaline casts, fever,diuretics,RD ii,red cell casts glomerulonephritis iii,w.cell casts pyelonephritis iv,waxy casts chronic renal disease
-
3,Imaging 1, Ultrasound 2, CT scan 3, IV pylogram 4, radio-isotope perfusion scan 5, renal angiogram
-
4,Renal biopsy 1, glomerulonephritis 2, vasculitis 3, SLE 4, Goodpasture syndrome 5, TTP 6, Interstitial nephritis 7, oligurea lasting > 8 weeks
-
Renal failureprophylaxis&protectionMethods 1, physiological 2,physical 3,pharmacological 4,replacement therapies
-
Physiological methods a, normalise blood volume iv fluids,(Na containg) b,optimise cardiac output iv fluids.inotropes,vasopressors c, optimise O2 delivery Hb,Spo2,avoid acidosis d, high sodium excretion
-
Physical methods Detection/management of IOH Detection/management-post renal obs. Limitation of aortic clamp times Avoidance of embolisation Minimise direct trauma
-
Pharmacological methods Avoid nephrotoxins Avoid inhibitors of autoregulation Diuretics Renodilators Other agents free radical scavengers Ca channel blockers
-
Renal replacement methods Haemo- filtration
Haemo-diafiltration
Haemodialysis
R. Transplant.
-
Renal failure---FrusemideBeneficial effects Increased tubular&urine flow Increase Na &osmolar clearance Decreased tubular O2 demand Stimulate vasodilator prostaglandinsDeleterious effects Hypovolaemia Hypokalamia,Hyponatraemia Ototoxicity
-
Uses in non renal failure Fluid overload Cerebral oedema Hyperkalaemia Renal protection ( decreased O2 demand)
-
Renal failure---Mannitol 1,Osmotic diuresis
2,Anti sludging ,tubular protect.
3,renal vasodilatory PG synthesis 4,Free radical scavenger 5,Decreased T. swelling
-
Renal failure---Dopamine Increases Fe Na excretion Increases urine out put Does not increase creatinine clearance Inotropic effect Doesnot prevent ac.renal failure Side effects, gastric stasis,inhibition of ant pit.hormones,hypoxic drive depression.
-
Renal failure---Nor-adrenaline
Increases perfusion pressure by increase
of efferent arteriolar resistance
more than afferent art.resistance
-
Other therapies 1,Calcium channel blockers 2,Adenicine recepter antagonists 3,Oxypentifylline 4,Chlorpromazine 5,Clonidine 6,ATP-MgCl2 7,ANF
-
Conclusion,Renal rescue therapyNormalise;- Blood flow blood volume blood pressure O2 delivery COCI Blood Pressure, s,m,d.