• Chronic Renal Failure (CRF)

    by  • 28/04/2013 • 0 Comments

     CRF = abnormally low GFR for >3/12  Causes: glomerulonephritis (30%), interstitial nephritis and reflux nephropathy (20%), polycystic kidneys (10%), DM (10%), renovascular disease/HTN (10%)obstructive uropathy and unknown causes (20%).  Incidence of CRF suitable for renal replacement therapy 65-100/million/year   Functions of kidneys and effects of failure:  Failure to regulate salt...

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    Acute Renal Failure (ARF)

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     Characterised by rapid decline in GFR over daysweeks with accumulation of nitrogenous waste  Often noticed by rapidly rising serum creatinine and urea, accompanied by reduced urine output  p/c: fluid overload, nausea, malaise, encephalopathy   Causes:  Pre-renal: o Reduced/inadequate perfusion and inability of post-glomerular arteriole to constrict o If these two...

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    Genetic/Hereditary Renal Disease

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    Autosomal dominant polycystic kidney disease (APKD)  Variety of inherited conditions affecting kidney – but adult polycystic kidney disease (APKD) is most common  Accounts for 8-10% of patients with end stage renal failure  Autosomal dominant inheritance: chromosome 16 (PKD1 gene in 95% of cases), or C14 PKD2 in 5%.  Typically presents...

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    Renal Involvement in Systemic Disease

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    Diabetes Mellitus:  DM causes renal disease (30% have nephropathy after 20 years).  It accounts for 10% of renal replacement therapy  Initial diabetic renal disease manifests as microalbuminuriaproteinurianephrotic syndrome  Loss of excretory function = increasing creatinine and urea  If nephropathy – suspect retinopathy and neuropathy  Mx: aggressive ACEi therapy...

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    Glomerulonephritis

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     Types of presentation: o Acute/chronic renal failure o Nephrotic syndrome (=oedema, proteinuria, hypoalbuminaemia) o Haematuria o Proteinuria and HTN  Cardinal signs of GN are: proteinuria, haematuria, urinary cysts.  GN affects both kidneys symmetrically  GN may affect kidneys only = primary GN or be systemic = Wegeners granulomatosis/SLE/other secondary glomerulonephritides. ...

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    Nephrotic/Nephritic Syndromes

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    Proteinuria and nephrotic syndrome:  Normal protein in urine <150mg/day (normal physiological protein = ‘Tamm-Horsfall protein’). o Proteinuria = 300mg-4.5g urinary protein/day o Microalbuminaemia = 30-300mg urinary albumin /day  Increased protein may = GN, if Bence-Jones (free light chains) = MM, if microalbuminaemia = diabetic nephropathy.  Ix: o Assess renal function: serum...

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    Acid-Base Balance Disorders

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    In all seriously ill pts – an ABG should be performed to rule out acid-base disturbances. Metabolic acidosis: pO2 <8kPa (sats <90%), pH <7.35, pCO2 <5kPa  Seen in diabetic ketoacidosis, lactic acidosis and renal failure.  Severe acidosis results in cardiac depression and death.  Body responds to acidosis with respiratory compensation. Increased...

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    Hyponatriemia/Hypernatriemia

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    Abnormalities of serum sodium are closely linked to water balance (excess losses vs excess administration). Hyponatriemia:  Serum sodium <130mmol/L  p/c: asymptomatic, confusion, coma, convulsions.  Types of hyponatraemia: o Hypovolaemia (‘dry’): with Na deficit. Renal losses (=diuretics, Addison’s, salt-losing nephropathy). Extra-renal losses (=vomiting, diarrhoea, burns, sweating). o Normovolaemia: with no change in...

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    Hypokalaemia/Hyperkalaemia

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    Hypokalaemia:  Serum potassium <3.5mmol/L  Mostly attributed by diuretic therapy (increased losses from urinary/GI tracts), poor intake (eating disorders), or a shift to the intracellular compartment (insulin use, or familial periodic paralysis). o GI losses = vomiting and diarrhoea, laxative abuse, villus adenoma of colon. o Renal losses = diuretics, mineralocorticoid excess (Conn’s...

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    Renal Physiology and Renal Function

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    Renal physiology and renal function  1 x kidney = 1 x million nephrons  Each nephron: glomerulus located in cortex – filters into renal tubule and LoH (main site of water and electrolytes reabsorption). Urine drains to collecting duct. Further water reabsorption. Drains to renal pyramids.  Thick ascending limb of LoH attaches...

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