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Chaplin
Chronic Renal
Failure
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KIDNEYS
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Prepared by D. Chaplin
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Functions:
prevent the buildup of wastes and extra fluid in the body
keep levels of electrolytes stable, such as sodium,
potassium, and phosphate
make hormones that help
regulate blood pressure
make red blood cells
bones stay strong
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Chronic Renal Failure
Progressive, irreversible damage to the
nephrons and glomeruli
Cause: recurrent kidney infections
Leading causes of ESRD
Diabetes
Hypertension
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Diabetes
Diabetes, often referred to by doctors as diabetes
mellitus, describes a group of metabolic diseases in
which the person has high blood glucose (blood
sugar), either because insulin production is
inadequate, or because the body's cells do not
respond properly to insulin, or both.
Diabetes can harm the kidneys by causing
damage to:
Blood vessels in the kidneys
Nerves in your body
Urinary tract
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Hypertension
Blood pressure is the force of your blood
against the walls of your blood vessels as your
heart pumps blood around your body. If this
pressure becomes too high, you are said to
have high blood pressure, or hypertension.
How does high blood pressure affect the
kidneys?
-damages blood vessels throughout your body
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Chronic Renal Failure
End Stage Renal Disease (ESRD)
Protein and waste metabolism accumulates
in the blood (azotemia)
90% of kidney function is lost (kidney cannot
adequately function)
Hypothesis: Nephrons remains intact, others
progressively destroyed.
Hypertrophy continues kidneys begin to
lose their ability to concentrate the urine
adequately
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Clinical Manifestations
You may experience a wide range of symptoms including:
a decrease in urine output
inability to urinate
fatigue
general ill feeling
headaches
unexplained weight loss
loss of appetite
nausea and vomiting
dry skin and itching
changes in skin color
bone pain
confusion and difficulty concentrating
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Glomerular filtration rate (GFR) is a test used to check how
well the kidneys are working. Specifically, it estimates how
much blood passes through the glomeruli each minute.
Glomeruli are the tiny filters in the kidneys that filter waste
from the blood.
Stage Description Glomerular Filtration Rate GFR)
At increased risk Risk factors for kidney disease (e.g.,
diabetes, high blood pressure, family history,
older age, ethnic group)
More than 90
1 Kidney damage (protein in the urine)
and normal GFR
More than 90
2 Kidney damage and mild decrease in GFR 60 to 89
3 Moderate decrease in GFR 30 to 59
4 Severe decrease in GFR 15 to 29
5 Kidney failure (dialysis or kidney transplant
needed)
Less than 15
Stages of CKD
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Treatment Modalities
Decrease fluid 1000ml/day
Decrease protein (.5-1kg body weight)
Decrease sodium (1-4gm variable)
Decrease potassium
Decrease phosphorous (<1000mg/day)
Dialysis (periotoneal, hemodialysis)
RBC, Vitamin D (calcitrol replacement) etc.
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Non-Dialysis
Diet therapy
Protein restriction (0.5-0.8mg/kg/d)
Adequte intake of calories(30-35kcal/kg/d)
Fluid intake: urine volume +500ml
Low phosphate diet (600-1000mg/d)
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Dialysis Hemodialyis & Peritoneal
Hemodialysis A medical procedure to
remove fluid and waste products from the
blood and to correct electrolyte imbalances.
This is accomplished using a machine and a
dialyzer, also referred to as an "artificial
kidney.
Peritoneal is a treatment for patients with
severe chronic kidney disease. The process
uses the patient's peritoneum in the abdomen
as a membrane across which fluids and
dissolved substances (electrolytes, urea,
glucose, albumin and other small molecules)
are exchanged from the blood.
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Peritoneal Dialysis
Catheter placement anterior abdominal
wall
Dialysis solution (1-2 liters sometimes smaller)
Three phases of PD
Inflow (fill) approximately 10 minutes,
could be in cycles)
Dwell (equilibration) (approximately 20-30
min or 8 hours+)
Drain (approximately 15 minutes)
These 3 phases are called Exchanges
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Peritoneal Dialysis
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Hemodialysis
AV Fistula Communication
AV Graph Access
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Hemodialysis
Hemodialysis Machine
Hemodialysis Circuit
