Upload
ankit-soni
View
227
Download
0
Embed Size (px)
Citation preview
8/7/2019 ARF & CRF
1/28
ARF & CRF
Dr Ankit SoniDNB Trainee ( Peds)
8/7/2019 ARF & CRF
2/28
Definition
Acute renal failure (ARF) is defined as asudden deterioration in kidney
functions resulting in inability tomaintain fluid & electrolyte balance.
2
8/7/2019 ARF & CRF
3/28
8/7/2019 ARF & CRF
4/28
Prerenal Disease
Dehydration
Sepsis
Hypoalbuminemia
Cardiac failure
Hemorrhage
4
8/7/2019 ARF & CRF
5/28
Intrinsic Renal Failure
5
GlomerulonephritisHUSAcute tubular necrosis
Cortical necrosisRenal vein thrombosisRhabdomyolysis
Acute interstitial nephritisTumour lysis syndrome
8/7/2019 ARF & CRF
6/28
Post-renal ARF
Posterior urethral valvesUreteropelvic junction obstruction
UreteroceleTumour
UrolithiasisHemorrhagic cystitis
Neurogenic bladder
6
8/7/2019 ARF & CRF
7/28
Symptoms of ARF Decrease urine output (70%)
Edema
Mental changes
Heart failure
Nausea, vomiting
Anemia
Tachypenic Cool, pale, moist skin
8/7/2019 ARF & CRF
8/28
Investigations
Hemogram
Electrolytes
KFTs S. phophate
S. calcium
ABG C3 levels
8/7/2019 ARF & CRF
9/28
ASO titre
Anti-nuclear/cytoplasmic antibodies
Urine RE Urine CS
CXR
Renal USG Renal biopsy
8/7/2019 ARF & CRF
10/28
r ne n ces
10
prerenal
ARF
ATN
Urine specific gravity >1.020 500 20 40
8/7/2019 ARF & CRF
11/28
FeNa
Calculation of fractional excretion ofsodium (FeNa)
FeNa = (urine Na/plasma Na)/(urinecreatinine/plasma creatinine)
FeNa 1% = ATN
11
8/7/2019 ARF & CRF
12/28
Treatment
Fluid management
Management of hyperkalemia
Treatment of metabolic acidosis Hypocalcemia
Hyponatremia
Hypertension Anemia
Nutrition
8/7/2019 ARF & CRF
13/28
Indication of Dialysis
Volume overload with evidence of HT/Pul
edema refractory to diuretics
Persistent hyperkalemia Severe metabolic acidosis unresponsive to
medical management
Neurological symptoms BUN > 100-150
Ca/P imbalance, with hypocalcemic tetany
8/7/2019 ARF & CRF
14/28
Chronic kidney disease
It is defined as either renal injury(proteinuria)
and/or a GFR < 60ml/min/1.73m2 for > 3
months.
8/7/2019 ARF & CRF
15/28
Pathogenesis
Hyperfiltration injury
Proteinuria
hyperphosphatemia
8/7/2019 ARF & CRF
16/28
CHRONIC RENAL FAILURE:
Sodiumand Volume Balance
Sodium and water retention:
CHF, Hypertension, ascites, edema
8/7/2019 ARF & CRF
17/28
CHRONIC RENAL FAILURE:
Potassium Balance
Hyperkalemia
Renin-aldosterone-mediated K transport in the
DCT K-sparing diuretics, ACEis, beta-blockers impair
Aldosterone-mediated actions
Exacerbation of hyperkalenia:
Exogenous factors: K-rich diet, etc.
Endogenous factors: infection, trauma, etc.
8/7/2019 ARF & CRF
18/28
CHRONIC RENAL FAILURE:
Metabolic
Acidosis
Decreased acid excretion and ability to
maintain physiologic buffering capacity:
Treat with oral sodium bicarbonate
8/7/2019 ARF & CRF
19/28
CHRONIC RENAL FAILURE:
Mineral
and
Bone
Bone disease (Figure 16-6) from:
Decreased Ca absorption from the gut Over-production of PTH
AlteredVitamin D metabolism
Chronic metabolic acidosis Impaired production of 1,25D.
8/7/2019 ARF & CRF
20/28
CHRONIC RENAL FAILURE:
CardiovascularandPulmonary
Abnormalities
Volume and salt overload
CHF and pulmonary edema
Hypertension
8/7/2019 ARF & CRF
21/28
CHRONIC RENAL FAILURE:
Hematological
Abnormalities
Anemia: lack of erythropoietin production
diet
Lab Abnormalities: Prolonged bleeding time,abnormal platelet aggregation
8/7/2019 ARF & CRF
22/28
CHRONIC RENAL FAILURE:
Neuromuscular Abnormalites
CNS Abnormalities:
Mild-Moderate: Sleep disorders, impairedconcentration and memory, irritability
Severe: Asterixis, myoclonus, stupor, seizures andcoma
8/7/2019 ARF & CRF
23/28
CHRONIC RENAL FAILURE:
Gastrointestinal
Abnormalities
Peptic Ulcer disease: Secondaryhyperparathyrodism?
Uremic gastroenteritis: mucosal alterations
Non-Specific abnormalities:
anorexia, nausea, vomiting, hiccoughs
8/7/2019 ARF & CRF
24/28
CHRONIC RENAL FAILURE:
Endocrine
Abnormalities
Insulin: Prolonged half-life due to reduced
clearance (metabolism)
Amenorrhea and pregnancy failure: lowestrogen levels
Impotence, oligospermia and geminal cell
dysplasia: Low testosterone levels
8/7/2019 ARF & CRF
25/28
CHRONIC RENAL FAILURE:
Dermatologic
Abnormalities
Pallor: anemia
Skin color changes: accumulation of pigments
Ecchymoses and hematomas: clottingabnormalities
Pruritus and Excoriations: Ca deposits from
secondary hyperparathyroidism
8/7/2019 ARF & CRF
26/28
Growth retardation
Inadequate calorie intake
Renal osteodystrophy
Met acidosis anemia
8/7/2019 ARF & CRF
27/28
Hyperlipidemia
Pericarditis/cardiomyopathy
Glucose intolerance
8/7/2019 ARF & CRF
28/28
Thank you