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Renal Failure Stages

The intensity of renal failure is determined by Glomerular Filtration Rate (GFR). Normal Glomerular

Filtration Rate in healthy people is approximately 90mL per minute or more and this value also refers

to stage 1 of the disease. The value of Glomerular Filtration Rate reduces in each of the following

stages of the disease. In stage 2 it ranges from 60 to 89 mL /min. In stage 3 GFR ranges from 30 to59 mL/min. In stage 4, 15 to 29 mL /min and finally, in stage 5 it is way below 15 mL/min. The

terminal stage requires dialysis.

Stage 1 of Renal FailureThis stage of the disease features with small changes in kidney function. They are actually anintroduction to the disease. The abnormalities of the kidney tissue can be only confirmed bypathohistological examination of the biopted kidney. The treatment of this stage is excellent andthere are numerous medications which can enhance the function of the kidneys. The patient needsto take care of the blood pressure and is due to report any change which may point to progression ofthe disease

Stage 2 of Renal FailureGFR is moderately reduced and the doctor requires additional blood and urine tests as well asimaging studies which will identify further damage of the kidneys.

Stage 3 of Renal FailureThis stage can be additionally divided into 2 sub-stages, 3A and 3B, according to the value of GFR.3B stage is more severe and the patient is further examined and treated in order to prevent furtherreduction in function of the kidneys.

Stage 4 of Renal FailureThis stage features with rather low level of GFR which indicates the onset of terminal kidney failure.Improper function of kidneys starts to affect other organs in the body and the patient's health ingeneral deteriorates. The patients in the stage 4 require dialysis.

Stage 5 of Renal FailureIn this stage the function of the kidneys is completely ruined. The only option for patients in this

stage is either dialysis or kidney transplantation.

SODIUM BICARBONATE:

NaHCO3 is administered as an IV bolus or by IV infusion. The standard dosage is 1 mg/kg of body weight

as the initial dose followed by 0.5 mg/kg every 10 minutes for the duration of the cardiac arrest. A 50-

milliliter bolus of NaHCO3 will raise the serum pH approximately 0.1 of a pH unit. If the pH is 7.0, it

requires four 50 mEq ampules of HCO3 to correct the pH to 7.40.

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The 2010 Guidelines promote high quality CPR and defibrillation to facilitate rapid ROSC as the method

of restoring acid-base balance.

Nephrotic syndrome:

1. Massive proteinuria

2. Hypoalbuminemia

3. Edema

4. Hyperlipidemia/hyperlipiduria

Nephritic syndrome:

1. Hematuria

2. Oliguria

3. Azotemia

4. Hypertension

Nephritic syndromes Nephrotic syndromes

RBC casts, hematuria

mild to moderate proteinuria

retention of salt, oliguria

periorbital puffiness, hypertension

fatty casts, oval fatbodies

proteinuria > 3.5g/dl/day

generalized pitting edema

ascites

Examples

type IV diffuse proliferative GN in SLE

PSGN

RPGN: Good pasture's syndrome, ...

IgAGN (Berger's disease) - M.C. GN

Alport syndrome - hereditary n.

deafness

Examples

MCD - M.C. in children

FSGS - M.C. in AIDS

MGN - M.C. in adults, HBV association

MPGN - type I - HCV association

diabetic glomerulosclerosis - begins with

microalbuminuria

amyloidosis