Chronic renal failure lec 3
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Transcript of Chronic renal failure lec 3
DISORDERS OF THE
URINARY SYSTEM
CHRONIC R
ENAL
FAIL
URE
DR. ASMATULLAH SAPAND
A H M A D S H A H A B D A L I I N S T U T U T E O F H I G H E R E D U C AT I O N D E P A R T M E N T O F I N T E R N A L M E D I C I N E K H O S T - A F G H A N I S T A N
10 . 05 . 2 016
MANAGEMENT OF COMPLICATIONS
RENAL OSTEODYSTROPHY:• This is the term used for various forms of bone
disease that develop in chronic renal failure i.e. Osteomalacia, Osteoporosis, Secondary Hyperparathyroid Bone Disease And Osteosclerosis.
MANAGEMENT OF COMPLICATIONS
1. OSTEOMALACIA:• Deficiency of 1,25 dihydroxy
cholecalciferol(active-vit.D).• Low vitamin D results in decreased calcium
intestinal absorption(hypocalcemia).• Hypocalcemia results in reduction of osteoid
calcification and finally Osteomalacia.
MANAGEMENT OF COMPLICATIONS
2. HYPERPARATHYROID BONE DISIEASE:• Low serum calcium causes PTH secretion from
the parathyroid gland(secondary hyperparathyroidism)
• Resorption of calcium from bone.• Formation of cysts within the bone(osteitis
fibrosa cystica).
MANAGEMENT OF COMPLICATIONS
3. OSTEOPOROSIS: causes from malnutrition in chronic renal failure.
4. OSTEOSCLEROSIS: cause is unknown and occurs in sacrum, base of the scull and vertebrae.
MANAGEMENT OF COMPLICATIONS
5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:
• GFR below 25% of normal results in low phosphate excretion(hyperphosphatemia)
• Hyperphosphatemia results in hypocalcemia due to deposition of calcium phosphate in bone.
• Hypocalcemia results in secondary hyperparathyroidism and its consequences.
MANAGEMENT OF COMPLICATIONS
5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:
Clinical features:• Bone pain, proximal muscle weakness, fractures,
pruritus and extra-skeletal calcification. Treatment:• Treatment should be started early in the course of
progressive renal failure.
MANAGEMENT OF COMPLICATIONS
5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:
Goal of Treatment:1. To maintain serum calcium and phosphate.2. To prevent hyperparathyroidism.3. To prevent extra-skeletal calcification.4. To maintain normal bone histology.
MANAGEMENT OF COMPLICATIONS
5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:
Correction of Hyperphosphatemia and secondary hyperparathyriodism:
1. Dietary restriction of Phosphate2. Use of Phosphate binding agents
MANAGEMENT OF COMPLICATIONS
5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:
6. Dietary restriction of Phosphate:• Dietary restriction of phosphate is advised when
GFR falls below 50ml/min.• Goal is to maintain phosphorous level between
4-5mg/dl.
MANAGEMENT OF COMPLICATIONS
5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:
6. Use of Phosphate binding agents:• Calcium carbonate 500mg-2g orally with meal.• If phosphorous level cannot be maintained between
4-5mg/dl or the initial phosphorous level is >7mg/dl then Aluminium hydroxide 15-30ml is used with meals.
MANAGEMENT OF COMPLICATIONS
5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:
Treatment of hypocalcemia:• If hypocalcemia persists after phosphate has been
controlled, Vit.D3 may be added.• Alfacalcidol 0.25mcg/day.• Note: vitamin D increases gut phosphorous absorption
and may therefore exacerbate hyperphosphatemia.
MANAGEMENT OF COMPLICATIONS
5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:
Indications of parathyroidectomy:• Calciphylaxis.• Severe hypercalcemia.• High PTH level.
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