Renal FailureNico Caponi

Overview

Why I chose it?

What is it?

Causes

Diagnostic Approach

Treatment

Why I chose this?

9 year old cousin

Battling since he was born

Has CKD

Will need a transplant in 2-4 years

Wanted to be more knowledgable

What is it?

Renal or Kidney Failure-

When kidneys fail to filter toxins/waste products from blood

Two Types:

Acute and Chronic

Acute Kidney Injury(AKI)

Rapid loss of kidney function

Caused by numerous things

Prerenal- decrease blood flow to kidney

Intrinsic- damage to glomeruli, renal tubules, or interstitium

Postrenal- Urinary tract obstruction

Diagnosis of AKI

Based on clinical history and laboratory data

Rapid reduction in kidney function - Serum creatinine levels

Rapid reduction in urine output

Further testing

Urine sediment analysis, renal ultrasound, or kidney biopsy

AKI Treatment

Specific Therapies

AKI without fluid overload- Administer intravenous fluids

AKI with low BP- Inotropes may be administered

i.e.- norepinephrine or dobutamine

Intrinsic AKI- Each have specific therapies pending on what causes it

i.e. Wegener’s granulomatosis would require steroid medication

Renal replacement

Chronic Kidney Disease(CKD)

Progressive loss in kidney function over a period of months or years

Range of symptoms

feeling generally unwell

reduced appetite

may not be found until you have a disease related to it

i.e. Cardiovascular disease, anemia, or pericarditis

Causes of CKD

3 Most Common

Diabetes mellitus, hypertension, and glomerulonephritis

Others

Vascular: Large/small vessel diseases

Glomerular: Primary/Secondary glomerular disease

Tubulointerstitial: Polycystic kidney disease

Obstructive: Kidney stones and diseases of the prostate

Diagnosis of CKD

Many times previous renal disease or other disease are present

Glomerular filtration rate (GFR) <60mL/min/1.73m2 for 3 months

CKD and AKI contrasts

CKD = smaller kidneys

CKD serum creatinine levels increase over months and years

Tests

Nuclear medicine MAG3 scan, DMSA

Stages of CKD

Stage 1: Slightly diminished function, normal/high GFR

Stage 2: Kidney Damage, mild reduction in GFR

Stage 3: Moderate reduction in GFR

Stage 4: Preparing for failure, severe reduction in GFR

Stage 5: Kidney failure

Treatment

Goal is to slow or halt CKD before Stage 5

Control BP

Treat original disease (when possible)

Angiotensin Converting Enzyme Inhibitors (ACEIs) or Angiotensin II Receptor Antagonists (ARBs)

If Stage 5 is reached either dialysis or a transplant is necessary

The most common cause of death in people with CKD is NOT renal failure

Bibliography

http://en.wikipedia.org/wiki/Renal_failure

http://en.wikipedia.org/wiki/Chronic_kidney_disease

http://en.wikipedia.org/wiki/Acute_kidney_injury