Renal failure

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					       Renal failure
       By B. M. Edrees M.D.
Assistant Professor in Pediatric and
       Pediatric Nephrology
     Umm Al-Qura University
      King fahad medical city
Topics
• Introduction
• AKI (ARF), (definition, causes,
  diagnosis, and management).
• CKD (CRF), (definition, etiology,
  complication, evaluation,
  management).
• Renal TX.
      Renal Function
GFR:
• 20-25% of cardiac output .
• 99% reabsorbed.
• 1% excreted.
• 24hr urine collection
  Ccr=Ucr x V/Pcr.
• Schwartz formula:
  Ccr=K x L/Pcr.
Tubular function
• Filtrate.
• ECV .
• regulate solutes e.g. K, Ca, Mg, PO4, Cl,
  Glucose.
• A/B balance.
• water regulation.
           Renal Function
Endocrine function :
• Renin Angiotensin system.
• EPO.
• 1hydroxylation of vit. D.
       Renal Function
Kidney as excretory organ:
• toxic products of metabolism.
• endogenous & exogenous toxins.
• Drug excretion.
    Acute renal failure
• Sudden & sustained loss of kidney
  function.
• Oliguria = <1cc/kg/hr & <0.5cc/kg/hr
  anuria.
  Acute renal failure
Causes :
• prerenal: (hypotension, shock ,
  dehydration).
• Renal: (e.g. glomerulous, tubules
  interstetium, or vasculature).
• Postrenal: (PUV, neurogenic bladder).
    Acute renal failure
• neonatal related to decrease kidney
  perfusion.
• Others include congenital diseases.
    Acute renal failure
• In childhood the commonest is
  glomerulonephritis, then HUS, sepsis,
  nephrotoxins, drugs, malaria etc.
       Acute renal failure
           diagnosis:
•   H/O & PE.
•   Laboratory BUN Cr, electrolyte.
•   WBC, Hb, platelet, blood film.
•   Urine analysis.
    Acute renal failure
      management:
The aim :
• anticipation & prompt treatment of
  complications.
• Ensure adequate blood volume &
  general body status.
• Prevent catabolism.
• Treat the cause.
  Acute renal failure
    management:
Fluid intake: I= insensible water
loss(400ml/m2/d or 20cc/kg/d) + U
  Acute renal failure
    management:
• Energy requirement : use the
  equation for 1st 10kg = 100cc/kg +
  2nd 10kg = 50cc/kg + then 20cc/kg
  for extra weight.
• Twice daily weight.
• Treat electrolyte disturbance.
     Acute renal failure
       management:
Dialysis is indicated :
• fluid over load.
• Refractory electrolyte .
• symptomatic.
• nutrition is compromised.
Chronic kidney disease
                                                 GFR*
                     Description               mL/min/1.7
Stage                                             23m

        Slight kidney damage with normal or    More than
 1
        increased filtration                   90
 2      Mild decrease in kidney function       60-89

 3      Moderate decrease in kidney function 30-59

 4      Severe decrease in kidney function     15-29
        Kidney failure requiring dialysis or
 5                                             Less than 15
        transplantation
• irreversible.
• Disturbed metabolic ,electrolyte ,
  anemia, renal osteodystrophy,
  increase BUN, Cr.
• Some drugs needs adjustment.
• If ESRD ,replacement therapy.
   Renal replacement therapy
• Incidence of ESRF is
  100-120 pmp per year
              SCOT 1999
• Higher in rural
            Ibrahim 1992

• Higher incidence in the            Dialysis centres 1971-2002
  south 215 pmp per year
            Al-Homrany 1998

• 1st HD unit started in
  1971 in Riyadh


                              Dialysis population, net annual increase
                              (average= 9.3%)
         ESRF in children
• prevalence ESRF in KSA, is 20.4 pmp
  (<18 years).
                  Aldrees et al 1991



• Higher in the south : CKD 15.6 pmp
  children/year and ESRF 9.2 pmp (<12
  years)
                  Al-Harbi 1997
   Chronic renal failure
        Etiology:
• obstructive uropathy ~ 30-40%.
• 2nd is GN except in KSA were
  hereditary diseases.
           complications:
• Electrolyte & bone disturbance.
• Feeding problems: anorexia.
 Chronic renal failure
    complications:
• GH resistance and growth failure
• Anemia: decrease EPO , decrease iron&
  vitamins.
• HTN: fluid, and R-Ag. System activation.
• Cardiac dysfunction
Chronic renal failure
    evaluation:
• Schwartz formula.
• 24hr (UV/P).
• H&P, US kidney, nuclear scan, MCUG,
  biopsy, lab. including immunological.
• bone status, electrolyte, CVS,
  electrolyte, growth.
Chronic renal failure
   management:
•   Diet: high caloric, restrict protein.
•   anemia: iron, folic acid, EPO.
•   HTN.
•   Acidosis.
•   hyperkalemia.
•   Renal osteodystrophy.
•   establish growth: diet, GH.
             Dialysis:
•   Indicated if patient GFR <10%.
•   Peritoneal dialysis.
•   Hemodialysis.
•   Advantage & disadvantage.
  Renal transplantation:
• Is the optimal form of renal
  replacement therapy.
Renal transplantation:
 • Prepare the patient.
 • Donors : living VS. cadaveric.
Renal transplantation in KSA
• 1st LRT 1979
• 1993: Saudi centre for organ transplantation
       (SCOT)
Renal transplantation
• 2491 LRT and 1267
  cadaveric till end of
  2002
• 2002:
   – 307 250 LRT and
     57 cadaveric
   – 436  LNRToutside
     KSA
Patient Survival with a Renal
        Graft in KSA
        (1990 – 2000)
                      100
        % Patients     90
        Surviving      80
                       70
                       60
                       50
                       40
                       30
                       20
                       10
                        0
                            1 Years 2   3   4   5

        Related n = 610
        Cadaver n = 315




    SCOT Data, National registry (1990-2000)

				
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