RENAL FAILURE

DEFINATION

  • it is the impairment of renal function over days or week which often results in increase plasma urea , creatinine , and oliguria.

  • it may be reversible or irreversible.

  • if it is reversible than it is called as acute renal failure.

  • if it is irreversible than it is called as chronic renal failure.

CLASSIFICATION

  • ACUTE RENAL FAILURE

  • CHRONIC RENAL FAILURE

ACUTE RENAL FAILURE

  • FUNCTIONALLY - Decrease GFR , Decrease urine output , Increase Nitrogenous waste.

  • STRUCTURALLY - Cell death due to necrosis/apoptosis , Loss of adhesion in intrinsic renal cell.

CAUSES OF ACUTE RENAL FAILURE


PRE-RENAL

  • Due to Sudden decrease in blood pressure.

  • flow obstruction to kidney

  • due to Atherosclerosis

INTRA-RENAL

  • Due to direct damage

  • inflammation

  • infection

  • drug

  • Autoimmune disease

POST-RENAL

  • Mainly Include obstruction of urine flow

  • Benign prostatic hyperplasia

  • Kidney stone

  • Bladder injury or tumor.

INTRA-RENAL CAUSES


A) Acute Glomerular Nephritis

  • Inflammation of glomerulus

  • it is due to Autoimmune condition such as systemic lupus erythromatosis

B) Acute Tubular Necrosis

  • Necrosis of proximal convoluted tube

  • 50% of acute renal cases due to this condition

C) Acute Interstitial Nephritis

  • Mostly due to Allergy & Infection

D) Post renal + prerenal cause Intrarenal cause

  • Vascular changes - decrease GFR , Endothelial dysfunction , Vasoconstriction in Afferent arteriole , Increase Adhesion of inflammatory cells such as neutrophils and it may produce Agg. and Inflammation.

  • Tubular changes - Cell loss + Damage Cell due to Necrosis -> Necrotic body cause obstruction in tube and is results the Filtration the back leak .(Back leak of urine ).

CHRONIC RENAL FAILURE


CAUSES

  • Acute renal causes

  • Hypertension

  • Diabetes type 1 & 2

  • Other kidney Disease such as polycystic ovarian disease.

MECHANISM

HYPERTENSION

DIABETES


Diabetic nephropathy


1) Mesangial cell expansion and cell proliferation

2) Podocytopathy -podocyte hypertrophy and atrophy

3) GBM Thickening

4) Sclerosis


SIGN AND SYMPTOMS

  • Decreased urine output, although occasionally urine output remains normal

  • Fluid retention, causing swelling in your legs, ankles or feet

  • Shortness of breath

  • Fatigue

  • Confusion

  • Nausea

  • Weakness

  • Irregular heartbeat

  • Chest pain or pressure

  • Seizures or coma in severe cases

RISK FACTOR

  • Diabetes

  • High blood pressure

  • Heart and blood vessel (cardiovascular) disease

  • Smoking

  • Obesity

  • Being African-American, Native American or Asian-American

  • Family history of kidney disease

  • Abnormal kidney structure

  • Older age

COMPLICATION

  • Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)

  • A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart's ability to function and may be life-threatening

  • Heart and blood vessel (cardiovascular) disease

  • Weak bones and an increased risk of bone fractures

  • Anemia

  • Decreased sex drive, erectile dysfunction or reduced fertility

  • Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures

  • Decreased immune response, which makes you more vulnerable to infection

  • Pericarditis, an inflammation of the saclike membrane that envelops your heart (pericardium)

  • Pregnancy complications that carry risks for the mother and the developing fetus

  • Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival

DIAGNOSIS AND INVESTIGATION


  • Blood tests Kidney function tests look for the level of waste products, such as creatinine and urea, in your blood.

  • Urine tests Analyzing a sample of your urine may reveal abnormalities that point to chronic kidney failure and help identify the cause of chronic kidney disease.

  • Imaging tests Your doctor may use ultrasound to assess your kidneys' structure and size. Other imaging tests may be used in some cases.

  • Removing a sample of kidney tissue for testing Your doctor may recommend a kidney biopsy to remove a sample of kidney tissue. Kidney biopsy is often done with local anesthesia using a long, thin needle that's inserted through your skin and into your kidney. The biopsy sample is sent to a lab for testing to help determine what's causing your kidney problem.

HOMOEOPATHIC THERAPEUTICS

  • Renal calculi - berb. vulgaris

  • Nephritis - Apis.

  • Cystitis - clematis erecta , cantharis

  • UTI - Cantharis

  • Urine retention - Caust. , Nux-v , Hell.

  • Nocturnal enuresis - Puls.



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