CHRONIC RENAL FAILURE

Dr.Rodman Tarigan, SpA.,MKes

DEFINITION
The stage of irreversible renal dysfunction result in
renal damage and inability of the kidney to
regulate homeostasis
Severity of renal function impairment various
CLASSIFICATION
1. Early renal failure
2. Chronic renal insufficiency
3. Chronic renal failure
4. End stage renal failure
ETIOLOGY CRF
- Congenital : Renal hypoplasia, renal dysplasia,
Obstructive uropathy
- Hereditary : Juvenile nephronophthisis, hereditary
nephritis, Alports syndrome
- Acquired : FSGS, membranous glomerulopathy
metabolic disorder
PATHOPHYSIOLOGY
Definite Mechanism ?
Factors Immune process
Hemodynamic hyperfiltration
Dietary phosphorus protein
Persistent proteinuria
Systemic hypertension
Clinical Manifestations CRF are from :
1. Inability of the kidney to regulate fluid and electrolyte
homeostasis
2. Toxic metabolite accumulation
3. Renal hormone (erythropoietin and active form of vit. D)
4. Abnormal response organ to androgen hormone

Symptoms may be non specific :
headache, fatigue, lethargy, anorexia, vomiting,
polydipsi, polyuria
Electrolyte imbalance
- Sodium : Excretie and retension
- Potasium : Hyper or hypokalemia
- Metabolic acidosis
- Fluid imbalance
- Urine concentrate impairment
Metabolic Impairment
- Carbohidrate glucose intolerance
- Fat hyperlipidermia
Anemia
Hemorrhage impairment
Impaired cardiovascular function
Hypertension
Heart Impairment
- Pericarditis, especially severe uremia
- Uremic cardiomyopathy
Neurologic impairment
- Peripheral neuropathy
- Hypertensive encephalopathy
Renal Osteodystrophy
Growth retardation
Sexual development
Diagnosis
- Clinical manifestation
- Supportive examination
laboratory blood routine, urine routine,
renal function : ureum, creatinine blood gas analysis
Radiologic : X-ray, Bone age, GFR, Renogram
Treatment
- Conservative :
adequate fluid intake
Control hypertension, anemia, fluid and electrolyte
imbalance acidosis, renal osteodystrophy, heart failure,
hemologic and muscle impairment, hyperuricemia,
toxic substance.
- Replacement Therapy :
Dialysis before GFR 5 ml/m/1,73 m
2

Transplantation
Diet :
Calori 100 kkal/kg BW/day
Protein restriction 1,4 g/kg BW/day (infant)
0,8 - 1,1 g/kgBW/day (Child)
Sodium, if edema (-) / hypertension (-) 2 mEq/kg BW/day
with edema 1 mEq/kg BW/day
Oliguria / anuria 0,2 mEq/kg BW/day
Fluid : 400 ml/m
2
/day + water losses (vomiting/ diuresis)
Potassium
- > 6 mEq/kg clinical symptons (-) food correction or
kayeksalat 1 g /kg BW until < 6 mEq/L
- > 7mEq/L Ca gluconate or Na bicarbonate
Renal Osteodystrophy
- Calcium 100 300 mg /m
2
/day
- Rocatrol 0,25 mg/day, Roxane 0,125 mg/day
Acidosis :
NaHCO 1-5 mEq/kg BW/day
Hypertension dietary salt restriction,
Fail ? Proranolol/etanolol,hydralazone, or captopil
Anemia Elemental iron 2-3 mg/kg BW/dose
folic acid 1-5/day for 3-4 week
Hb < 6g/dl PRC tranfusion 10 20 ml/kg BW
Heart impairment Furosemide
BYE - BYE
BYE - BYE
BYE - BYE