RENAL FAILURE

Prepared by: Alhane Ann Enriquez Pathophysiology - MAN

INCIDENCE

INCIDENCE

RENAL FAILURE

Failure to remove metabolic end-products from the blood and regulate the fluid, electrolyte and pH balance of the ECF.
Acute Renal Failure Chronic Renal Failure

Abrupt in onset Reversible Causes:

Prerenal Intrarenal Postrenal

End result of the damage to the kidneys Irreversible destruction

PREDISPOSING FACTORS

PREDISPOSING FACTORS

Diabetes
It

is the most common cause of kidney failure, accounting for nearly 44 percent of new cases. Almost 40% of new dialysis patients have diabetes, making it the fastest growing risk factor for kidney disease. Type 2 diabetes is the number one cause of kidney failure
Source: United States Renal Data System.USRDS 2007 Annual Data Report.

PREDISPOSING FACTORS
o

Hypertension
o

is a major factor in the development of kidney problems in people with diabetes.

High blood pressure

Renal tubular perfusion

PREDISPOSING FACTORS
o

Atherosclerosis
o

deposition of various fatty substances on the linings of the arteries carrying blood; hence, causing hardening of the arteries.
Hardening of the arteries Blood supply to the kidneys

PREDISPOSING FACTORS
o

Overuse of Painkillers and Allergic Reactions to Antibiotics

o

Heavy use of painkillers containing ibuprofen, or naproxen have been linked to interstitial nephritis, a kidney inflammation that can lead to kidney failure.

PREDISPOSING FACTORS
o

Drug Abuse o Use of certain nonprescription drugs, such as heroin or cocaine, can damage the kidneys, and may lead to kidney failure

PREDISPOSING FACTORS
Other factors:
a. b. c. d. e.

Family History of Kidney Disease Premature Birth Age Trauma or Accident Certain Disease

A rapid decline in renal function sufficient to increase blood levels of nitrogenous wastes and impair fluid and electrolyte balance.

Prerenal

Intrarenal

Postrenal

PRERENAL FAILURE
Causes:
Hypovolemia

Vascular filling Heart failure Renal perfusion d/t vasoactive mediators

Impaired renal mechanisms

Renal blood flow

GFR

Ischemic changes

Ischemic Tubular Necrosis

U.O

BUN

Creatinine

INTRARENAL (ACUTE TUBULAR NECROSIS)

THREE PHASES:

Oliguric phase (lasting for 36 hours) characterized by further damage to the renal tubular wall and membranes Diuretic Phase

source of obstruction has been removed but the residual scarring and edema of the renal tubules remains.

Recovery Phase

edema decreases, the renal tubules begin to function adequately

INTRARENAL (ACUTE TUBULAR NECROSIS)

Causes:
Acute

Tubular Necrosis prolonged renal ischemia exposure to nephrotoxic drugs, organic solvents acute renal disease (acute glomerulonephritis)

Tubule cell injury Loss of cell polarity Na delivery

Vasoconstrictio n

Detachment Luminal obstruction

Intratubular pressure

Edema

HPN

GFR

OLIGURIA

POSTRENAL FAILURE
Causes:
Bilateral

ureteral obstruction Bladder outlet obstruction

Obstruction of urine outflow

known as End-Stage Renal Disease (ESRD)

Stages: GFR
Renal Impairment 2. Renal Insufficiency of normal 3. Renal Failure 4. End-stage renal disease
1.

40 50% of normal 20% to 50% < 20% of normal < 5% of normal

Renal Failure
Sodium and water balance Elimination of nitrogenous wastes Erythropoietin production Acid-base balance

HPN

Anemia Acidosis

Vascular volume

Edema Coagulopathies

Skeletal buffering

Heart Failure

Uremia Osteodystrophies

GI manifestation s

Neurologic manifestation s

Sexuality dysfunction

THANK YOU!

On every thorn, delightful wisdom grows, In every rill a sweet instruction flows. -Edward Young