Renal failure + Renal Function Tests + Dialysis.pptx

Renal failure + Renal Function Tests + Dialysis DR LAIBA SHAKEEL MBBS BATCH 2022 (LNMC)  Kidneys The kidneys are paired retroperitoneal organs lie at the level of the T12 to L3 vertebral bodies - protected by muscle, fat, and ribs. Healthy kidneys fi...

Renal failure + Renal Function Tests + Dialysis DR LAIBA SHAKEEL MBBS BATCH 2022 (LNMC)  Kidneys The kidneys are paired retroperitoneal organs lie at the level of the T12 to L3 vertebral bodies - protected by muscle, fat, and ribs. Healthy kidneys filter about a half cup of blood every minute , removing wastes and extra water to make urine. The urine flows from the kidneys to the bladder through ureters, one on each side of the bladder. The bladder stores urine. Kidneys, ureters, and bladder are part of the urinary tract.  Kidneys Primary Function It is a major excretory organ for elimination of metabolic wastes from the body. It regulates the amount of water, solutes, and electrolytes in the blood.  Kidneys Secondary Function Acid-base balance It produces erythropoietin which stimulates the production of red blood cell. It produces renin for blood pressure regulation Carries out the conversion of vitamin D to its active form, ultimately helps in calcium absorption  How do the Kidneys work? kidneys is made up of about a million filtering units called nephrons. Each nephron includes a filter, called the glomerulus, and a tubule. The nephrons work through a two-step process: 1. Glomerulus filters your blood (180 L / day) 2. Tubule returns needed substances to your blood and removes wastes.  Renal Function Tests (RFT) RFT is ordered, if the doctor Suspects a person's kidneys may not be working properly which is known from signs and symptoms If a person has other conditions that can harm the kidneys, such as diabetes or high blood pressure  Renal Function Tests (RFT) Tests of renal function are useful for: Identifying the presence of renal disease Monitoring the response of kidneys to treatment Determining the progression of renal disease  Renal Function Tests (RFT) Urine Analysis Blood examination Tests for GFR Tests for Tubular Functions Miscellaneous tests / imaging  Renal Function Tests (RFT) URINE ANALYSIS Physical – colour , clearity , odour , volume , appearance Chemical – glucose , albumin , blood , bile salts , bile pigments , urobilinogen , ketone body Microscopic – pus cells , epithelial cells , crystals , cysts  Renal Function Tests (RFT) URINE ANALYSIS COLOUR – Normal - Pale yellow Cloudy - pus, bacteria, fungi , Chyle and amorphous urates and phosphates. Milky or opaque-Nephrotic Syndrome Greenish yellow-Obstructive Jaundice  Renal Function Tests (RFT) URINE ANALYSIS Red-Haematuria-Infections, drugs,injuries and malignancies Black - Parentral Iron therapy Greenish blue-Infection with Psuedo.Aeruginosa.  Renal Function Tests (RFT) URINE ANALYSIS Volume Normal-1.2-2L/day(avg.1.5L) Oliguria – less than 400 ml Anuria – less than 100 ml Polyuria – greater than 2.5 liter/day  Renal Function Tests (RFT) Urine analysis Specific gravity Normal 1.001-1.040 Influenced by-Na+,Cl-,Albumin and sugar. Increases – Diabetes , Albuminuria , Acute nephritis. Decreases - Tubular damage,absence of ADH Normal pH : 6 - 6.5  Renal Function Tests (RFT) Blood tests: There are several blood tests that can aid in evaluating kidney function. These include: Blood urea nitrogen test (BUN). Creatinine test. Measurement of the blood levels of sodium, potassium, chloride, bicarbonate, calcium, magnesium, phosphorus, protein, uric acid, and glucose.  Renal Function Tests (RFT) Blood tests: Serum Urea ( 15-45 mg/dl) Serum Creatinine (0.6 – 1.2 mg/dl) Serum Uric acid (males 3.5-7.2 mg/dl, females 2.6-6 mg/dl) Total protein (6.4-8.1 g/dl) Serum albumin (3.2-4.6 g/dl) Serum electrolytes Na (136-146 mEq/L) K (3.5-5.1 mEq/L) Cl (101-109 mEq/L) Phosphate (2.8-4 mg/dl) Calcium (8.8-10.2 mg/dl  Renal Function Tests (RFT) Glomerular function test CLEARANCE MEASUREMENTS: It is the volume of plasma (ml) completely freed of a given substance per min by the kidneys CLEARANCE TESTS FOR GFR 1. Inulin clearance 2. Creatinine clearance : Ccr= Ucr. V / Pcr 3. Urea clearance  Renal Function Tests (RFT) Glomerular filtration rate (GFR) The best test to assess glomerular function is Glomerular filtration rate (GFR), which is the rate in milliliters per minute at which substances in plasma are filtered through the glomerulus; in other words, the clearance of a substance from the blood. The normal GFR for an adult male is 90 to 120 mL per minute. Glomerular filtration rate (GFR)  Renal Function Tests (RFT) Glomerular permeability Detection of urinary protein via dipstick method  Renal Function Tests (RFT) Tubular Function tests Urine concentration test In CKD kidneys loses the ability to concentrate urine Specific gravity is measured in urine Low fixed specific gravity is indicative of chronic kidney disease Dilution test After overnight water deprivation patient is asked to take 1200ml of water in half hour, urine specific gravity is measured in samples collected over next 4 hours. At least one sample should show sp gr of 1.003 or below Renal Failure  Renal Failure Kidney (renal) failure is when kidneys don't work as well as they should, to the point where kidney replacement is required. Kidney replacement can be accomplished by different kinds of dialysis or by kidney transplant. The term "kidney failure" covers a lot of problems. These problems can result in kidney failure: Your kidney doesn't get enough blood to filter Your kidney is hurt by a disease like high blood sugar (diabetes) high blood pressure glomerulonephritis (damage to the kidney's tiny filters; one example: lupus) polycystic kidney disease and many others Your kidney is blocked by a kidney stone or scar tissue  Renal Failure Acute Renal Failure Acute renal failure (ARF) [also known as acute kidney injury (AKI)] is defined as a relatively sudden (over hours to days) decrease in renal function leading to serious derangements of body fluid homeostasis. Acute renal failure (ARF):Is a reversible clinical condition where there is a sudden and almost complete loss of kidney function (decreased GFR) over a period of hours to days with failure to excrete nitrogenous waste products and to maintain fluid and electrolyte homeostasis.  Renal Failure Acute Renal Failure Causes of ARF Prerenal Renal: intrinsic; parenchymal Postrenal  Renal Failure Acute Renal Failure 1. Prerenal- occurs in 60%-70% of cases, is the result of impaired blood flow to that leads to hypoperfusion of the kidney and a decrease in the GFR. 2. Intra-renal is the result of actual parenchymal damage to glomeruli or kidney tubules. 3. Post renal – is usually the result of an obstruction distal to the kidneys. Pressure rises in the kidney tubules and eventually, the GFR decreases.  Renal Failure Phases of Acute Renal Failure: There are four phases of ARF: Initiation Oliguria Diuresis Recovery  Renal Failure 1. Initiation phase: Time from event to signs of decreased renal perfusion. Few hours to 2 days Potentially reversible. 2. Maintenance phase (oliguria/anuria): BUN and creatinine increase daily (Oliguria is common urine output less than 400 mL/day). Fluid overload, electrolyte imbalances, and acidosis – Renal replacement therapy require  Acute Renal Failure Signs and symptoms swelling of the hands, feet and face (edema) internal bleeding confusion seizures coma abnormal blood and urine tests high blood pressure  Acute Renal Failure Treatment will often include: dehydration will be treated with fluids drugs which affect kidney function will be stopped infection will be treated with antibiotics if there is inflammation of the kidneys, drugs to suppress the immune system may be used (for example steroids) any obstruction will be relieved (for example, a catheter may be inserted into the bladder) severe kidney failure may need to be treated temporarily with dialysis; a process to remove waste products if they have reached a dangerously high level  Chronic Renal Failure / Chronic Kidney Disease Diabetes mellitus type 2 (30% to 50%) Diabetes mellitus type 1 (3.9%) Hypertension (27.2%) Followed by - Primary glomerulonephritis (8.2%), Chronic Tubulointerstitial nephritis (3.6%), Hereditary or cystic diseases (3.1%), Secondary glomerulonephritis or vasculitis (2.1%), Plasma cell dyscrasias or neoplasm. Non-Modifiable CKD Risk Factors - Older age, male gender, a non- Caucasian ethnicity Modifiable CKD Risk Factors - Include systemic hypertension, obesity, smoking, metabolic factors such as dyslipidemia, and hyperuricemia.  Chronic Kidney Disease Classification stage 1: >90: kidney damage with normal or elevated GFR stage 2: 60-89: kidney damage with mild reduction in GFR stage 3: 30-59: moderate reduction in GFR stage 4: 15-29: severe reduction in GFR stage 5: