chronic renal failure


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vikas a    on Jun 30, 2012 Says :

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1 : Dept of medicine
2 : CHRONIC RENAL FAILURE
3 :
4 :
5 : DEFINITION It refers to the permanent loss of renal function. OR It is defined as irreversible deterioration in renal function over 3 months with GFR <15/minute/1.73m
6 : COMMON CAUSES Primary or secondary GN Diabetic nephropathy Hypertensive nephrosclerosis Polycystic kidney disease Chronic pyelonephritis Analgesic nephropathy Interstitial nephritis Renal tuberculosis
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10 : 1.Anaemia 2.Renal osteodystrophy Reduced erythropoietin production Reduced dietary intake Increased blood loss Failure of kidney to produce 1,25 dihydroxycholecalciferol
11 : MANAGEMENT It falls into 3 parts a)Investigations to determine the underlying disease & to detect any reversible factors b)Measures to prevent further damage c)Supportive measures in the form of dialysis or transplantation when required
12 :
13 : INVESTIGATIONS URINE ANALYSIS:- specific gravity which is around 1.010 i.e isothenuria & presence of broad casts White cells indicate infection Eosinophils indicates allergic tubulointerstitial disease
14 : 2.BLOOD HAEMATOLOGY-normocytic normochromic anaemia biochemistry- elevated levels of blood urea & creatinine, hypocalcaemia,hyperphosohataemia,hyperuricaemia & hyperkalaema Creatinine clearence is important to assess severity of renal failure
15 : 3.ultrasonography To assess the size of kidneys Both kidneys are small & contracted 4. RENAL BIOPSY May be carried if renal size is normal
16 : TREATMENT Treat any irreversible cause,relive obstruction avoid nephrotoxic drugs & treat underlying infection Monitor & treat hypertension- ACE inhibitors Dietary advice Adequate calories Vitamins & iron Salt restriction Protien restriction to 40g/day
17 : To avoid diet containing potassium Diet predominantly containing carbohydrate to be taken 4. Anaemia may respond to erythropoietin 5.Renal bone disease to be treated by lowering phosphate with phosphate binders like calcium carbonate . 6. Avoid aluminium containing drugs like antacids as they cause encephalopathy
18 : 7.VIT D replacement i.e alphacalcidol in the dose of 0.25-1 mg daily orally. 8.Calcium supplements to reduce the risk of metastatic calcification 9.Treatment of hiccups with chlorpromazine 25mg/8h orally.
19 : 10.For edema- frusemide 250mg-gm/day 11. Dialysis in preparation for renal transplantation. 12. Renal transplantation is the definitive treatment.
20 : DIALYSIS
21 : DEFINITION It is a process by which attempt is made to maintain normal internal homeostasis artificially in the absence of normal renal function. It is the usual therapy for ESRD i.e when GFR Is <5ml/min
22 : INDICATIONS FOR URGENT DIALYSIS Severe hyperkalaemia Pulmonary edema or severe fluid overload Severe metabolic acidosis Uraemic pericarditis Uraemic encephalopathy Toxicity with a dialyzable poison like methanol & phenobarbitol.
23 : There are 2 types Haemodialysis Peritoneal dialysis
24 : Haemodialysis It allows accumulated uraemic toxins and electrolytes to diffuse across a semi permeable membrane from blood where they are in high concentrations to the dialysate on the other side of the membrane
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26 : Procedure Blood is circulated through artificial kidney It consists of blood compartment and dialysate compartment seperated by a semi permeable membrane made up of cellulose, cellulose acetate As the blood and dialysis fluid move on either side of membrane diffusion of electolytes and small molecular weight substances occurs Each session lasts for 4-5 hours and 2-3 sittings per week may be required.
27 : Peritoneal dialysis Here peritoneum of the patient acts as a semi permeable membrane A plastic or silicon catheter is placed into the per.cavity through anterior abdominal wall and dialysate(2 ltrs) is instituted into peritoneal space Water,urea and toxins pass across the peritoneum into dialysate Fluid is removed by gravity after 30 to 60 mins and procedure repeated several times,used in ARF
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29 : Other forms useful for chronic dialysis are: Continuous ambulatory peritoneal dialysis(CAPD)- here dwelling time of fluid is long and done in 3-5 cycles, the dialysate is allowed to remain for 4 hrs during day and 8-12 hrs at night, mainly used for patients with CRF Continuous cycling peritoneal dilalysis(CCPD)-here dwelling period is longer than CAPD during day but at night automated cycler performs short exchanges
30 : Complications Haemodialysis –infection, thrombosis,vascular compromise,haemorrhage,hypotension and seizures Peritoneal dialysis-peritonitis,catheter blockage,weight gain and pleural effusion.
31 : Thank you….. Masudi Sheetal 9 th term…

 

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