AZOTEMIA
Azotemia is a medical condition
characterized by a higher than normal
blood level of urea or other nitrogen
containing compounds in the blood as a
result of insufficient filtering of the blood
by the kidneys or inability of the kidney
to excrete these compounds
UREMIA
Uremia is a toxic condition resulting
from renal failure, when kidney
function is compromised and urea
and waste products normally
excreted in the urine, is retained in
the blood.
ACUTE RENAL FAILURE
Acute renal failure (ARF) is a rapid loss of renal
function resulting in retention of nitrogenous (urea
and creatinine)and non nitrogenous waste
products.
Depending on the severity and duration of the renal
dysfunction, this accumulationis accompanied by
metabolic disturbances, such as metabolic acidosis
and hyperkalaemia, changes in body fluid balance,
and effects on many other organ systems.
It can be characterised by oliguria.
The first consensus definition of
acute renal failure (RIFLE)
Consensus criteria for the diagnosis of ARF
are:
Risk: serum creatinine increased 1.5 times
OR urine production of <0.5 ml/kg body
weight for 6 hours
Injury: creatinine 2.0 times OR urine
production <0.5 ml/kg for 12 h
Failure: creatinine 3.0 times OR creatinine
>355 mol/l (with a rise of >44) or urine
output below 0.3 ml/kg for 24 h
Loss: persistent ARF or more than four
weeks complete loss of kidney function
End Stage in relation to kidney function
CHRONIC RENAL FAILURE
Chronic renal failure is a gradual and
progressive loss of the ability of the
kidneys to excrete wastes, concentrate
urine, and conserve electrolytes.
Chronic renal failure usually occurs over a
number of years as the internal
structures of the kidney are slowly
damaged.
In the early stages, there may be no
symptoms. In fact, progression may be so
gradual that symptoms do not occur until
kidney function is less than one-tenth of
normal.
Functions of Kidney
Has three major functions
Excretion of wastes.
Maintenance of ECF volume & concentration
Hormone synthesis
Kidneys receive about 25% of cardiac
output.
Normal GFR is 120 ml/min 170 L/24 hrs
Urine production is 1 2 L/24 hrs.
Impaired kidney function may be
"prerenal", "renal", or "postrenal".
Prerenal azotemia results from
underperfusion of the kidney: dehydration,
hemorrhage, shock, congestive heart
failure; glomerulonephritis is likely also to
be "prerenal" if mild, since it comprmises
renal blood flow more than tubular function
Renal azotemia has several familiar causes:
acute tubular necrosis, chronic interstitial
nephritis, some glomerulonephritis, etc.
Postrenal azotemia results from obstruction
of urinary flow: prostate trouble, stones,
surgical mishaps, tumors
BLOOD UREA NITROGEN
(BUN)
BUN
To evaluate kidney function and monitor the
effectiveness of dialysis and other treatments related
to kidney disease or damage.
This test measures the amount of urea nitrogen in the
blood.
Nitrogen, in the form of ammonia, is produced in the
liver when protein is broken into its component parts
and metabolized.
The nitrogen combines with other molecules in the liver
to form the waste product urea.
The urea is then released into the bloodstream and
carried to the kidneys, where it is filtered out of the
blood and excreted in the urine.
Since this is an ongoing process, there is usually a
small but stable amount of urea nitrogen in the blood.
What does the test result mean?
Increased BUN levels suggest impaired kidney function.
This may be due to acute or chronic kidney disease,
damage, or failure.
It may also be due to a condition that results in
decreased blood flow to the kidneys, such as
congestive heart failure, shock, stress, recent heart
attack, or severe burns.
It may be due to conditions that cause obstruction of
urine flow, or to dehydration.
BUN concentrations may be elevated when there is
excessive protein catabolism (breakdown),
significantly increased protein in the diet, or
gastrointestinal bleeding.
DECREASED BUN
Lack of protein (celiac disease, some
patients with nephrotic syndrome)
Severe liver disease (end-stage
cirrhosis, yellow atrophy, really bad
hepatitis, halothane or acetaminophen
toxicity, enzyme defects)
Overhydration (iatrogenic, psychogenic
water-drinking)
Both decreased and increased BUN
concentrations may be seen during a
normal pregnancy.
BUN & BLOOD UREA
BUN x 2.14 = blood urea
BUN = Blood Urea/2.14
Reference Range:
Blood urea: 3.3 6.7 mmol/l
(10 50 mg/dl)
BUN: 2.9 - 8.9 mmol/L
(8 - 25 mg/dL )
CREATININE
Creatinine is a waste product produced in
muscles from the breakdown of a compound
called creatine.
Creatine is part of the cycle that produces
energy needed to contract muscles.
Creatinine are produced at a relatively
constant rate.
Almost all creatinine is excreted by the
kidneys, so blood levels are a good measure of
how well kidneys are working.
The quantity produced depends on the size of
the person and their muscle mass.
For this reason, creatinine concentrations will
be slightly higher in men than in women and
children.
What does the test result mean?
Increased creatinine levels in the blood suggest
diseases or conditions that affect kidney function.
These can include:
damage to or swelling of blood vessels in the kidneys
(glomerulonephritis) caused by, for example, infection
or autoimmune diseases;
bacterial infection of the kidneys (pyelonephritis);
death of cells in the kidneys small tubes (acute tubular
necrosis) caused, for example, by drugs or toxins;
prostate disease, kidney stone, or other causes of
urinary tract obstruction; or
reduced blood flow to the kidney due to shock,
dehydration, congestive heart failure, atherosclerosis,
or complications of diabetes.
Creatinine can also increase temporarily as a result of
muscle injury.
Drugs such as aminoglycosides (gentamicin) can
cause kidney damage and so creatinine is
monitored.
3 Moderate 30-59
decrease in GFR