Understanding

Renal Failure
RENAL FAILURE
 Acute Renal Failure or
Acute Kidney Injury (AKI)

 Chronic Renal Failure or

Chronic Kidney Injury (CKD) or
End-Stage Renal Disease (ESRD)
 ACUTE KIDNEY INJURY
• It is characterized by a rapid decline in
glomerular filtration rate (GFR) over hours
to days.

• Retention of nitrogenous waste products,

oliguria (urine output <400 mL/d
contributing to extracellular fluid overload),
and electrolyte and acid-base
abnormalities are frequent clinical
features.
Causes of AKI are divided into 3
Major Categories:
• (1) diseases that cause renal
hypoperfusion, resulting in decreased
function without frank parenchymal
damage (prerenal ARF, or azotemia)
(~55%)

• (2) diseases that directly involve the renal

parenchyma (intrinsic ARF) (~40%).

• (3) diseases associated with urinary tract

obstruction (postrenal ARF) (~5%).
 CLINICAL FEATURES
• Determine if the disease is acute or chronic.

• Rise in BUN and creatinine suggests that

the process is acute.

• Findings that suggest CKD:

- anemia
- evidence of renal osteodystrophy
- small scarred kidneys
 Acute Renal Failure:
Treatment
• Because there are no specific
therapies, prevention is of paramount
importance.

• Many cases of ischemic ARF can be

avoided by close attention to
cardiovascular function and
intravascular volume in high-risk
patients, such as the elderly and
those with preexisting chronic kidney
disease.
• Adjusting drug dosage according to
circulating drug levels also appears to
limit renal injury

• Diuretics, NSAIDs, ACE inhibitors,

ARBs, and vasodilators should be used
with caution in patients with suspected
true or "effective" hypovolemia or
renovascular disease as they may
precipitate prerenal ARF or convert the
latter to ischemic ARF.
 Indications and Modalities
of Dialysis
• During ARF, dialysis is often used
to support renal function until renal
repair/recovery occur.
• Absolute indications for dialysis
include symptoms or signs of the
uremic syndrome and management
of refractory hypervolemia,
hyperkalemia, or acidosis.
 Outcome and Long-Term
Prognosis
• The in-hospital mortality rate
among patients with ARF ranges
from 20 to 50% or more, depending
on underlying conditions, and has
declined only marginally over the
past 15 years.
 Chronic Kidney Disease
(CKD)
• Chronic kidney disease (CKD)
encompasses a spectrum of
different pathophysiologic processes
associated with abnormal kidney
function and a progressive decline in
glomerular filtration rate (GFR).
Classification of CKD
Stage GFR

0 >90

1 =90

2 60 – 89

3 30 – 59

4 15 - 29

5 < 15
 Leading Etiologies of
CKD
• Diabetic glomerular disease
• Glomerulonephritis
• Hypertensive nephropathy
• Polycystic kidney disease
• Interstitial nephritis
 Treatment Plan
Stage Description
1 Kidney damage with normal
or increased GFR
2 Kidney damage with mild
decreased GFR
3 Moderate decreased GFR
4 Severe decreased GFR
5 Kidney Failure
Action
Diagnosis and treatment,
treatment of comorbid
conditions, slowing
progression, CVD risk
reduction
Estimating progression
Evaluating and treating
complications
Preparation for kidney
replacement therapy
Kidney replacement (if uremia
present)
Thank You...

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