Download to - Owokoniran Memorial Hospital Limited

SEPTEMBER PRESENTATION
AS PRESENTED BY
AWOLESI AISHAT AND ODUNEYE O.D
 The
human kidney is a bean-shaped organ
located at each side of the vertebral column
approximately after the twelfth rib i.e. there
is one kidney on each side of the spine.
 It is about 4-5in (11-14cm) long,2.4in (6cm)
wide,1.6in (4cm)thick and it weighs
approximately 150g
 Formation
and excretion of urine and
other waste products
 Regulation of body water, electrolyte
and acid-base balance
 Production and secretion of hormones
e.g. erythropoietin which aids
production of red blood cells and
vitamin D
 Control of blood pressure by producing
rennin
 Reabsorption of vital nutrients e.g.
glucose, amino acids.
 Chronic
kidney disease also known as
chronic renal disease is a slow gradual
process of kidney destruction which may
go unidentified until there is destruction
of the functional renal tissue.
 It is therefore defined as the progressive
loss of renal function affecting one or
both kidneys over a long period of time.
 This
disease can be differentiated from acute
kidney disease in that the reduction in
kidney function must be present for over
3months.
CAUSES
 Diabetes
 Hypertension
 Sickle
cell anaemia
 Prolong use of certain medications
 Bladder tumor
 Family history of kidney disease
 Bladder obstruction
 Stage
1 - GFR rate is normal. However,
evidence of kidney disease has been
detected.
 Stage 2 - GFR rate is lower than 90 ml
(60-89mL/min/1.73 m², and evidence of
kidney disease has been detected.
 Stage 3 - GFR rate is lower than 60 ml,
regardless of whether evidence of
kidney disease has been detected.
 Stage 4 - GRF rate is lower than 30 ml,.
 regardless
of whether evidence of kidney disease has
been detected
 Stage 5 - GFR rate is lower than 15 ml. Renal failure has
occurred.
 The majority of patients with chronic kidney failure
rarely progress beyond Stage 2. If the patient does not
feel symptoms until Stage 4, any kidney damage is
irreversible.
 Stage 5 being a severe illness with poor expectancy if
untreated it is often called end-stage kidney disease or
end stage renal disease or end stage kidney failure.
 Chronic renal failure usually means the patient requires
renal replacement therapy which may involve a form of
dialysis but ideally constitutes a kidney transplant.
 Non
Dialysis Dependent Chronic Kidney
Disease (NDD-CKD): Means that the patient
do not require the life support treatments
for renal failure known as renal replacement
therapy which includes dialysis or renal
transplantation.
 End Stage Renal Disease (ESRD): Identifies
patients who either require dialysis or
transplant. This also means that the
beginning of ESRD is practically the
irreversible conclusion of NDD-CKD
 Anemia
 Blood
in urine
 Dark urine
 Decreased mental alertness
 Decreased urine output
 Edema - swollen feet, hands and ankles
 Fatigue (tiredness)
 Hypertension (high blood pressure)
 Insomnia
 More
frequent urination, especially at night
 Muscle cramps
 Muscle twitches
 Nausea
 Pain on the side or mid to lower back
 Panting (shortness of breath)
 Protein in urine
 Sudden change in bodyweight
 Unexplained headaches
 Itchy skin, can become persistent
 Loss of appetite
 Male inability to get or maintain an erection (erectile
dysfunction)
 Blood
test - to determine whether waste substances are
being adequately filtered out. If levels of urea and
creatinine are persistently high, the doctor will most
likely diagnose end-stage kidney disease.
 Urine
test - to find out whether there is either blood
and/or protein in the urine.
 Kidney
scans - this may include a magnetic resonance
imaging (MRI) scan, computed tomography (CT) scan, or
an ultrasound scan. The aim is to determine whether
there are any blockages in the urine flow.
 These
scans can also reveal the size and shape of the
kidneys - in advanced stages of kidney disease the kidneys
are smaller and have an uneven shape.
 Kidney biopsy - a small sample of kidney tissue is
extracted and examined for cell damage. An analysis of
kidney tissue makes it easier to make a specific diagnosis
of kidney disease.
 Chest X-ray - the aim here is to check for pulmonary
edema (fluid retained in the lungs).
 There
is no current cure for chronic kidney
failure. However, there are therapies that
can help control the signs and symptoms,
reduce the risk of complications, and slow
the progression of the disease. The
management of chronic kidney disease
includes treatment of underlying causes and
dialysis.
 Reduction of diary intakes i.e. eggs, red
meat and fish to help reduce phosphate
 Calcitrol may be given to help activate
vitamin D
 Angiotensin
Converting Enzymes(ACE) Inhibitors e.g.
Caporal, Enalapril,Lisinopril and Ramipril may be given to
help control blood pressure.
 Angiotensin Receptor Blockers (ARBs) e.g.
Losartan,valsartan may also be given to help control
blood pressure
 Loop diuretic e.g. Lasix is given to help reduce fluid
retention in the body
 Anti-emetics e.g. metoclopramide is administered to help
relieve nausea
 Anti-histamine e.g. chlorphenamine is administered to
help relieve itching
 Protein, salt, phosphorus and potassium intake is
restricted
NSAIDs (nonsteroidal anti-inflammatory drugs) - such as aspirin
or ibuprofen should be avoided.
 Kidney dialysis - this is the removal of waste products and
excessive fluids from blood when the kidneys cannot properly
do the job any more.
 There are two main types of kidney dialysis. Each type also has
subtypes. The two main types are:
 Hemodialysis - blood is pumped out of the patient's body and
goes through a dialyzer (an artificial kidney). The patient
undergoes hemodialysis about three times per week. Each
session lasts for at least three hours.


Peritoneal dialysis - the blood is filtered in the patient's own
abdomen, a catheter is implanted into the abdomen, into
which a dialysis solution is infused and drained out for as long
as is necessary to remove waste and excess fluid.



Continuous ambulatory peritoneal dialysis - the dialysis solution is
exchanged in the abdomen four times a day, every day. Sessions are
equally spaced throughout the day. The patient carries out the
procedure himself/herself.
Continuous cycling peritoneal dialysis - a cycler machine
automatically infuses daily solution into the peritoneal cavity and
takes it out while the patient is sleeping.
Kidney transplant is also considered where dialysis fails
COMPLICATIONS
Anemia
 Central nervous system damage.
 Hyperkalemia
 Insomnia
 Lower libido (sex drive) and male erectile dysfunction
 Ostemalacia
 Pecarditis

 Drugs
are defined as natural or synthetic
substances that are used for medical or
recreational purposes and the repeated use
leads to transient or chronic dependency.
 Some drugs may cause kidney damage/failure
either directly or indirectly since they are
involved in drug metabolism. Significant
alterations have been observed in the
structures of the kidney.
 The continuation of substance or drug abuse
after the appearance of renal damage
increases the risk of permanent renal disease
and consequently leads to ESRD
 Drugs
that can cause kidney damage include:
 Heroin
 Amphetamines
 Benzodiazepines: diazepam
 Cannabis
 Cocaine
 Marijuana
 Morphine
 Painkillers
 Ketamine
 Depressants
 Babiturates
 Drug
abuse must now be considered in the
differential diagnosis of any patient with
unexplained renal pathology.
 Decreasing the numbers of users seems to be
the best way to avoid renal complications.
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