Pathophysiology of Renal Failure

What is renal failure ?
A condition in which the kidneys stop working and are not able to remove waste and extra water from the blood or keep body chemicals in balance. Acute or severe renal failure happens suddenly (for example, after an injury) and may be treated and cured.

Types of renal failure :- Its two types.
1.Acute renal failure
2.Chronic renal failure

Acute renal failure : Sudden decrease in renal function. Acute renal failure may be pre-renal, intra-renal or post-renal in nature. Acute renal failure is often reversible so long as permanent injury to the kidney has not occurred.

Manifestations :-
• Oliguria (reduced urine output)
• Possible edema and fluid retention
• Elevated blood urea nitrogen levels (BUN) and serum creatinine – Alterations in serum electrolytes

Symptoms of acute renal Failure :-
• Decreased kidney function (electrolyte imbalance)
• Obstruction in the urinary tract
• Blood in urine
• Reduced urine output
• Dehydration
• Detectable abnormal mass
• Pale skin
• Poor appetite

Diagnosis :-
• Routine Laboratory Test (creatinine and blood urea nitrogen)
• Ultrasound of the kidney helps to determine whether kidney problem is acute or chronic.
• Kidney Biopsy
• Computed Tomography Scan

Treatment :-
1. Prevention of acute renal failure through support of blood pressure and blood volume.
2. Correction of fluid and electrolyte imbalances – Dialysis, which may be employed while the kidneys are in the recovery phase.
3. Low protein, high carbohydrate diet to minimize the formation of nitrogenous wastes.

Chronic Renal Failure :-
Chronic renal failure is the end result of progressive kidney damage and loss of function. Chronic renal failure is often classified into four progressive stages based on the loss of GFR.

Stages of Chronic Renal Failure :-
1.Diminished renal reserve — GFR decreased to 35 to 50% of normal.
2. Renal insufficiency — GFR decreased to 20 to 35% of normal.
3. Renal failure — GFR reduced to less than 20% of normal.
4. End-Stage Renal Disease — GFR is less than 5% of normal.

Causes of Chronic Renal :-
• Chronic glomerulonephritis.
• Chronic infections.
• Renal obstruction (prolonged).
• Exposure to toxic chemicals, toxins or drugs(aminoglycoside antibiotics and nephrotoxicity).
• Diabetes.
• Hypertension.
• Nephrosclerosis (atherosclerosis of the renal artery).
• Diabetic nephropathy.
• Alport syndrome (inherited disorder causes deafness, progressive kidney damage and eye defects).
• Polycystic kidney disease.
• Interstitial nephritis or pyelonephritis.

Symptoms of Chronic Renal Failure :– Until very kidney function remains, chronic renal failure may not developed.
• Anemia, increased levels of phosphates (in blood) are complications of kidney failure.
• Malaise
• Dry skin
• Poor appetite
• Vomiting
• Bone pain
• Metallic taste in mouth

Treatment of Chronic Renal Failure:-
• Careful management of fluids and electrolytes.
• Prudent use of diuretics.
• Careful dietary management; restriction of dietary protein intake.
• Recombinant erythropoietin to treat anemia.
• Renal dialysis.
• Renal transplantation.

Mr. Shubham Parmar, II Semester, B. Pharmacy, School Of Health & Allied Sciences, Career Point University, Kota

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