Chronic Kidney Disease

Chronic kidney disease : Causes : Pre-renal : dehydration, severe bleeding, sepsis, infection Renal : HTN, DM, chronic GN Post-renal : tumor, stones, stricture, albert syndrome (defense , hyperplasia, CRF ) Renal failure History : sign and symptoms : LL edema, nausea, vomiting,convulsion, insomnia, itching due to urea deposition under the skin (dusty skin) lion pain, dysuria (UTI + obstruction) Headache , hematuria, dyspnea ( heart failure) chest pain ( pericarditis ) orthpedia polyuria,deplypsia ( DM ) ascites (liver disease ) general symptoms (fatigue malasia,sweating ) renal ostoeostrophy ( in advanced stage) puffiness of eyelids pallor,palpitation (anemia) hypercagulopathy ( nephrotic syndrome easilypruising ) frothy urine ( proteinuria) hyperventilation ( metabolic acidosis ) deep sign breathing reliable of repeated infection generalized edema (nephrotic syndrome ) peripheralneuropathy retinopathy (retinal detachment ) complication of DM nephropathy butterfly rash (malor rash ) seen in SLE and mitral stenosis GN diagnosed by renal biopsy lab diagnosis in renal disease : electrolytes creatinene fasting glucose in DM GFR urine analysis ANA in SLE imaging : UT to see ( medulla and cortex size ) anatomy of the kidney + any obstruction   large kidney (obstruction ) normal size ( pre-renal disease ) CT to detect kidney stone and laizotrips Examination : Normal kidney is not palpable Auscultation is done on renal angle( murmur (stenosis of renal artery ) Reno-vascular disease it is reversible caused by hypertension treated by dilatation of the artery using ACEI is a contraindication) VIP note : Nephrotic syndrome is characterized by  Hypoprotienemia  Hypercoagulative state  Edema  Hyperlipidemia  Hematuria it is not diagnostic we have to find out what the cause nephrotic syndrome: edema proteinuria hematuria nephritic syndrome : edema proteinuria hematuria the difference between nephrotic and nephritic syndrome is not important clinically and both are treated by corticosteroid Hypertension will lead to renal disease (vice versa ) HYPO + HYPER thyroid will cause hypertension GRF is less than 15 (CKD5 ) the patient need dialysis Dialysis: 3 mes a week Types :  Hemodialysis : In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing it to a partially permeable membrane. The dialyzer is composed of thousands of tiny synthetic hollow fibers. The fiber wall acts as the semipermeable membrane. Blood flows through the fibers, dialysis solution flows around the outside of the fibers, and water and wastes move between these two solutions. The cleansed blood is then returned via the circuit back to the body. Ultrafiltration occurs by increasing the hydrostatic pressure across the dialyzer membrane. This usually is done by applying a negative pressure to the dialysate compartment of the dialyzer. This pressure gradient causes water and dissolved solutes to move from blood to dialysate, and allows the removal of several litres of excess fluid during a typical 4-hour treatment Contraindication in patient with hypotension 3 hours is enough to eliminate waste substance from our body ‫ ﺳﺎﻋﺎت ﺣﻧﺗﺧﻠص ﻣن ﻣوﯾﺔ ﺑس‬٣ ‫اﻛﺛر ﻣن‬  Peritoneal dialysis : In peritoneal dialysis, a sterile solution containing glucose (called dialysate) is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a partially permeable membrane. The peritoneal membrane or peritoneum is a layer of tissue containing blood vessels that lines and surrounds the peritoneal, or abdominal, cavity and the internal abdominal organs (stomach, spleen, liver, and intestines). Diffusion and osmosis drive waste products and excess fluid through the peritoneum into the dialysate until the dialysate approaches equilibrium with the body's fluids. Then the dialysate is drained, discarded, and replaced with fresh dialysate. This exchange is repeated 4-5 mes per day; automa c systems can run more frequent exchange cycles overnight. Peritoneal dialysis is less efficient than hemodialysis, but because it is carried out for a longer period of time the net effect in terms of removal of waste products and of salt and water are similar to hemodialysis. Peritoneal dialysis is carried out at home by the patient, often without help. This frees patients from the routine of having to go to a dialysis clinic on a fixed schedule multiple times per week. Peritoneal dialysis can be performed with little to no specialized equipment (other than bags of fresh dialysate). Liable to infection Need a disinfected environment Difficult to use in Obese + non-educated people Note : continuous veno-venous hemo-dia-filteration (CVVHDF) used in fluid overload +CHF+ acute renal failure Amino acid and folic acid are lost with dialysis Indication of acute renal dialysis :       Metabolic acidosis Hyperkalemia Uremia Uremic pericarditis Pulmonary edema Drug intoxication GROUP 12