DEFINATION
- it is the impairment of renal function over days or week which often results in increase plasma urea , creatinine , and oliguria.
- it may be reversible or irreversible.
- if it is reversible than it is called as acute renal failure.
- if it is irreversible than it is called as chronic renal failure.
CLASSIFICATION
- ACUTE RENAL FAILURE
- CHRONIC RENAL FAILURE
ACUTE RENAL FAILURE
- FUNCTIONALLY – Decrease GFR , Decrease urine output , Increase Nitrogenous waste.
- STRUCTURALLY – Cell death due to necrosis/apoptosis , Loss of adhesion in intrinsic renal cell.
CAUSES OF ACUTE RENAL FAILURE
PRE-RENAL
- Due to Sudden decrease in blood pressure.
- flow obstruction to kidney
- due to Atherosclerosis
INTRA-RENAL
- Due to direct damage
- inflammation
- infection
- drug
- Autoimmune disease
POST-RENAL
- Mainly Include obstruction of urine flow
- Benign prostatic hyperplasia
- Kidney stone
- Bladder injury or tumor.
INTRA-RENAL CAUSES
A) Acute Glomerular Nephritis
- Inflammation of glomerulus
- it is due to Autoimmune condition such as systemic lupus erythromatosis
B) Acute Tubular Necrosis
- Necrosis of proximal convoluted tube
- 50% of acute renal cases due to this condition
C) Acute Interstitial Nephritis
- Mostly due to Allergy & Infection
D) Post renal + prerenal cause Intrarenal cause
- Vascular changes – decrease GFR , Endothelial dysfunction , Vasoconstriction in Afferent arteriole , Increase Adhesion of inflammatory cells such as neutrophils and it may produce Agg. and Inflammation.
- Tubular changes – Cell loss + Damage Cell due to Necrosis -> Necrotic body cause obstruction in tube and is results the Filtration the back leak .(Back leak of urine ).
CHRONIC RENAL FAILURE
CAUSES
- Acute renal causes
- Hypertension
- Diabetes type 1 & 2
- Other kidney Disease such as polycystic ovarian disease.
MECHANISM
HYPERTENSION
DIABETES
Diabetic nephropathy
1) Mesangial cell expansion and cell proliferation
2) Podocytopathy -podocyte hypertrophy and atrophy
3) GBM Thickening
4) Sclerosis
SIGN AND SYMPTOMS
- Decreased urine output, although occasionally urine output remains normal
- Fluid retention, causing swelling in your legs, ankles or feet
- Shortness of breath
- Fatigue
- Confusion
- Nausea
- Weakness
- Irregular heartbeat
- Chest pain or pressure
- Seizures or coma in severe cases
RISK FACTOR
- Diabetes
- High blood pressure
- Heart and blood vessel (cardiovascular) disease
- Smoking
- Obesity
- Being African-American, Native American or Asian-American
- Family history of kidney disease
- Abnormal kidney structure
- Older age
COMPLICATION
- Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)
- A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart’s ability to function and may be life-threatening
- Heart and blood vessel (cardiovascular) disease
- Weak bones and an increased risk of bone fractures
- Anemia
- Decreased sex drive, erectile dysfunction or reduced fertility
- Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures
- Decreased immune response, which makes you more vulnerable to infection
- Pericarditis, an inflammation of the saclike membrane that envelops your heart (pericardium)
- Pregnancy complications that carry risks for the mother and the developing fetus
- Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival
DIAGNOSIS AND INVESTIGATION
- Blood tests Kidney function tests look for the level of waste products, such as creatinine and urea, in your blood.
- Urine tests Analyzing a sample of your urine may reveal abnormalities that point to chronic kidney failure and help identify the cause of chronic kidney disease.
- Imaging tests Your doctor may use ultrasound to assess your kidneys’ structure and size. Other imaging tests may be used in some cases.
- Removing a sample of kidney tissue for testing Your doctor may recommend a kidney biopsy to remove a sample of kidney tissue. Kidney biopsy is often done with local anesthesia using a long, thin needle that’s inserted through your skin and into your kidney. The biopsy sample is sent to a lab for testing to help determine what’s causing your kidney problem.
HOMOEOPATHIC THERAPEUTICS
- Renal calculi – berb. vulgaris
- Nephritis – Apis.
- Cystitis – clematis erecta , cantharis
- UTI – Cantharis
- Urine retention – Caust. , Nux-v , Hell.
- Nocturnal enuresis – Puls.
