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1、LOGOChronic Renal Failure (CRF)Chengwu Liu 20152Company Logo1. Review of ARF 2. Definition of CRF 3. Etiology 4. Clinical causes 5. Pathogenesis 6. Alterations of metabolism and function 7. Uremia 8. Prevention and treatmentOutline3Company Logocauses and classification of ARFvprerenal ARF: renal hyp
2、operfusionvintrinsic ARF: acute tubular necrosis(ATN)vpostrenal ARF: urethral calculus 1. ReviewReview of ARF4Company LogoPathogenesis of ARFv(1) Renal hypoperfusionv(2) Renal vasoconstrictionv(3) Injury of renal tubulesv(4) renal endothelial cell andmesangial cell injure Review of ARF5Company LogoA
3、lterations of metabolism and functionOliguric ARFOliguric phase: oliguria or anuria,azotemia,hyperkalemia,metobolic acidosisDiuretic phase: diuresis,hyponatremiahypokalemia Recovery phase: urine volume andNPN return to normal levelReview of ARF6Company Logo2. DefinitionvCRF: A critical syndrome char
4、acterizing an accumulation of metabolic waste, disturbance of base-acid and electrolytes balance and renal endocrine functiondue to chronic and progressive renal diseases.Definition7Company Logo(1) kidney parenchyma disorders: Chronic glomerular nephritis (50-60%) Diabetes SLE nephropathy Multiple r
5、enal cysts (polycystic kidney disease) about 5% of cases 3. EtiologyEtiology8Company Logo(2) Renal Vascular Disease : Hypertensive nephropathy Diabetes:most common cause ESRD;over 30% cases ESRD areprimarily to diabetesESRD: end stage of renal diseaseEtiology9Company Logo(3) Obstruction of ureteric
6、tract: Calculus Tumor Prostatic hypertrophyEtiology10Company LogoChronic glomerular nephritisNormal kidneySmall and atrophic Sclerous osteodystrophyDecrease excretion by kidney Increase phosphate load from bone metabolismIncrease PTH levelsParathyroid gland hyperplasia occursDanger of calciphylaxisM
7、etabolism *RAAS ;*vasodilative substances : PGA2 , kininMetabolism & Function32Company Logov 2) renal anemia： Due to reduced erythropoietin production by kidney Occurs when creatinine rises to2.5-3mg/dL or exceed it.Metabolism & Function33Company Logov 3) bleeding tendency： Platelet dysfunction - us
8、ually with prolonged bleeding times. v 4) immunity dysfunctionv 5) Renal osteodystrophyMetabolism & FunctionP3+ excretion failure, serum P3+acidosisBone salt dissolveCRFSensitivity of target cell to PTHBone Ca2+ Intestine absorb Ca2+ HypocalcemiaPTH inhibitor Bone calcium deposit failureMechanism of
9、 renal osteodystrophyRenal osteodystrophy1,25(OH)2D3PTH Metabolism & Function35Company LogoARF CRFHistory Kidney function normal History of BUN and Cr Kidney size shrink, excluding diabetic, polycystic kidney, etc NormalBone X-rayNo evidence of ROevidence of ROAnemia Rare, unless caused by hemorrhag
10、e commonComparison of AFR and CRFRO: renal osteodystrophyMetabolism & Function36Company Logov(1) conceptconcept：a clinical and biochemical syndrome occurs in ARF or CFR showing a series of toxicity symptoms due to metabolic products, endogenic toxins and the disturbance of homeostasis.7. Uremia37Com
11、pany Logov(2) Function and metabolic changes1) NS uremic encephalopathy: coma, paralysis peripheral neuropathy: unusual feeling, nerve paralysis, etc. 2) Digestion system: It is the earliest and prominent symptoms in uremic patient: no appetite, vomit, etc.Uremia 38Company Logo3) Cardiovascular syst
12、em:congestive heart failure,arrhythmia,uremic pericarditis. 4) Other changes:itchy skin,uremic pneumonia.Uremia 39Company Logov(3) mechanism 1) guanidine：methylguanidine, polyamines 2) middle molecules :urea, creatinine , uric acid 3) large polypeptides: PTH, GHUremia 40Company Logov Evaluation: 1.S
13、earch for underlying causes 2.Laboratory a.Calcium, phosphate, uric acid, magnesium and albumin b.Urinalysis, microscopic exam, c.Calculation of CCr and protein losses d.Complete blood count e.Renal biopsy - particularly in mixed or idiopathic disease8. Preventation and treatment41Company Logov Dialysis: peritoneal, hemodialysisIndications: a. Uremia - azotemia b. Severe hyperkalemia c. Volume overload42Company LogovTransplantation Predialysis Delay may increase ATN Pre-transplant: ImmunotherapyLOGO
