Question

Chronic renal failure

Explain the pathophysiology of the disease. Discuss common clinical manifestations. List differential diagnoses. Determine which lab tests would confirm the diagnosis and expected results. Analyze a current protocol for treatment and discuss how the treatment works from the pathophysiological perspective.

Answer 1

CHRONIC RENAL FAILURE :- is also known as end stage renal disease. When a patient has sustained enough kidney damage to require renal replacement therapy on permanent basis is called chronic renal failure.

1. Pathophysiology :-

2.Clinical manifestation are :-

It affects different systems :-

- cardiovascular system - hypertension, heart failure signs like pitting edema ,engorged neck veins ,pericardial friction, effusion,tamponade, hyperkalemia , hyperlipidemia.

-pulmonary system - crackles ,dyspnea ,tenacious sputum , pleural effusion , pleuritic pain ,tachypnea ,kussmaul respiration.

- gastrointestinal system - nausea ,vomiting ,ulcers ,ammonia odour to breath ,metallic taste ,anorexia , constipation or diarrhea.

- neurologic system - weakness ,fatigue ,confusion ,tremors , asterixsis,seizures, behaviour changes ,inability to concentrate

-Musculoskeletal , reproductive and integumentary system :-muscle cramps ,loss of muscle.strength,bone pain , amenorrhea,decreased libido, infertility,anemia thrombocytopenia ,dry skin , pruritus,thining of hair ,purpura etc.

3. Differential diagnosis means the process of differentiating between two diagnosis which have similar sign and symptoms .

List of differential diagnosis are:-

- acute kidney injury

- chronic glomerulitis

- nephrosclerosis

- nephrolithiasis

- multiple myeloma

- diabetic nephropathy

4. Lab tests are :-

- urine analysis and output measurements

- kidney function test, analysis of GFR

- renal ultrasound

- CT

- MRI

The above mentioned first two tests confirm renal failure.

5. Current treatment method are :-

# pharmacological management of hypertension, hyperphosphatemia, anemia , seizures ,cardiac problems ,electrolyte imbalance, pulmonary problems by :-

-providing oxygen therapy

- semi Fowler's positioning

- administering diuretics

- providing phosphate binders

- administering antihypertensives

- IV electrolyte and fluid management

- blood transfusion

- Erythropoietin medications

- Anti coagulant therapy

# Nutritional therapy - adequate calorie and vitamin intake , fluid intake and output balance ,protein is restricted fluid restriction , carbohydrate and fat intake to prevent wasting .

# Dialysis therapy

# Renal transplant

Treatment decreases the inflammation and hyper filtration/ permeability of glomerules and hence decrease the excretion of proteins and macromolecules and decreases RAAS .