Question

Research the many causes of chronic renal failure. What is the connection between the causative agent and damage to the kidney be specific. discuss the current treatments, Including their advantages and disadvantage for instance dialysis removes waste products from the body. does ir also remove substances that are needed? if so, which ones and how are these issues dealt with medically?

Answer 1

1) Causes of Chronic Renal Failure?

A) The term chronic Renal Failure applies to the process of continuing significant irreversible reduction in nephron number and typically corresponds to CKD stages 3-5.

The dispiriting term end stage renal disease represents a stage of CKD where the accumulation of toxins,fluid, and electrolytes normally excreated by the kidneys results in the Uremic syndrome.

Etiology and Epidemiology : 6% of the adult population in the US has CKD at stages 1 and 2. 4.5% of US population is estimated to have stages 3 and 4 CKD.

Leading categories of Etiologies of CKD :

​​​​​​a. Diabetic Glomerular Disease,

b. Glomerulo Nephrities,

C. Hypertensive Nephropathy,

- Primary glomerulopathy with Hypertension,

- Vascular and Ischemic renal disease.

d. Autosomal dominant Polycystic kidney disease,

e. Other cystic and tubulo interstitial Nephropathy.

2. Connection between the causative agent and damage to the kidney ?

A) The pathophysiology of CKD involves two broad sets of mechanisms of damage :

1. Initiating mechanisms specific to the underlying etiology:

Eg: Genetically determined abnormalities in kidney development or integrity, immune complex deposition and inflammation in certain types of glomerulo Nephrities or toxin exposure in certain diseases of the renal tubules and interstitium.

2. A set of progressive mechanisms involving

- Hyperfiltration and Hypertrophy of the remaing viable nephrons,

- long term reduction of renal mass, irrespective of underlying etiology,

A. The responses to reduction in nephron number are mediated by vasoactive hormones , cytokines and growth factors.

B.Hypertrophy and Hyperfiltration become maladaptive as the increased pressure and flow predisposes to distoration of Glomerular architecture associated with sclerosis and dropout of the remaing nephrons.

Identification of Risk factors and Staging of CKD :

- Risk factors include : Hypertension, Diabetes Mellitus, Auto immune disease, Old age, African ancestry, a family history of renal disease, previous episode of acute kidney injury, presence of proteinuria, abnormal Urinary sediment, or structural abnormalities of the Urinary tract.

- Recent research in the genetics of predisposition to common complex disease has revealed DNA sequence variants at a number of genetic loci that are associated with common forms of CKD.

Stages of Classification :

Stage	0	1	2	3	4	5
GFR	>90	>90	60-90	30-59	15-29	<15

3.current treatment including their advantages and disadvantages for instance dialysis removes waste products from the body ?

Treatment: Treatment aimed at specific causes of CKD include:

- Optimised glucose control in diabetes mellitus,

- immunomodulatory agents for specific therapies to retard cytogenesis in Polycystic kidney disease,

- treat the acceleration factors like ECFV depletion, Uncontrolled Hypertension,urinary tract infection, new obstructive uropathy, exposure to nephrotoxic agents such as NSAIDs or Radiographic dye.

1. Slowing the progression of CKD

- redusing intraglomerular Hypertension and protenuria.

2. Slowing the progression of Diabetic renal disease,

3. Managing other complications of chronic kidney disease,

- Medication dose adjustment,

- preparation of renal replacement therapy.

4. Dialysis : may be required for the treatment of either acute and chronic kidney disease, the use of continuous renal replacement therapies ( CRRT) and slow efficacy dialysis (SLED).

Advantages : control volume overload, in Hyperkalemia and in acidosis, in some toxic ingestion and complications of Uremia.

Disadvantages : late initiation of dialysis carries the risk of avoidable volume, electrolyte and metabolic complications of AKI,

- risks of Infections, bleeding , procedural complications and hypotension when expose to IV lines and invasive procedures.

Goals of Dialysis : The hemodialysis procedure is targeted at removing both low and high molecular weight solutes,

- the procedure consists of pumping heparinized blood through the dialyzer at a flow rate of 300-500ml /min, while dialysate flows in an opposite counter current direction at 500-800ml/min.

4. Dialysis can be performed by Peritoneal and hemodialysis which helps for the removal of waste products from the circulation. It is the still good practice but in developed countries also rarley do Peritoneal dialysis due to risk of abdominal infections for the treatment of acute renal failure and less efficient clearance per unit of time.

5. Transplantation of kidney is the last option for renal failure.