This is orientation program design for pharmacologist students.
Renal dialysis unit is care about end the stage kidney disease that required hemodialysis as favorite option of renal replacement therapy.
Hemodialysis is also indicated in:
- Acute renal failure, which can be reversable or irreversible become end stage kidney disease.
- https://kidneydiseaseclinic.net/blogs/landing.php?A=Diagnoses%20of%20irreversible%20renal%20disease.php to read more
- hyperkalemia, elevated potassium level in the blood causing cardiac arrhythmias
- acidosis usually metabolic with pH <7
- hypervolemia due to left sided heart failure with pulmonary edema
- Ingestions of dialyzable drug such as salicylates, lithium, isopropanol, methanol, and ethylene glycol
Definition end stage kidney disease is inability of the kidneys to perform their functions to sustain life.
By performing the urine, kidneys perform the fowling functions:
Remove excess water.
Remove toxic materials such as urea, creatinine and uric acid as end products of catabolism process.
Maintain acid base balance to keep blood pH in normal range about 7.35 by excreating hydrogen ion in the urine.
Maintain electrolyte balance especially sodium and potassium.
Git ride of chemical substances as drugs and ingested toxins
The kidney behaves as gland, which do the following functions:
Regulating blood pressure by hormone renin, which keeps blood pressure normal. If blood pressure falls, renin is secreted by the kidneys to constrict the small blood vessels, thereby increasing blood pressure. If the kidneys aren’t functioning correctly, too much renin can be produced, increasing blood pressure.
Activation of Vitamin D which is essential for the absorption of calcium by the intestine, the normal structure of bones and effective muscle function. In impaired kidney function, there is often a low blood calcium and an inadequate amount of Vitamin D, resulting in muscle weakness and a softening of the bones (osteomalacia or rickets).
Secretion of Erythropoeitin which is a hormone that acts on the bone marrow to increase the production of red blood cells.
Renal failure when it start, it not end, it is all life disease.
The aim of management of renal failure is to slow and prevent progression to terminal stage and manage its complications.
There is five stages for renal failure which end by completely renal failure. These stages depend on glomerular filtration rate (GFR). In the normal it is about 125 ml per min.
The five stages are:
- Stage 1 with normal or high GFR (GFR > 90 mL/min)
- Stage 2 Mild CKD (GFR = 60-89 mL/min)
- Stage 3A Moderate CKD (GFR = 45-59 mL/min)
- Stage 3B Moderate CKD (GFR = 30-44 mL/min)
- Stage 4 Severe CKD (GFR = 15-29 mL/min)
- Stage 5 End Stage CKD (GFR <15 mL/min)
Gfr calculation:
GFR=(140-age) *body weight/(72*serum creatinine mg/dl)
For females, it multiplies by 0.85 due to high fat percentage.
Read more about GFR https://kidneydiseaseclinic.net/gfrr/gfr%20des.php
Major sing of RF is foaming urine due high protein concentration, which called proteinuria
Read more about proteinuria https://kidneydiseaseclinic.net/gfrr/proteinuria.php
Major renal failure causes:
- Diabetes, read more about Diabetic nephropathy https://kidneydiseaseclinic.net/gfrr/diabetic%20nephropathy.php
- High blood pressure
- Glomerulonephritis
The above about 90% of all causes worldwide
Other causes include:
Alport syndrome
Polycystic