Renal failure

Renal failure

Failure of the excretory function of the kidneys.

Acute Renal Failure (ARF):
Sudden decrease in renal function (usually a few hours to a few days) – usually reversible. Occurs in about 5% of hospitalised patients

Aetiology:
• pre-renal (eg heart failure, shock, renal artery occlusion)
• intrinsic renal disease (eg acute tubular necrosis, septic renal failure, glomerular disease, interstitial disease)
• post-renal (eg stones, tumour)

Clinical features:
Vague and non-specific; signs of cause will be present; increased urine output

Management:
Urgent correction of fluid and electrolyte balance (especially hyperkalaemia)
Loop diuretics increase renal blood flow
Treatment of cause

Chronic Renal Failure (CRF):
Gradual decrease in renal function – usually irreversible. There is normally a 1% annual decline in renal function naturally from age 40.

Aetiology:
Due to any condition that affects the structure and function of the kidney.
• Hypertension, diabetes mellitus, glomerulonephritis, renal artery stenosis, interstitial disease, systemic lupus erythematosus, polycystic kidneys

Clinical features:
Initially only as biochemical abnormality.
Early – hypertension, proteinuria, nephrotic syndrome, haematuria, recurrent nephritic syndrome
Later – oedema, nausea, lethargy, pruritis, nocturia, anorexia, anaemia, electrolyte imbalances (especially hyperkalaemia), hypertension, renal osteodystrophy, peripheral neuropathy, pigmentation of nails. Progresses to confusion and coma

Involvement of foot:
Nail changes – Muehrcke nails (transverse white bands) and half-and-half nails (proximal half of nail is white).
14% develop keratotic pits of palms and soles
Higher prevalence of onychomycosis and tinea pedis
Peripheral oedema
Peripheral neuropathy

Management:
Treatment of underlying disease; prevention of further deterioration of renal function;
Dialysis
Transplant
Pharmacological

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