Transcript Chronic renal failure - Department of Pathological Physiology

Chronic renal failure
and common accompanying diseases
Hradec Králové, November 2007
© by Adrian Franke
Etiology
• can be found in every age
 highly depending on educational, social
and hence nutritional status
• is either acquired or inherited
• occurs with higher probabilities in certain
diseases (e.g. diabetes mellitus,
arteriosclerosis, arterial hypertonia, viral
diseases)
• occurs with higher probabilities in older
people
Definition
•
1.
2.
3.
4.
we speak of a chronic kidney disease, if
there is either:
proteinuria or microalbuminuria
or a kidney function of less than 60% of
normal
or a pathological alteration of the kidneys
and if this situation if present for more
than 3 months
Measurement of kidney function
• achieved by measurement of creatinin
(metabolic waste product)
concentration in the blood
(physiological: 50 – 120 µmol/L)
creatinin
• estimation of glomerular filtration rate (GFR) by
usage of a formula
 creatinin clearance (= rate of expulsion from the body)
creatinin clearance =
concentration of creatinin in the urine * volume of urine
concentration of creatinin in the plasma * time
5 stadia after KDOQI
= renal disease outcomes quality initiative
• based on the ultra-filtration rate of the glomeruli
in the kidney
Stadium
GFR
with proteinuria
without proteinuria
1
> 89
renal disease with normal function
normal finding
2
60 – 89
renal disease with mild renal
insufficiency
mild renal insufficiency, but no
renal disease
3
30 – 59
renal disease with moderate renal insufficiency
4
15 – 29
renal disease with heavy renal insufficiency
5
< 15
chronic renal failure
http://www.unckidneycenter.org/kcpp/index.htm
Role of the kidney
 removal of metabolic waste products
• water balance
• electrolyte balance
• acid-base balance
• removal of medications and toxic substances
• release of hormones:
– renin (blood pressure)
– erythropoietin (eryhtropoiesis)
– Vitamin D3 (metabolism of the bones)
diseases occurring with renal
insufficiency

diseases leading to renal
insufficiency
Percentual distribution of diagnoses at the
beginning of renal substitution therapy
Year
1996
1997
1999
2000
2001
2002
2003
2004
2005
diabetes mellitus II
24
29
30
31
32
32
33
31
32
nephrosklerosis
14
16
16
15
17
18
20
22
23
glomerulonephritis
16
15
14
15
14
14
14
12
13
interstitial nephritis
13
11
11
10
9
9
8
8
8
unknown genesis
11
9
10
9
10
9
9
9
8
cystic kidneys
6
6
6
6
6
5
5
5
4
systemic diseases
4
4
4
4
3
4
4
4
4
various
4
4
3
4
4
4
4
4
4
diabetes mellitus I
7
6
6
5
4
4
3
3
3
congenital diseases
1
1
1
1
1
1
1
1
1
1996
7%
1%
4%
24%
4%
6%
11%
14%
13%
16%
diabetes mellitus II
nephrosclerosis
glomerulonephritis
interstitial nephritis
unknown genesis
diabetes mellitus I
cystic kidneys
congenital disease
systemic disease
various
2005
4%
3% 1%
4%
4%
32%
8%
8%
13%
23%
terminal renal insufficiency &
treatment possibilities
1. hemodialysis
2. peritoneal dialysis
3. transplantation
1. hemodialysis
2. peritoneal dialysis
 cannot be applied indefinitely due to sclerosis of the endothelium
3. transplantation
prevention of renal insufficiency
• healthy nutrition in combination with
exercise
• balanced blood pressure
• balanced diabetes (treatment with insulin)
• sufficient water intake (approx. 2L of water
a day)
 in all cases prevention is the better way to
go for rather than acute treatment
economical aspects of renal
insufficiency
• 60.000 people in Germany need to go to dialysis
(94% hemodialysis, 6% peritoneal dialysis)
• treatment of a patient costs cca 50.000 –
60.000€ per year
• a transplantation surgery costs cca. 30.000€ and
the costs for sustaining the transplant within the
patient cca. 20.000 – 25.000€ a year
•  costs of transplant would already be
amortized after one year
• waiting list: 12.000 – 15.000 patients
•  3.000 patients are receiving a draft organ
sneak peek into the future
• health prevention subject at school
• optimization of dialysis treatment
– reusage of dialysators
– more adequate solutions for peritoneal dialysis
• optimization of transplantation
–
–
–
–
living donation
optimization of legitimate principles
xenotransplantation
artificial organs produced by monoclonal stem cells
Sources
• http://de.wikipedia.org
• http://www.fresenius.de
• http://www.unckidneycenter.org/kcpp/inde
x.htm
• http://www.nephrologe.de/patient/erkranku
ngen/nierenversagen/chr_nierenvers1.htm