Topic: pyelonephritis, renal failure, nephrotic syndrome
Question: Discuss in short the aetiology, clinical features, investigations and management of chronic renal failure.
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Brief overview of chronic renal failure:
Aetiology:
– Diabetes mellitus
– Hypertension
– Glomerulonephritis
– Polycyctic kidney disease
– Urinary tract infections
– Vesicoureteral reflux
– Analgesic nephropathy
Clinical Features:
– Fatigue, lethargy
– Anorexia, nausea, vomiting
– Fluid overload – edema, pulmonary edema
– Hypertension
– Anemia
– Metabolic acidosis
– Uremic fetor in breath
– Uremic pericarditis, neuropathy, encephalopathy in advanced disease
Investigations:
– Blood urea and serum creatinine – elevated
– Glomerular filtration rate (GFR) – decreased
– Urinalysis – proteinuria, casts
– Ultrasound – small, contracted kidneys
– Kidney biopsy – to determine underlying pathology
Management:
– Treat underlying cause
– Control blood pressure
– Low protein diet
– Fluid, electrolyte and acid-base balance
– Anemia management with erythropoietin
– Dialysis – hemodialysis or peritoneal dialysis
– Renal transplantation in eligible patients
– Treatment of complications
The goal is to slow progression, manage complications, and replace kidney function via dialysis and transplantation when indicated.
