End Stage Renal Failure
End Stage Renal Failure is the failure of kidney to function properly. Renal failure has two types. These are acute and chronic renal failure.
Acute renal failure (ARF) is sudden-onset renal failure with failure of excretion of the products of nitrogen metabolism, water, electrolytes and failure to maintain osmotic and acid-base balance. These changes are the result of acute severe impairment of renal blood flow, GFR and tubular re-absorption, usually all occurring at the same time.
Acute renal failure occurs when both kidneys suddenly stop working.
Chronic renal failure/ Chronic kidney disease (CKD) occurs when renal failure damage persist and kidneys are permanently damaged. It is most of the times the acute renal failure which fails to recover and then progresses to the chronic renal failure.
Acute renal failure may occur for various reasons, including structural diseases of kidney, partial or complete blockage of the urinary tract and the reduction of blood volume, for example, after a severe blood loss. Symptoms may develop over several days: urine output may decrease sharply, and the fluid to be excreted is stored entirely in the tissues resulting in edema and weight gain, particularly in the dependent areas e.g. legs.
Causes of acute renal failure are divided into three groups.
– Pre-renal Acute Renal Failure (ischemic)
• Kidney shock (trauma, loss of fluid, solid tissue decay, hemolysis, septic shock, cardiogenic shock).
• Loss of extracellular volume (gastric or urinary loss of fluid, burns).
• Loss of intravascular volume or re-distribution (sepsis, bleeding, hypo-albuminemia).
• Decreased cardiac output (heart failure , cardiac tamponade, cardiac surgery).
• Other causes of decreased GFR (hypercalcaemia, hepatorenal syndrome).
– Renal Acute Renal Failure.
• Exogenous intoxication (kidney damage by poisons used in industry and everyday life, bites of poisonous snakes and insects, intoxication with drugs and radio-opaque substance).
• Acute infectious renal intoxication due to indirect and/or direct effects on the kidneys
• Renal vascular lesions (hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, scleroderma, systemic necrotizing vasculitis, thrombosis of arteries or veins, atherosclerotic emboli in severely atherosclerotic main vessels – especially the aorta and renal arteries).
• Open and closed kidney trauma.
• Post-ischemic acute renal failure.
– Post-renal Acute Renal Failure.
• Extra-renal obstruction in urinary tract (obstruction of the urethra, bladder tumor, prostatic cancer , pelvic masses, blockade in ureter due to stone, pus, blood clots etc. Kidney stones, tubular blockade by urate in the natural course of leukemia, myeloma, gouty nephropathy, treatment with sulfonamides, ligation of the ureter during surgery)