RCS 6080 Medical and Psychosocial Aspects of Rehabilitation CounselingFunction of KidneysDefinitionsNephronsRenal FailureChronic Renal FailureSlide 7Stages of Chronic Renal FailureDiabetic NephropathyTreatment for Diabetic NephropathyMetabolic changesUremic SyndromeAssociated problems with CFRSlide 14Treatment of Chronic Renal FailureSlide 16Treatment of End Stage Renal FailureHemodialysisSlide 19Slide 20Treatment of End Stage Renal DiseaseSlide 22Additional Resources and Information from the WebRCS 6080 Medical and Psychosocial Aspects of Rehabilitation CounselingRenal FailureRenal FailureFunction of KidneysRemove toxic waste productsRemove toxic waste productsRemove excess water and saltsRemove excess water and saltsPlay a part in controlling blood pressurePlay a part in controlling blood pressureProduce erythropoetin (epo) which Produce erythropoetin (epo) which stimulates red cell productionstimulates red cell productionHelps to keep calcium and phosphate in Helps to keep calcium and phosphate in balance for healthy bonesbalance for healthy bonesMaintains proper pH for the bloodMaintains proper pH for the bloodDefinitionsAzotemia: Elevated blood urea nitrogenAzotemia: Elevated blood urea nitrogen(BUN>28mg/dL) & Creatinine (Cr>1.5mg/dL)(BUN>28mg/dL) & Creatinine (Cr>1.5mg/dL)Uremia: azotemia with symptoms or signs of renal failureUremia: azotemia with symptoms or signs of renal failureEnd Stage Renal Disease (ESRD): uremia requiring End Stage Renal Disease (ESRD): uremia requiring transplantation or dialysistransplantation or dialysisChronic Renal Failure (CRF): irreversible kidney Chronic Renal Failure (CRF): irreversible kidney dysfunction with azotemia >3 mos.dysfunction with azotemia >3 mos.Creatinine Clearance (CCr): rate of filtration of creatinine by Creatinine Clearance (CCr): rate of filtration of creatinine by the kidney (marker for GFR)the kidney (marker for GFR)Glomerular Filtration Rate (GFR): the total rate of filtration Glomerular Filtration Rate (GFR): the total rate of filtration of blood by the kidney.of blood by the kidney.NephronsNephrons are the units in the kidney that transfer Nephrons are the units in the kidney that transfer waste products from the blood to urine.waste products from the blood to urine.A human kidney has approximately one million A human kidney has approximately one million nephrons.nephrons.Glomeruli are the filtration units of the nephron. Glomeruli are the filtration units of the nephron. The Glomerulus (first structure of the nephron) is a tuft of capillaries. Blood enters the glomerulus by the afferent arteriole and exits by the efferent arteriole Bowman’s capsule is a tough layer of epithelial Bowman’s capsule is a tough layer of epithelial cells that surrounds the glomerulus ;there is a cells that surrounds the glomerulus ;there is a small holding area for the initial filtrate in small holding area for the initial filtrate in between the capillary walls of the glomerulus between the capillary walls of the glomerulus and the inner layer of Bowman’s capsule; this and the inner layer of Bowman’s capsule; this area is called Bowman’s space. Fluid and solutes area is called Bowman’s space. Fluid and solutes filtered by the glomerulus collect in this space. filtered by the glomerulus collect in this space. The space connects to the proximal convoluted The space connects to the proximal convoluted tubule, which is the first section of the nephron’s tubule, which is the first section of the nephron’s tube system tube system a network of tubules extends from Bowman’s a network of tubules extends from Bowman’s capsule: capsule: proximal convoluted tubule (PCT)proximal convoluted tubule (PCT)Loop of Henle—has a descending and Loop of Henle—has a descending and ascending limb ascending limb distal convoluted tubuledistal convoluted tubuleCollecting ductCollecting ductRenal FailureAcute Renal FailureAcute Renal FailurePrerenal azotemiaPrerenal azotemiaAn abnormally high level of An abnormally high level of nitrogen-type wastes in the nitrogen-type wastes in the bloodstream. It is caused by bloodstream. It is caused by conditions that reduce blood conditions that reduce blood flow to the kidneys.flow to the kidneys.Postrenal azotemiaPostrenal azotemiaAn obstruction of some kind An obstruction of some kind (i.e., bladder cancer, uric acid (i.e., bladder cancer, uric acid crystals, urethral stricture etc)crystals, urethral stricture etc)Intrinsic Renal DiseaseIntrinsic Renal DiseaseUsually glomerular diseaseUsually glomerular diseaseUsually leads to End Stage Usually leads to End Stage Renal DiseaseRenal DiseaseChronic Renal FailureDiabetic NephropathyDiabetic Nephropathy50K cases of DN ESRD annually50K cases of DN ESRD annuallyDiabetes most common contributor to ESRDDiabetes most common contributor to ESRD>30% of ESRD cases attributed to Diabetes>30% of ESRD cases attributed to DiabetesHypertensionHypertensionCFR with Hypertension causes 23% of ESRD annuallyCFR with Hypertension causes 23% of ESRD annuallyGlomerulonephretis: 10%Glomerulonephretis: 10%Polycystic Kidney Disease: 5%Polycystic Kidney Disease: 5%Rapidly progressive glomerulonephrities (vasculitis): 2%Rapidly progressive glomerulonephrities (vasculitis): 2%Renal Vascular Disease (i.e., renal artery stenosis)Renal Vascular Disease (i.e., renal artery stenosis)MedicationsMedicationsAnalgesic Nephropathy (progression after many years)Analgesic Nephropathy (progression after many years)Pregnancy: high incidence of increased creatitine and HTN during pregnancy Pregnancy: high incidence of increased creatitine and HTN during pregnancy associated with CRFassociated with CRFChronic Renal FailureCRF is defined as a permanent reduction in glomerular filtration rate (GFR) sufficient to produce detectable alterations in well-being and organ function. This usually occurs at GFR below 25 ml/min. About 100 to 150 per million persons in the U.S. About 100 to 150 per million persons in the U.S. develop CRF annually develop CRF annually Average annual cost is $25,000 – 35,000 per Average annual cost is $25,000 – 35,000 per patient per year patient per yearStages of Chronic Renal Failure1.1.Silent – GFR up to 50 ml/min.Silent – GFR up to 50 ml/min.2.2.Renal insufficiency – GFR 25 to 50 Renal insufficiency – GFR 25 to 50