Chronic renal failureand 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

• we speak of a chronic kidney disease, if there is either:

1. proteinuria or microalbuminuria

2. or a kidney function of less than 60% of normal

3. or a pathological alteration of the kidneys

4. 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)

• 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

creatinin

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 – 89renal disease with mild renal

insufficiencymild 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

24%

14%

16%

13%

11%

6%

4%

4%

7% 1%

2005

32%

23%

13%

8%

8%

4%

4%4%

3% 1%

diabetes mellitus II nephrosclerosis glomerulonephritis interstitial nephritis

unknown genesis cystic kidneys systemic disease various

diabetes mellitus I congenital disease

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/index.htm

• http://www.nephrologe.de/patient/erkrankungen/nierenversagen/chr_nierenvers1.htm