14
DISORDERS OF THE URINARY SYSTEM CHRONIC RENAL FAILURE DR. ASMATULLAH SAPAND AHMADSHAH ABDALI INSTUTUTE OF HIGHER EDUCATION DEPARTMENT OF INTERNAL MEDICINE KHOST - AFGHANISTAN 10.0 5. 2 01 6

Chronic renal failure lec 3

Embed Size (px)

Citation preview

Page 1: Chronic renal failure lec 3

DISORDERS OF THE

URINARY SYSTEM

CHRONIC R

ENAL

FAIL

URE

DR. ASMATULLAH SAPAND

A H M A D S H A H A B D A L I I N S T U T U T E O F H I G H E R E D U C AT I O N D E P A R T M E N T O F I N T E R N A L M E D I C I N E K H O S T - A F G H A N I S T A N

10 . 05 . 2 016

Page 2: Chronic renal failure lec 3

MANAGEMENT OF COMPLICATIONS

RENAL OSTEODYSTROPHY:• This is the term used for various forms of bone

disease that develop in chronic renal failure i.e. Osteomalacia, Osteoporosis, Secondary Hyperparathyroid Bone Disease And Osteosclerosis.

Page 3: Chronic renal failure lec 3

MANAGEMENT OF COMPLICATIONS

1. OSTEOMALACIA:• Deficiency of 1,25 dihydroxy

cholecalciferol(active-vit.D).• Low vitamin D results in decreased calcium

intestinal absorption(hypocalcemia).• Hypocalcemia results in reduction of osteoid

calcification and finally Osteomalacia.

Page 4: Chronic renal failure lec 3

MANAGEMENT OF COMPLICATIONS

2. HYPERPARATHYROID BONE DISIEASE:• Low serum calcium causes PTH secretion from

the parathyroid gland(secondary hyperparathyroidism)

• Resorption of calcium from bone.• Formation of cysts within the bone(osteitis

fibrosa cystica).

Page 5: Chronic renal failure lec 3

MANAGEMENT OF COMPLICATIONS

3. OSTEOPOROSIS: causes from malnutrition in chronic renal failure.

4. OSTEOSCLEROSIS: cause is unknown and occurs in sacrum, base of the scull and vertebrae.

Page 6: Chronic renal failure lec 3

MANAGEMENT OF COMPLICATIONS

5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:

• GFR below 25% of normal results in low phosphate excretion(hyperphosphatemia)

• Hyperphosphatemia results in hypocalcemia due to deposition of calcium phosphate in bone.

• Hypocalcemia results in secondary hyperparathyroidism and its consequences.

Page 7: Chronic renal failure lec 3

MANAGEMENT OF COMPLICATIONS

5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:

Clinical features:• Bone pain, proximal muscle weakness, fractures,

pruritus and extra-skeletal calcification. Treatment:• Treatment should be started early in the course of

progressive renal failure.

Page 8: Chronic renal failure lec 3

MANAGEMENT OF COMPLICATIONS

5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:

Goal of Treatment:1. To maintain serum calcium and phosphate.2. To prevent hyperparathyroidism.3. To prevent extra-skeletal calcification.4. To maintain normal bone histology.

Page 9: Chronic renal failure lec 3

MANAGEMENT OF COMPLICATIONS

5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:

Correction of Hyperphosphatemia and secondary hyperparathyriodism:

1. Dietary restriction of Phosphate2. Use of Phosphate binding agents

Page 10: Chronic renal failure lec 3

MANAGEMENT OF COMPLICATIONS

5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:

6. Dietary restriction of Phosphate:• Dietary restriction of phosphate is advised when

GFR falls below 50ml/min.• Goal is to maintain phosphorous level between

4-5mg/dl.

Page 11: Chronic renal failure lec 3

MANAGEMENT OF COMPLICATIONS

5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:

6. Use of Phosphate binding agents:• Calcium carbonate 500mg-2g orally with meal.• If phosphorous level cannot be maintained between

4-5mg/dl or the initial phosphorous level is >7mg/dl then Aluminium hydroxide 15-30ml is used with meals.

Page 12: Chronic renal failure lec 3

MANAGEMENT OF COMPLICATIONS

5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:

Treatment of hypocalcemia:• If hypocalcemia persists after phosphate has been

controlled, Vit.D3 may be added.• Alfacalcidol 0.25mcg/day.• Note: vitamin D increases gut phosphorous absorption

and may therefore exacerbate hyperphosphatemia.

Page 13: Chronic renal failure lec 3

MANAGEMENT OF COMPLICATIONS

5. CALCIUM, PHOSPHATE AND BONE ABNORMALITIES:

Indications of parathyroidectomy:• Calciphylaxis.• Severe hypercalcemia.• High PTH level.

Page 14: Chronic renal failure lec 3

THANK YOU