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General Summary

Renal Function

Kidney is located around vertebra L2.

Nephron: Glomerulus, proximal convulated tubule, Loop of Henle, distal convulated tubule, collecting duct.

Renal function

1. Conversion of calcidiol to calcitriol (vitamin D3). Raises blood concentration of calcium by promoting intestinal absorption and slightly inhibiting loss in urine. More calcium available for bone deposition.
2. Secretes renin, converting angiotensinogen to angiotensin 1. Angiotensin-converting enzyme on the lining of blood capillaries converts it to angiotensin 2. This hormone causes vasoconstriction.
3. Secretes 85% of the body’s erythropoietin. Promotes RBC production and increases oxygen carrying capacity of blood.
4. Filter blood plasma, separates and eliminates waste from the blood.
5. Regulate blood volume and pressure
6. Regulate osmolarity of body fluids
7. In extreme starvation, they carry out gluconeogenesis by deaminating amino acids and excreting the amino group as ammonia.

Investigations:

Types of tests and investigations:

1. Urine Test

2. Blood Test

3. Ultrasound

4. Angiography

Renal Failure:

Pathophysiology/Aetiology

Acute renal failure :
-Severe and prolonged circulatory shock or heart failure
*Burns
*Crush injuries
*Sepsis
-Nephrotoxins
-Glumerulonephritis
-Mechanical obstruction
*Calculi
*Blood clots
*Tumour

Chronic renal failure :
-Chronic Kidney Disease :
*Bilateral pyelonephritis
-Systemic disorder
*Hypertension
*Diabetes

Signs/Symptoms

Acute renal failure

• Bloody stools
• Breath odour
• Bruising easily
• Prolonged bleeding
• Changes in mental status or mood
• Decreased apetite
• Decreased sensation, especially in the hands or feet
• Fatigue
• Flank pain (between the ribs and hips)
• Hand tremor
• High blood pressure
• Metallic taste in mouth
• Nausea or vomiting, may last for days
• Persisent hiccups
• Nosebleeds
• Seizures
• Slow, sluggish movements
• Swelling-generalised 
• Swelling of the ankle, feet, and leg swelling
• Urination changes
• Shortness of breath

Chronic renal failure

Initial symptoms

• Fatigue
• Frequent hiccups
• General ill feeling
• Generalised itching
• Headache
• Nausea, vomiting
• Unintentional weight loss

Later symptoms

• Blood in the vomits or in stools
• Decreased alertness, including drowsiness, confusion, delirium, or coma
• Decreased sensation in the hands, feet, or other areas
• Easy bruising and bleeding
• Increased or decreased urine output
• Muscle twitching or cramps
• Seizures
• White crystals in and on the skin (uremic frost)

Additional symptoms

• Abnormally dark or light skin
• Agitation
• Breath odour
• Excessive nighttime urination (nocturia)
• Excessive thirst
• High blood pressure

Differential Diagnosis

• UTI
• Urinary Obstruction
• Urinary Incontinence
• Chronic Renal Failure
• Acute Renal Failure

Predisposing Factors/Risk Factors

Risk factors for developing acute Renal Failure

• Advanced age
• Chronic infection
• Diabetes
• High blood pressure
• Kidney diseases
• Liver diseases 
• Prostate gland enlargement
• Bladder outlet obstruction

Risk factors for developing chronic Renal Failure

• Diabetes
• High blood pressure 
• Sickle cell disease 
• Systemic Lupus erythematosus 
• Chronic glomerulonephritis 
• Kidney disease present at birth (congenital) 
• Bladder outlet obstruction 
• Overexposure to toxins and to some medications 
• Family history of kidney disease 
• Age 60 or older 

treatment and management

wk

Prevention

Fluid balances will be carefully monitored.

o    Your intake and output will be measured, and you may be weighed every day.

o    Your blood pressure will be checked frequently. You may be given IV fluids to help maintain normal blood pressure.

·         You will have frequent blood tests to make sure your electrolytes are in the proper balance.

·         Your diet will be managed to make sure that you receive at least 100 grams of carbohydrates each day. The amount of protein in your diet may be restricted.3

·         Your medicines will be carefully checked. Medicines that contain magnesium may be stopped. The dosages of your other medicines may be adjusted.

Sociological Access to Health Care

Barriers to Access for immigrants and migrants.
1. Structural access
 Universal i.e. made open & available to all(no discrimination)
 Financial i.e. affordable
 Geographical i.e. physically reachable
2. Socio-cultural access ie.“culturally acceptable” to patients
3. Factors affecting the presence of barriers:Legal or illgegal migrants,
origin of migrant, healthcare policies laws, type of foreigner (refugee,
migrant workers), aid of NGOs ie principle of goodwill, presence of
social activists and advocates.

Ethical Legal Issues of Organ Transplant
Donors
-Live Donors
~ consent
~ risks
~ organ tourism
- Cadaveric Donors
~Consent
~ Definition of death
Allocation of Organs
- in particular, kidneys in malaysia
~criteria

Kidney Transplant Compatibility

1. Blood type matching
2. Tissue Matching
3. Crossmatching