1. Conservative therapy for chronic renal failure involves dietary modifications like restricting protein intake to manage symptoms and prevent further deterioration. 2. Renal replacement therapy includes hemodialysis, which involves pumping blood through a dialyzer to remove waste, and peritoneal dialysis, which uses the peritoneal membrane for diffusion. 3. The document discusses in detail the various treatment options for managing chronic renal failure from conservative management to renal replacement therapies like hemodialysis and peritoneal dialysis.

1. MANAGEMENT OF
CHRONIC RENAL FAILURE
1.Conservative therapy
2.Renal replacement therapy

2. 1.CONSERVATIVE THERAPY
Dietary
Modifications
Elimination of symptoms and prevention of further
1. Aim deterioration
2.Initiated When patient becomes azotemic
Manage diet,fluid,electrolytes and calcium phosphate
3.What we do? balance

3. (A)DIETARY MODIFICATIONS
Includes
1.Dietary regulation of protein 2.Nutritional supplements,if
(20 -40 g/day) needed
(a)Improves acidosis,azotemia and (a)Multivitamin supplements
nausea (b) Patients with early renal
(b)Reduces the excretory load of insufficiency,supplement diet with
the kidney & CaCO3 along with limited intake of
Thereby intraglomerular pressure phosphate containing foods
and secondary injury to nephrons

4. Take Care of “BEANS”
(Practical clinical approach to the management of patients with chronic
renal failure)
1. Blood pressure should be maintained in a target range lower than
130/80 mm Hg
2.Haemoglobin levels should be maintained at 10-12 g/dL
3.Hyperlipidemia should be treated with a “statin” lipid lowering
medication
4.Smoking cessation should also be encouraged

5. (B) DIALYSIS (DIA-THROUGH , LYSIS –LOOSENING)
Serum creatinine> 4.0g/dL
*When the access should be
created??? GFR falls to <20 mL/min
*Close monitoring of nutritional status is
important

6. INDICATIONS:
The decision to initiate dialysis renal failure depends on several
factors. divided into acute or chronic indications.
in the patient with acute kidney injury -vowel acronym of
"AEIOU":
1.Acidemia from metabolic acidosis
2.Electrolyte abnormality, such as severe hyperkalemia,
3.Intoxication, that is, acute poisoning with a dialyzable substance.
4.Overload of fluid
5.Uremia complications, such as pericarditis, encephalopathy,
or gastrointestinal bleeding.
Chronic indications for dialysis:
1.Symptomatic renal failure
2.Low glomerular filtration rate (GFR) In diabetics, dialysis is
started earlier <15cc/min
3.Difficulty in medically controlling fluid overload, serum
potassium, and/or serum phosphorus when the GFR is very low

7. (a)Haemodialysis
Dialysis
(b)Peritoneal dialysis
(a)Haemodialysis is the removal of
nitrogenous and toxic products of
metabolism from the blood by means of a
haemodialyzer system
#Exchange occurs between the patient’s
plasma and dialysate (electrolyte
composition of which mimics that of
extracellular fluid) across a semi permeable
membrane that allows uremic toxins to
diffuse out of the plasma while retaining
the formed components and protein
composition of blood
NOT provides the same degree of health as renal function provides because
there is no resorptive capability in the dialysis membrane.

8. COMPONENTS of dialysis unit
1.Dialyzer
2.Dialysate production unit
3.Roller blood pump
4.Heparin infusion pump
5.Devices to monitor the
conductivity,temperature,flow rate and
pressure of dialysate

9. The frequency and duration of dialysis treatment are related to
1. Body size
2. residual renal function
3.Protein intake
4.Tolerance to fluid removal
#The typical patient undergoes
haemodialysis 3 times/week with each
treatment lasting approximately 3-4 hours
on standard dialysis units and slightly less
time on high efficiency/high flux dialysis
units
NEWER FORMS :Nocturnal and daily
dialysis with improved control of
1.Biochemical abnormalities
2.Blood pressure and volume status

11. 1. In hemodialysis, the patient's blood is pumped through the blood
compartment of a dialyzer, exposing it to a partially permeable membrane.
2.Blood flows through the fibers, dialysis solution flows around the outside
of the fibers, and water and wastes move between these two solutions.
3.The cleansed blood is then returned via the circuit back to the body.
***. Ultrafiltration occurs by increasing the hydrostatic pressure across the
dialyzer membrane.
This usually is done by applying a negative pressure to the dialysate
compartment of the dialyzer
.
4.This pressure gradient causes water and dissolved solutes to move from
blood to dialysate, and allows the removal of several liters of excess fluid
during a typical 3- to 5-hour treatment

12. Types of vascular access foe maintenance
haemodialysis
**Classic construction is side to side
anastomosis b/w the radial artery and
cephalic vein at the forearm
1.Primary arteriovenous(AV)
fistula/shunt/external cannula system:
Preferred for long term treatment.
2. Synthetic AV graft: Fistulae are created by
means of autografts,PTFE grafts ,Dacron etc.
A fistula is an enlarged vein (usually in your
arm), created by connecting an artery directly
to a vein.
3.Double lumen
4.Cuffed tunneled catheters: indwelling
central venous catheters used

13. (B) Peritoneal dialysis(accounts for10% of dialysis t/t)
1. access is achieved via a catheter through the
abdominal wall into the peritoneum
2. 1-2 liters of dialysate is placed in the peritoneal
cavity and is allowed to remain for varying intervals
of time
3. Substances diffuse across the semipermeable
peritoneal membrane to dialysate
4. #Tenckhoff Silastic catheter has made peritoneal
puncture for each dialysis unnecessary
**little baby who needed dialysis. You can see
his Tenckhoff Catheter coming out of his
tummy. This type of catheter is used for
peritoneal dialysis.
#

14. Hookup Infusion Diffusion Diffusion Drainage
(fresh) (waste)

15. Various Regimens for peritoneal dialysis:
1.Chronic ambulatory patients..:2 L of
dialysis fluid instilled in the peritoneal cavity,
allowed to remain for 30 mins and drained out
2.Continuous cyclic peritoneal dialysis,in
which 2-3 L of dialysate is exchanged every
hour over a 6-8 hour period overnight,7days
/week
*** as it allows (a)great deal of personal freedom
(b)No risk of air embolism and blood leaks
(c) Hepariniztion unnecessary
SO used as PRIMARY therapy/as a TEMPORARY MEASURE

16. 2.RENAL TRANSPLANTATION
Treatment of choice for patients with
irreversible kidney failure
However the use of transplantation is
limited by organ availability
INDICATIONS:1. ESRD
2. Glomerulonephritis
3.Pyelonephritis
4.Congenital abnormalities
5.Nephrotic syndrome

17. Other Approaches:
1.Hemofilteration
a) based on the principle of convection and physiologic function of glomerulus
b) Standard dialysis technique is modified prediluting the blood with an electrolyte
sol’n and ‘ultrafiltering’ it under high hydraulic pressure
2.Adjunctive techniques used with
maintenance dialysis include the use of
ABSORBENT materials for solute removal
The Recirculating DialYsis System( REDY
2000, REDY Sorbent system)
Differs from regular single- pass dialysis in
that after passing through dialyzer, the REDY
dialysate fluid is regenerated, rather than
discarded, by passing through a sorbent
cartridge.