03.05.2016

1. 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 PA 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 TA N

2. DEFINITION OF CRF:
Chronic renal Failure (CRF) now called
Chronic Kidney Disease (CKD) is the
irreversible deterioration of renal function
OR when the GFR is reduced to
<60ml/min/1.73m2 for at least 3 or more
months it is called CKD or CRF.

3. CKD results from the loss of the following
Kidney functions:
• Excretory
• Regulatory
• Endocrine
• Metabolic

4. STAGES OF CKD:

5. ETIOLOGY OF CKD:

6. ETIOLOGY OF CKD:

8. PATHOPHYSIOLOGY OF CKD:
It circles on the following 2 conditions:
1. Hyperfiltration
2. Uremic syndrome

9. 1. Hyperfiltration
• Hyperfunction of the glomerules and
renal tubules.
• Enlargement of the glomerules and
renal tubules.
• Overload and hypertrophy of the
Nephrons
• Finally fibrosis and sclerosis of the
Nephrons.
All due to
DAMAGE
OF THE
RENAL
TISSUE

10. Hyperfitration

11. 2. Uremic Syndrome
• Accumulation of the Urea and Creatinine.
• Accumulation of other Hundreds of toxins other than
Urea and Creatinine.
• Abnormal regulation of Acid-Base balance.
• Decreased degradation, excretion and abnormal
regulation of many hormones includind PTH, FGF-23,
prolactin, steroid hormones, insulin and glucagon.
• Progressive systemic inflammation.

12. Clinical Features of CKD and Uremia
• In the early stages CKD is asymptomatic.
• Symptoms and Signs of Uremia are manifested with
GFR of less than 5-10ml/min/1.73m2.
• At this point, the build-up of metabolic waste products
or uremic toxins can result in uremic syndrome.

13. Clinical Features of CKD and Uremia