hello in this video we're going to talk about chronic kidney failure it can also be referred to as chronic kidney disease but failure I guess is the end stage and chronic kidney failure is essentially where you have loss an irreversible loss of the nephrons and the nephrons are the functional units of your kidneys and this can result in a state a toxic State uh such as ureia and we'll learn about that in this video so here uh before we go into chronic kidney failure let's just recap the anatomy slightly so here I'm drawing the kidneys the kidneys connects the urer to the bladder bladder stores urine ready for um mation and here we have the inferior VAB in the descending aota which has vessels coming in and out from the kidneys okay so there are many causes of chronic kidney failure and these include acute kidney injury or acute kidney failure hypertension diabetes and other kidney diseases other kidney diseases includes polycystic kidney disease so all of this can lead to an irreversible loss of nefron which is chronic kidney failure or disease so let us look at each of these causes of chronic kidney failure in a bit more detail let's begin by looking at acute um kidney failure or acute renal failure it's same thing so acute kidney failure can lead to you know chronic kidney failure acute kidney failure um unlike chronic kidney failure is reversible and there are many causes of acute renal failure in itself one way to categorize it is into um pre-renal causes intrarenal causes and postrenal causes so uh pre-renal cause includes renal artery stenosis heart failure and Hemorrhage all which leads to acute kidney failure and then you have intrarenal causes such as glomo nephritis tubular necrosis and interstial nefritis all this can also lead to acute kidney failure then you have post renal causes such as benign prosthetic hyperplasia renal stones and tumors it is also important to note that pre-renal causes and post-renal causes often lead to intrarenal um causes essentially and this will all lead to acute kidney failure acute renal failure so that was you know acute renal failure and some causes again acute renal failure can lead to chronic kidney failure next let us talk about hypertension and how this can cause chronic kid KY failure in order to do so let us draw this kidney here which has a renal artery and a renal vein leaving the kidney the function the functional unit of the kidney which actually filters you know our blood to form urine are the nephrons and here I'm drawing one nefron the head of the nefron is the Bowman's capsule and it has capillaries entering and exiting this is where blood you know is getting filtered through to the nefron now when there's normal blood pressure everything is smooth and everything is filtered so let us see what happens in hypertension let us zoom into this area here the head of the nefron and um you know this is the Bowman capsule area so blood vessels will enter this area these blood vessels originate you know from the renal artery so here I am drawing part of the renal artery which enters the kidney when someone has hypertension it causes thickening of the blood vessels which leads to narrowing of the Lumen because we have narrowing of the Lumen there is less blood flow to the kidneys to the nephrons the afren arterial is a blood vessel which brings blood towards the head of the nefron but with less blood flowing through due to hypertension there there is a decrease in filtration thus a decrease in the glomerular filtration rate so the point is when you have a decrease in blood flow to the nefron there are cells in this area that detect this and then start producing renin which subsequently leads to the activation of the renin Angiotensin aldosterone system or Ras for short now the RAS uh system is a system which leads to increase in hot rate and further hypertension this is unfortunate because less blood is Flowing to the kidneys the kidney thinks by increasing blood pressure it will receive more blood it might work for some time but eventually the cycle will continue There is further vessel thickening and vessel narrowing so it's a vicious cycle now this all eventually will lead to glomerulosclerosis which is thickening and hardening of the vessels in the Bowman's capsule um in the glomerulus itself glomerulosclerosis inevitably leads to es schic injury and so loss of the nefron itself next let us look at the most common cause of chronic kidney failure which is diabetes a massive complication in diabetes is diabetic nephropathy now diabetic nephropathy y eventually will lead to chronic kidney failure to learn about diabetic nephropathy let us cut a section of the bman capsule and the glomerulus and see what changes occur the four main changes we see in diabetic nephropathy are mangial expansion and proliferation we see pyop cytopathy which includes poite hypertrophy and eventually atrophy we see glome glomular basement membrane thickening and sclerosis um and sclerosis is essentially what we see in hypertension as well so how do all these changes occur well people develop diabetes because of risk factors which include hypertension diabetes is a condition where you have high blood glucose high blood glucose leads to over production of um reactive oxygen species now these reactive oxygen species or Ross leads to a Cascade of events but in summary um this will lead to activation and production of unnecessary growth factors pro-inflammatory cyto kindes and ox and producing essentially oxidative stress all this leads to the four diabetic uh nephropathy changes we just uh we just talked about so going back to where we initially started uh chronic kidney failure again is where you have irreversible loss of nephrons and this can be uh caused as we have learned um by acute uh renal failure or acute kidney failure hypertension diabetes and other kidney diseases such as polycystic kidney disease so when you have loss of nephrons in in the area the blood the blood flow will shift to nephrons that are still alive and working this leads to glomerular hyper hyper filtration so let me draw it out for example here is a you know here's a dead nefron essentially loss of nefron and here is a functional nefron the blood flow will shift to the functional nefron leading to glomerular hyperfiltration there'll be more blood flow now during the early stages glomerular hyperfiltration is tolerated we get a big increase in GFR in the functional nefron after a while this hyperfiltration results in sclerosis because there's so much pressure and eventually sclerosis glome sclerosis will eventually lead to loss of that nephron as well and the cycle will continue in the late stage you lose so much of your uh kidney's function that you that your GFR decreases your urine output decreases and you begin to retain waste resulting in ureia all this leads to the clinical manifestations of chronic kidney failure and this will bring us to the next topic which is the clinical presentation or clinical manifestation of chronic kidney failure so here in this part we will talk about um disruption that occurs uh with sodium and water balance disruption that occurs with potassium balance we talk about metabolic acidosis mineral balance and Osteo distrophy and other manifestations of ureia so let's begin by looking at sodium and water balance a DE inrease in GFR leads to increase in sodium and water retention which leads to an increase in blood pressure and peripheral edema it is important to restrict fluid intake for for for these patients and when vomiting and diarrhea occurs uh in patients with chronic kidney failure this is very dangerous because of the already restricted fluid intake further loss from vomiting and diarrhea can be very very uh dangerous next potassium balance so again a decrease in GFR leads to an increase in potassium retention this causes hyper calmia which can result in muscle weakness it can result in ECG changes and cause fibrillations it is important to note that the loss of nephrons leads to a decrease in renin production as well eventually which leads to a decrease in aldosterone when you have a decrease in aldosterone the distal sodium potassium pump does not work um which leads to pottassium retention therefore using pottassium sparing diuretics and ACE inhibitors can further aggravate the problem because you are essentially you're promoting more potassium and remember if I draw it in this uh nefron the sodium potassium pump the sodium pottassium atpa is at the distal part of the nefron and is responsible for the exchange between sodium and potassium so if aldosterone is not being produced this uh transporter does not work and so we are retaining pottassium metabolic acidosis now metabolic acidosis we get diminished capacity you know in chronic kidney failure to excrete hydrogen and to generate bicarbonate which leads to the acidosis acidosis can lead to Bone decalcification amongst many other things so normally the nefron is responsible for maintaining the P pH of our body the blood by it does this by producing bicarbonate if necessary um or to secrete hydrogen ions if necessary next let's talk about mineral and osteodystrophy now when you have loss of nephrons the kidneys cannot produce the hormone it normally produces which is calcitriol now with no calcitriol you have a decrease in calcium reabsorption from the git and the kidneys and this will lead to hypocalcemia h hypocalcemia and a decrease in Cal triol will stimulate the parathyroid glands always continuously and this will lead to secondary hyper parathyroidism the hyperparathyroidism State leads to osteodystrophy because of the hormone par parathyroid hormone which actually stimulates bone breakdown and um yeah bone breakdown essentially the loss of nephrons eventually also lead to a decrease in GFR and so you know when you have a decrease in GFR you have a decrease in filtration and so this will lead to hyperphosphatemia because the body cannot secrete phosphate um yeah now let's talk about ureia which is essentially a lot of UA in the blood UA is normally excreted by the kidneys in urine let's see what normally happens to Ura so the vasar recta are the blood vessels responsible for secretion of substances substances into the nefron and the reabsorption of substances from the nefron in the last part of the nefron the Ura is actually reabsorbed into the vasera which helps drag water into these vessels Ura then gets secreted back into the nefron because we don't want to keep it and the water just remains water remains in the vessels because here the sodium is also reabsorbed allowing for um you know equilibrium and so if this whole process does not work if the kidneys don't work at all you actually retain UA and so you you get ureia and ureia is bad because it results in neurological signs and symptoms such as hiccups cramps gastro problems anorexia and vomiting reproductive changes including decrease in estrogen and testosterone resulting in Amara and and impotence and this ureia also results in some skin changes and um so that was most of the clinical manifestations in chronic kidney failure finally as we have mentioned briefly in late chronic kidney failure or chronic kid disease when a lot of nephrons are lost this will eventually result in a decrease in renin production resulting in a decrease in blood pressure a decrease in erythropoetin which results in anemia and also as I mentioned earlier a decrease in the production of the hormone calcor trial which causes renal osteodystrophy um as I mentioned earlier so I hope you enjoy this video we essentially talked about chronic kidney failure some of the causes and some of the clinical manifestations um that results thank you for watching