pathophysiological changes in ckd patients for anaesthetic concern

DR SHOWKET AHMAD DAR

PATHOPHYSIOLOGICAL CHANGES IN CRF PATIENTS FOR RENAL

TRANSPLANTATION


HISTORY

• Dr. Joseph Murray in 1954.

• Noble price in Medicine in 1990.

• India started its kidney transplant program in 1970.

• In 1994 Indian Parliament passed the transplantation of human organ act (THO).


CRD

• When GFR is less than 60 ml / mint / 1.73 m2

for more than 3 months---CRD


INDICATIONS FOR RENAL TRANSPLANTATION

• ESRD caused by

-D.M (40%)

-Hypertension

-glomerular disease

-PCKD

-Tubulointerstitial disease

-other familial and congenital diseases.


PATHOPHSIOLOGICAL CHANGES ---ANAESTHESIOLOGIST


CONTI

CARDIOVASCULAR SYSTEM

SYSTEMIC HYPERTENSION•SODIUM AND WATER RETENSION•ALTERED RENIN-ANGIOTENSIN SECREATION

CHF•PRIMARY: UREMIC CARDIOMYOPATHY•SECONDARY: FLUID OVERLOAD

CAD• ACELERATED ATHEROSCLEROSIS

UREMIC PERICARDITIS

CARDIAC TEMPONADE

CARDIAC DYSARRYTEMIAS•HYPERKALEMIA•HYPOCALCEMIA


CONTI

PULMONARY ABNORMALITIES

PULMONARY EDEMA, PLEURAL EFFUSION, ATELECTASIS AND INFECTION

•FLUID OVERLOAD

•MALNUTRITION

•ANEMIA

•IMPAIRED HUMORAL AND CELLULAR IMMUNITY

•DECREASED SURFACTANT


CONTI

OXYGEN CARRYING CAPACITY

•RIGHT WARD SHIFT OF OXYGEN DISSOCIATION CURVE

•INCREASED CARDIAC OUT PUT

•DECREASED BLOOD VISCOSITY


FLUID AND ELECTROLYTE IMBALANCE

HYPERVOLUMIA•CHF•PULMONARY EDEMA•PLEURAL EFFUSION•HYPERTENSION

HYPERKALEMIA•CARDIAC DYSARRHYMIAS

HYPOCALCEMIA•OSTEODYSTROPHIC ABNORMALITIES•OSTEOPOROSIS•PATHOLOGICAL BONE FRACTURE

HYPERMAGNESEMIA•HYPOTENSION•POTENTIATION OF NON DEPOLARIZING MUSCLE RELAXANTS•COMA

CONTI


CONTI

HEMATOLOGICAL ABNORMALITIES

ANEMIA

DECREASED ERYTHOPOITIN PRODUCTION

REDUCED LIFE SPAN•NORMO CHROMIC NORMOCYTIC ANEMIA

DEMINISHED ERYTHROCYTE PRODUCTION•FIBROSIS OF BONE MARROW

DIETARY DEFICIENCY•IRON•FOLIC ACID

BLOOD LOSS•HEMATEMESIS•DIALYSIS

PLATELET DYSFUNCTION

QUALITATIVE DYSFUCTION

BLEEDING DIATHESIS


CONTI

GASTROINTESTINAL SYSTEM

DELAYED GASTRIC EMPTYING

NAUSEA AND VOMITING

PEPTIC ULCER DISEASE

GASROINTESTINAL BLEEDING

UREMIC GASTROENTRITIS


CONTI

CENTRAL NERVOUS SYSTEM DYSFUNCTION

BEHAVOIRAL CHANGES

LOSS OF MEMORY

NEUROMUSCULAR IRRITABILITY

LETHARGY

COMA

MYOCLONUS

CONVULSIONS


CONTI

PERIPHERAL NEUROPATHY

MUSCLE WEAKNESS•PERIPHERAL NERVE PALSY WITH FOOT DROP

AUTONOMIC NEUROPATHY

ACID BASE ABNORMALITIES METABOLIC ACIDOSIS


CONTI

ENDOCRINE DISTURBANCES

ALTERED TEMPERATURE REGULATION

ALTERED EXOGENOUS INSULIN REQUIREMENT

REDUCED / IMPAIRED ERYTHROPOITIN PRODUCTION

SECONDARY HYPERPARATHYROIDISM

RENAL OSTEODYSTROPHY•BONE PAIN•FRACTURES

OSTEOMALASIA


CONTI

DIALYSIS RELATED PROBLEMS

DIALYSIS DEMENTIA

DIALYSIS DISEQUILIBRIUM SYNDROME

HYPOVOLUMIA

PERITONITIS

SYSTEMIC ANTICOUGULATION


TREATMENT OPTIONS FOR ESRD

• DIALYSIS

• RENAL TRANSPLANT


TAKE HOME MASSAGE


THANK YOU

LOVE YOUR KIDNEY’S

pathophysiological changes in ckd patients for anaesthetic concern

Health & Medicine

crddr showket ahmad

youdr showket ahmad

tubulointerstitial disease

renaltransplantation

uremic cardiomyopathysecondary

congenital diseases

treatment options

indian parliament