Renal Failure - Clinical Problems PDF

Renal Failure u.reem elbakheit fallih  Objectives Anatomy Function Acute Renal Failure (ARF) – Causes – Symptoms – Management Chronic Renal Failure (CRF) – Causes – Symptoms Dialysis  Terminology CRF: Chronic Renal Failure ARF: A...

Renal Failure u.reem elbakheit fallih  Objectives Anatomy Function Acute Renal Failure (ARF) – Causes – Symptoms – Management Chronic Renal Failure (CRF) – Causes – Symptoms Dialysis  Terminology CRF: Chronic Renal Failure ARF: Acute Renal Failure ESRD: End stage renal disease ESRF: End stage renal failure GFR: Glomular filtration rate Azotemia: Retention of nitrogenous waste products as renal insufficiency develops  Glomerular Disease Nephritis (acute or chronic ) Inflammation seen on histological exam( large inflamed glomeruli with decrees capillary lumen) Causes streptococci, SLE, acute kidney infection, some drugs Variable degree of proteinuria (< 3g/day) hematouria, anemia, BUN+ ,Scr+, uremia Active sediment: Red cells, white cells, granular casts, red cell cast Nephrotic Can caused by several disease that result in injury and increase permeability of glomerular basement membrane HIV, SLE, Hep. C, Hep. B, Malignancy (usually of GI tract or lung), Diabetic nephropathy, Massive Obesity, NSAIDS No inflammation Bland sediment: No cells, fatty casts Nephrotic range proteinuria (>3.5 g/day) Nephrotic syndrome = proteinuria + hyperlipidemia + edema Glomerulonephritis Nephrotic  Interstitial/Tubular Disease Acute: – Acute Tubular Necrosis: – One of the most causes of acute renal failure in hospitalized patients – Causes: » Hypotension, Sepsis » Toxins: Aminoglycosides, – Urine sediment: muddy brown granular casts – Acute Interstitial Nephritis: – Causes: » Drugs: Antibiotics, NSAIDS, allopurinol » Infections: Leptospirosis » Auto-immune disorders – Urine sediment: urine eosinophils (but not always present), white blood cells, red blood cells, white cell casts – Cast Nephropathy – Multiple Myeloma – Tubular casts Lab finding :- decrease GER, decrease urinary concentrating ability, metabolic acid extension. In appropriate control sodium Acute Tubular Necrosis- muddy brown casts Acute Interstitial Nephritis Chronic Tubular Disease – Causes :Polycystic Kidney Disease, Hypercalcemia, Autoimmune disorders – Decrease excretion, reabsorption of certain substance, reduce urinary concentrating capability, – RTA (renal tubular acidosis ) affecting acid base balance tow types: – Proximal RTA: decreas in bicarbonat reabsorption (hypercholoramic acidosis), low serum phosphorous and uric acid and glucose and amino acid in urine – Distal RTA: renal tubules can are unable to keep up vital ph gradient between blood and tubular fluid  Acute Versus Chronic Acute – sudden onset – rapid reduction in urine output – Usually reversible – Tubular cell death and regeneration Chronic – Progressive – Not reversible – Nephron loss 75% of function can be lost before its noticeable  Acute vs Chronic Renal Failure Rapidly Rising Creatinine = Acute Kidney Size – Small = Chronic Renal Ultrasound – Increased Echogenicity = Chronic Urine Flow Rate – Oliguric or Anuric usually = Acute  Acute Renal Failure is a rapidly progressive loss of renal function generally characterized by oliguria (decreased urine production, quantified as less than 400 mL per day in adults, less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); and fluid and electrolyte imbalance. generally classified as Prerenal = 55% Renal parenchymal (intrinsic)= 40% postrenal =5—15% An underlying cause must be identified and treated to arrest the progress.  ACUTE RENAL FAILURE CLASSIFICATION BY URINE VOLUME OLIGURIC: 500 CC/24 Hrs ANURIC