Renal Dysfunction - Shori Thakur - PDF

Renal dysfunction Learning objectives Outline normal kidney function Classification of kidney disorders Describe electrolyte imbalance in renal disorders  Homeostatic Functions of the Renal System Body water regulation Excretory reg...

Renal dysfunction Learning objectives Outline normal kidney function Classification of kidney disorders Describe electrolyte imbalance in renal disorders  Homeostatic Functions of the Renal System Body water regulation Excretory regulation Nitrogenous waste Urine output products Blood pressure Drug metabolites and other wastes Normal kidney functions in Uric Acid homeostasis Electrolyte Metabolic (endocrine) Balance regulation Sodium Acid-base balance Erythropoietin Potassium Metabolic Renin-angiotensin- Phosphorus compensation aldosterone Calcium Vitamin D Magnesium  Renal dysfunction Accumulation of nitrogenous waste products Increased serum creatinine Disturbance of extracellular fluid balance Acid-base disturbance Electrolyte and mineral disorders  Classification of Renal Dysfunction (Based on location) 1. Pre-renal - loss of blood supply Characterized by decreased renal perfusion  Dehydration by poor oral intake, diarrhorea, massive bleeding or sepsis  Hypotension Most common cause of ARF 2. Intra-renal (renal) - loss of functional renal tissue Result from direct damage to nephron Glomerular disorders – ( E.g. Glomerulonephritis) Tubulointerstitial disorders – disorders of the medullary tubules and interstitial cells (E.g. Pyelonephritis) 3. Post-renal - disrupted urine flow Commonly due to urinary tract obstruction  Kidney stones  Tumors of bladder, ureters or prostate gland  Renal Dysfunction Renal damage can be described as acute or chronic Acute Renal Failure Is a sudden decline in glomerular and tubular function, resulting in the failure of the kidneys to excrete nitrogenous waste products and to maintain fluid and electrolyte homeostasis (reversible) Chronic Renal Failure Gradual increase in urea & creatinine, progressive loss of renal function over years (irreversible)  Acute Renal Failure Pathophysiology Increase in serum urea and creatinine  Decreased GFR Metabolic acidosis  Inability of the kidneys to excrete hydrogen ions Electrolytes abnormalities:  K+  phosphate  Na+  calcium Decreased GFR  Acute Renal Failure Pathophysiology continued…. Hypervolemia Hypertension Oliguria - anuria Clinical progression of reversible ARF occurs in four phases: – Initiation phase  Begins with initial insult and ends when oliguria develops – Oliguric phase  Accompanied by rise in serum concentrations of substances usually excreted by kidneys (urea, creatinine, organic acids, intracellular cations [K+ & Mg])  urinary output