Renal Failure & Therapeutic Management PDF

Renal Failure & Therapeutic Management  S Anatomy 1 1 Smil nephrons each. kidney it 10interfa ↑  * Nephron function Glomerulusi Filters fluid is solutes from blood Proximal Convoluted Tubule Reabso...

Renal Failure & Therapeutic Management  S Anatomy 1 1 Smil nephrons each. kidney it 10interfa ↑  * Nephron function Glomerulusi Filters fluid is solutes from blood Proximal Convoluted Tubule Reabsorbs Nat, K+, Cl HCO3 , - , and amino acids glucose Descending Loop of Henle-Site of action for osmotic diuretics(Mannitol) Loop of Henle-site of action for loop Ascending diuretics (Lasix) Distal Convoluted Tube Reabsorbs water, acd base - balance affected by ADH and aldosterone; site of action for thiazides (HOTZ) collecting Duct-last step in H20 and wat balance, site of action for potassium sparing diuretic Finally Ispironolactonel wrine  Renal SystemFunctions (maintain adequate) electrolyte balance Regulation of Ions in the blood :Sodium , potassium , calium chloride , phosphate Regulation of blood volume : adjusts the volume of blood or eliminates it in the Urine of blood pro excretes a variable amount Regulation of hydrogen in the wine Production of hormones Calcitrl : calcium homeostasis · of · Erythropoietin: production RBCsfrenal patients -anemia-oxygenation lack Remin :helps regulate BP · which of waste Excretion · Ammonia andurea : amino acid Creatinine : Creatinine phosphate · · Drugs Adid base val Everythropoiesis Titoxin removal DiBP control Eielectrolyte Balance Divitamin D Activation  Labs Bun 5-20 Creative 0 5-1 2.. Bun to Creatine Ratio 20 : I Creative Clearance 110-120 275-293 Osmolarity Anion Gap 8-16 Hemoglobin Hematocrit (112-16) M/13 5-17 5).. Albumin 3 5-5 WHO-54)m(37-47) thing. BunkHydration * # problem ikidney  Urine Dipstick Appearance (color , Clarity , s odor · Urine PH Inormal unne is acidic 4 5-8) ·. · Protein /150 mg/day indicate kidney injury Glucose (monitor · glucose for hyperglycemia Dm) serum ↳ blood over 180 · WBC (Infection) Ipilling glucose) cystitis produce a lot of blood Blood IFew RBC's normal/benign · in bladder LUTI's, kidney infections , cancer, tranma meds , Imaging Studies · Ultrasound Irena · Angiography KUBkidney inveterbladder · 'CT % VPC Inject contrast dye to get pictures · MRI of uninary fract  Acute Kidney Injury characterizedbysuddenincreasein · creatininea · caused by a decrease GFR and retention of blood in products normally excreted by the kidneys Most common causes of AILI-sepsis , hypovolemial · drugs or medication induced , and cardiogenic shock for Al Diagnostic criteria · - serum creatinine increases by >0 3 mgld within 48hrs. - semm creatinine increases by 1 5 mg/dl from baseline. within t days - urine volume decreases to0 5 ml/kg/h. forChrs RisksFactors Sepsis - Burns - Disease - Trauma - Chronic Kidney Advanced Age - Diabetes Mellitus-CAlumineral leaking protein) - which /Raptor Missis ; damage muscles release myoglobin 1 clogs the glomeres occur in trauma, sepsis, nurs  Causes of Acute Kidney PRETENAL , INTARENAL POSTRENGL Prerenal Risk AKI Injury => I Advanced Acute Tubular syndrome necrosis,moston (Damage to tubularocells thatareresponsiblea  Postrenal AKI Injury Risk the uretura, prostate (most often caused by an obstruction of or bladder / Man I - Menigpstateca Unna ais Infection ~ Four Phases of Acute Injury 1) Initiation Oliguric ↳ Diuretic 4) Recovery  & Phases Initiation of Acute Kidney Injury olnitial Insult - unine output < 0. Smighr - lasts for hours to days -Ends who guric Phase Oliguric Phase A · Decreased GFR Dark · Urine specific Gravity 1 010 - Hyperkalemia. - · Occurs 1-7 days after Hyperphosphatemia injury - Hypocalcemialnot secreting calcium)- can last up to 14 days - U:Cast RBC's · -Elevated Bun creatinine , Lobs protein Decreased · damaged · Tubules semm osmolarity uremia Hyponatremia - · - Increased retention · Metabolic Acidosis of fluid *Decreased urinary outbur Fluid volume overload · 2400midday * Additional SB Fatigue - - Distended neck veins - Headache - Bounding pulse - seizures - Edema - Kussmanlbreathing - HTM - Ekzichanges/anhythmas Edema - Hausea , loss of appetite Pulmonary - Hony Skin - - Heart Failure pte Diuretic Phase · Lasts 1-3weeks · unive output Is liters/day osmotic diuresis - luvinating alorf in the tubules high areazunable to concentrate - o Monitor for decreased - volume > - dehydration - blood pressure - sodium - Dotassium Phase Recovery · can take up to 12months · urine output normalizes improve imbalances "Electrotyte resolve · Fluid imbalances balance improves · Acid-base  - Chronic Kidney Disease stages - Stage 1- normal GFR : albuminuria Stage 2-GFR 60-89 ; albuminuria Stage 3-GFR Staged-GFR 30-59 15-29 * StageS-GFRLISESKD young adults ,normal GFR In is 120 m//min/1 73m. ? - Causes - Diabetes - Polycystic Kidney Disease High blood pressure Recurrent Kidney infections - - - Glomerulonephritis - Prolonged use of meds likeNSAIDS Prolonged blockages - in the tract urinary Symptoms muscle cramps Fatigue, weakness - - in urination patterns changes Edemalles , anke ,feet) - - itchy skin - Nausea or vomiting - shortness - of breath - loss of appetite difficulty sleeping -  Cardiorenal Syndrome (CRS) CRS: Acu heart failure that results Al Typel All 2 CRS :Chronic heart failure that results in Type : AkI that results in acute heart failure Type3CRS chronic heart failure