Post on 05-Apr-2018
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Altered Renal Function
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Clinical features
1-Loin pain
2-Renal ureteric pain
3-Dysurea, oliguria, polyuria,anuria,Nocturia,Frequency,Urinary incontinence
4-Dribbing of urine
5-Hematuria
6-Retension of urine
7-Fever and rigor
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Investigations
1-Urine analysis
2-Ultrasound 3-IVP
4-Renal arteriograph
5-MRI 6-Renal biopsy
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Overview of Kidney Diseases
Classified by site or cause of disease Organization by site:
Prerenal
Intrarenal (Renal)
Postrenal
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Prerenal disease Results from inadequate blood flow to the
kidney Decreased intravascular volume
Lesions in the renal arteries
Hypotension Systemic disorders that decrease urine output
Creatinine clearance? Plasma creatine?
BUN?
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Renal diseases
Result from direct damage to nephron
Glomerular disorders
Tubulointerstitial disorders disorders ofthe medullary tubules and interstitial cells
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Postrenal diseases
Commonly due to urinary tract obstruction
Kidney stones
Tumors of bladder, ureters or prostate gland
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Obstructive Disorders
Interference with urine flow at any point
Anatomic or functional
Impedes flow proximal to blockage
Dilates urinary system
Increases risk for infection
Compromises renal function
Anatomic changes are called obstructiveuropathy
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Causes of obstruction
Congenital malformations
Stones
Abdominal tumor
Tumor of urinary system or prostate
Severe pelvic organ prolapse in women
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Urinary Tract infections
Bacteria most common cause
Can also be due to viruses, fungi or
parasites
Classified by location in system or by
complicating factors
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Cystitis inflammation of the bladder
Urinary frequency Dysuria painful or difficult urination
Urgency
Lower abdominal, lower back or suprapubic
pain
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Incidence Young adult women 0.2/month
Lifetime risk in women 50%
Young adult men prevalence < 1%
High risk groups:
Premature infants
Sexually active women
Women using a diaphragm or spermicide
Diabetics
HIV or immunosuppressive disorders
Obstruction of lower urinary tract
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Treatment
Antibiotics
Drink normal amounts of water, but avoid
bladder irritants, such as caffeine
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Acute pyelonephritis
Inflammation is usually focal, affecting
pelvis, calyces, and medulla but glomerulinot usually involved.
Kidney is infiltrated with wbcs pyuria
Healing involves scarring and atrophy ofaffected tubules
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Acute pyelonephritis Clinical manifestations:
Acute onset Fever or chills
Flank or groin pain
Frequency and dysuria May be difficult to distinguish from cystitis
look for white cell casts
Treatment: Microorganism specific antibiotics
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Chronic Pyelonephritis Manifestations are often minimal-
Hypertension Frequency and Dysuria
Flank pain
Diagnosis Urine analysis
Intravenous pyelography, ultrasound
Treatment Relieve obstruction
antibiotics
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Glomerulonephritis
Caused by a number of factors, mostcommonly abnormal immune response
Infection
Toxins
Vascular diseases
Systemic diseases (diabetes mellitus)
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Acute Glomerulonephritis
Symptoms occur 10-21 days after infection
Hematuria Proteinuria
Decreased GFR, oliguria
Hypertension Edema around eyes, feet and ankles
Ascites or pleural effusion
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Nephrotic Syndrome
Defined as excretion of 3.5 or more grams
of protein / day
Also see hypoalbuminemia, edema,
hyperlipidemia
Decrease in vitamin D
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Nephrotic Syndrome
Treatment:
Diet normal protein, low-fat, salt restricted
Diuretics
Protein supplements
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Renal Failure Acute renal failure abrupt decrease in renal
function Increase in BUN and creatinine
Usually oliguria (output < 30 ml/hour or 400ml/day)
Most cases are reversible if diagnosed and treatedearly
Prerenal most common cause failure to
restore blood volume or pressure and oxygencan lead to acute tubular necrosis or acutecortical necrosis
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Acute Renal Failure
Intrarenal acute renal failure
Usually due to acute tubular necrosis
Usually caused by ischemia most often
after surgery (40 -50 %)
Also sepsis, burns, obstetricalcomplications, antibiotics, radiocontrast
media, other toxic substances
Whatever the cause, get decreased
GFR and oliguria
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Acute Renal Failure
Postrenal acute renal failure
Usually due to urinary tract obstruction that
affects both kidneys
Characterized by several hours of anuria
with flank pain, followed by polyuria
A t R l F il
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Acute Renal Failure Clinical symptoms of ARF are divided into three
stages:Stage1 Oliguria:
urine vol.about 25 % of normal to anuria
can last 1-3 weeksBUN, plasma creatinine
K+ (hyperkalemia) and electrolyte imbalance
fluid retention and edema
congestive heart failure
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Stage 2 Diuresis:
3-4 L/day of urine
Stage 3 Recovery
May take 3-12 months for plasma
creatinine to return to normal
About 30 % never regain normal kidney
function.
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Acute Renal Failure Treatment
Prevention if possible Maintain individuals life until renal function is
recovered
Correct fluid and electrolyte imbalances Treat infections
Maintain nutrition and cardiac function
Remember drugs and/or medications are
not excreted!
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Chronic Renal Failure Progressive and irreversible loss of
nephrons Slow development (years)
Alterations in salt and water balance not
apparent until renal function is less than25% of normal.
Common causes:
Chronic glomerulonephritis
Chronic pyelonephritis
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Chronic Renal Failure Clinical manifestations are often described using the
term uremia
symptoms due to accumulation oftoxins in plasma.
hypertension
Anorexia
Nausea
Vomiting
Diarrhea
Weight loss
Pruritis (itching)
Edema
Anemia
Neurologic changes
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Chronic Renal Failure Diagnosis is by increased BUN and serum
creatinine; imaging will show smallkidneys, and can be confirmed by biopsy
Management includes:
Diet control restrict proteins, potassium Evaluate fluid and sodium levels
Treat with erythropoietin as needed.