• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Alterations and renal
 

Alterations and renal

on

  • 446 views

 

Statistics

Views

Total Views
446
Views on SlideShare
446
Embed Views
0

Actions

Likes
0
Downloads
9
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Alterations and renal Alterations and renal Presentation Transcript

    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1 Alterations of Renal and Urinary Tract Function
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2 Urinary Tract Obstruction  Urinary tract obstruction is an interference with the flow of urine at any site along the urinary tract  The obstruction can be caused by an anatomic or functional defect • Obstructive uropathy
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3 Urinary Tract Obstruction (cont’d)  Severity based on:  Location  Completeness  Involvement of one or both upper urinary tracts  Duration  Cause
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4 Upper Urinary Tract Obstruction  Hydroureter  Hydronephrosis
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5 Urinary Tract Obstruction
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 6 Upper Urinary Tract Obstruction  Compensatory hypertrophy and hyperfunction  Obligatory growth  Compensatory growth  Postobstructive diuresis (nephrogenic diabetes insipidus)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 7 Upper Urinary Tract Obstruction (cont’d)  Kidney stones  Calculi or urinary stones • Masses of crystals, protein, or other substances that form within and may obstruct the urinary tract  Risk factors: • Gender • Race • Geographic location • Seasonal factors • Fluid intake • Diet • Occupation  Kidney stones are classified according to the minerals that make up the stone
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 8 Kidney Stone Formation  Supersaturation of one or more salts  Presence of a salt in a higher concentration than the volume able to dissolve the salt  Precipitation of a salt from liquid to solid state  Temperature and pH  Growth into a stone via crystallization or aggregation
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 9 Kidney Stone Formation (cont’d)  Other factors affecting stone formation:  Crystal growth-inhibiting substances  Particle retention  Matrix  Stones:  Calcium oxalate or calcium phosphate  Struvite stones  Uric acid stones
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 10 Kidney Stones  Manifestation  Renal colic  Evaluation  History  Stone and urine analysis  Intravenous pyelogram (IVP) or kidney, ureter, bladder x-ray (KUB)  Spiral abdominal CT
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11 Kidney Stones (cont’d)  Treatment:  High fluid intake  Decreasing dietary intake of stone-forming substances  Stone removal
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 12 Lower Urinary Tract Obstruction  Neurogenic bladder  Dyssynergia • Detrusor hyperreflexia-overactive • Detrusor areflex-underactive  Overactive bladder syndrome (OBS) • Frequency, urgency, nocturia  Obstruction • Urethal stricture, prostate enlargement, pelvic organ prolapse • Partial obstruction of bladder outlet or urethra  Low bladder wall compliance
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 13 Tumors  Renal tumors  Renal adenomas  Renal cell carcinoma (RCC)  Bladder tumors  Transitional cell carcinoma (most common)  Gross, painless hematuria  Most common in males older than 60 years and smokers
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 14 Urinary Tract Infection (UTI)  UTI is inflammation of the urinary epithelium caused by bacteria  Acute cystitis  Painful bladder syndrome/interstitial cystitis  Acute and chronic pyelonephritis
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 15 Urinary Tract Infection (UTI) (cont’d)  Most common pathogens  Escherichia coli  Virulence of uropathogens  Host defense mechanisms
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 16 Urinary Tract Infection (UTI) (cont’d)  Acute cystitis  Cystitis is an inflammation of the bladder  Manifestations: • Frequency • Dysuria • Urgency • Lower abdominal and/or suprapubic pain  Treatment: • Antimicrobial therapy • Increased fluid intake • Avoidance of bladder irritants • Urinary analgesics
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 17 Urinary Tract Infection (UTI) (cont’d)  Interstitial cystitis  Nonbacterial infectious cystitis  Manifestations: • Most common in women 20 to 30 years old • Bladder fullness, frequency, small urine volume, chronic pelvic pain  Treatment • No single treatment effective, symptom relief
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 18 Urinary Tract Infection (UTI) (cont’d)  Pyelonephritis  Acute pyelonephritis • Acute infection of the renal pelvis interstitium  Vesicoureteral reflux, E. coli, Proteus, Pseudomonas  Chronic pyelonephritis • Persistent or recurring episodes of acute pyelonephritis that lead to scarring • Risk of chronic pyelonephritis increases in individuals with renal infections and some type of obstructive pathologic condition
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 19 Chronic Pyelonephritis
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 20 Glomerular Disorders  Glomerulonephritis  Inflammation of the glomerulus • Immunologic abnormalities (most common) • Drugs or toxins • Vascular disorders • Systemic diseases (secondary) • Viral causes
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 21 Glomerulonephritis  Mechanisms of injury  Deposition of circulating soluble antigen- antibody complexes, often with complement fragments (Type III hypersensitivity)  Antibodies reacting in situ against planted antigens within the glomerulus (Type II hypersensitivity–cytotoxic)  Nonimmune (drugs, toxins, ischemia)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 22 Glomerulonephritis (cont’d)  Manifestations:  Two major symptoms if severe • Hematuria with red blood cell casts • Proteinuria exceeding 3 to 5 g/day with albumin (macroalbuminuria) as the major protein  Oliguria  Hypertension  Edema  Nephrotic sediment  Nephritic sediment
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 23 Glomerulonephritis (cont’d)  Types:  Membranous nephropathy/glomerulonephritis  Rapidly progressing glomerulonephritis • Antiglomerular basement membrane disease (Goodpasture syndrome)  Chronic glomerulonephritis
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 24 Glomerulonephritis (cont’d)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 25 Nephrotic Syndrome  Excretion of 3.5 g or more of protein in the urine per day  The protein excretion is caused by glomerular injury  Findings:  Hypoalbuminemia  Edema  Hyperlipidemia and lipiduria  Vitamin D deficiency
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 26 Nephrotic Syndrome (cont’d)  Membranous glomerulonephritis  Focal glomerulosclerosis  Minimal change disease (lipoid nephrosis)  Nephritic syndrome  Hematuria  Mild proteinuria  Immune injury
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 27 Acute Kidney Injury (AKI)  Renal insufficiency  Renal failure  End stage renal failure (ESRF)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 28 Acute Kidney Injury (AKI) (cont’d)  Prerenal  Most common cause of ARF  Caused by impaired renal blood flow  GFR declines because of the decrease in filtration pressure
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 29 Acute Kidney Injury (AKI) (cont’d)  Intrarenal  Acute tubular necrosis (ATN) is the most common cause of intrarenal renal failure • Postischemic or nephrotoxic • Oliguria  Postrenal  Occurs with urinary tract obstructions that affect the kidneys bilaterally
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 30 Acute Kidney Injury (AKI) (cont’d)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 31 Acute Kidney Injury (AKI) (cont’d)  Initiation phase  Kidney injury is evolving  Prevention of injury is possible  Maintenance phase  Established kidney injury and dysfunction  Urine output is lowest during this phase and serum creatinine and blood urea nitrogen both increase  Recovery phase  Injury repaired and normal renal function reestablished  Diuresis common  Decline in serum creatinine and urea  Increase in creatinine clearance
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 32 Chronic Kidney Disease (CKD)  Progressive loss of renal function that affects nearly all organ systems  Associated with HTN, diabetes, intrinsic kidney disease  Stages:  Normal (GFR >90mL/min)  Mild (GFR 60-89mL/min)  Moderate (GFR 30-59mL/min)  Severe (GFR 15-29mL/min)  End stage (GFR less than 15)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 33 Chronic Kidney Disease (CKD) (cont’d)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 34 Chronic Kidney Disease (CKD) (cont’d)  Proteinuria and uremia  Due to glomerular hyperfiltration  Damages interstitial tissue of kidney via inflammation  Creatinine and urea clearance  GFR falls  Plasma creatinine increases
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 35 Chronic Kidney Disease (CKD) (cont’d)  Fluid and electrolyte balance  Sodium and water balance • Sodium excretion increases with obligatory water excretion leading to sodium deficit and volume loss • Concentration and dilution ability diminishes  Potassium balance • Tubular secretion increases early • Once oliguria sets in, potassium retained  Acid-base balance • Metabolic acidosis when GFR 30%-40%
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 36 Chronic Kidney Disease (CKD) (cont’d)  Fluid and electrolyte balance  Calcium, phosphate, bone • Reduced renal phosphate excretion, decreased renal synthesis of 1,25-(OH)2 vitamin D3, and hypocalcemia. • Fractures  Protein, carbohydrate, fat metabolism  Anemia • Lethargy, dizziness, and low hematocrit are common
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 37 Chronic Kidney Disease (CKD) (cont’d)  Alterations seen in following systems:  Cardiovascular  Pulmonary  Hematologic  Immune  Neurologic
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 38 Chronic Kidney Disease (CKD) (cont’d)  Gastrointestinal  Endocrine and reproduction  Integumentary
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 39 Signs and Symptoms of Kidney Failure