This document discusses the classification, causes, diagnosis, and treatment of acute renal failure (ARF). It covers the major types of ARF including pre-renal azotemia, acute tubular necrosis, acute glomerulonephritis, obstructive nephropathy, interstitial nephritis, and intratubular obstruction. For each type, the document outlines characteristic clinical features, diagnostic testing, underlying etiologies, and management approaches. A wide range of potential causes of ARF are thoroughly examined, from hemodynamic changes to toxic insults and obstructive pathologies.
Brief explanation of each *refer harrison textbook for details causes of TIN
Acute interstitial nephritis
Chronic interstitial nephritis
Reflux nephropathy
Papillary necrosis
Sickle-cell nephropathy
Chronic Kidney Disease, CKD, Nephrology, Dee Evardone
This document provides an overview of chronic kidney disease (CKD). It defines CKD as the presence of kidney damage or decreased kidney function for three or more months. Key points include:
- CKD is defined based on evidence of kidney damage through structural abnormalities found on biopsy, imaging, or urine tests, or decreased glomerular filtration rate (GFR) below 60 mL/min/1.73m2.
- Common causes of CKD include diabetes, hypertension, glomerulonephritis, cystic kidney diseases, and vascular diseases.
- The document outlines clinical and laboratory manifestations of CKD and approaches to evaluating and managing patients with CKD.
Henoch-Schönlein purpura (HSP) is a vasculitis disorder typically seen in children that involves small vessel inflammation of the skin, gastrointestinal tract, kidneys, and joints. It is characterized by purpuric rash, abdominal pain, arthritis, and potential kidney involvement. While usually self-limiting, long term kidney damage can occur in some cases. Treatment focuses on symptom relief and monitoring for complications. Prognosis is generally good but recurrence and long term kidney issues are possible.
Polycystic kidney disease can be autosomal dominant or recessive. Autosomal dominant PKD is caused by mutations that result in multiple bilateral cysts in the kidneys and liver, and those with a parent with the disease have a 50% chance of developing it. Diagnosis involves family history, imaging showing cysts, and ultrasound or MRI. There is no treatment to prevent cyst growth, but blood pressure and infections should be controlled. Autosomal recessive PKD requires both parents to have the disease, and is diagnosed through ultrasound showing large cystic kidneys and liver fibrosis. Treatment focuses on intensive care, dialysis, and transplantation as survival into adulthood is now possible.
Glomerulonephritis is an inflammation of the glomerular capillaries in the kidney. It can be caused by an immunological reaction that results in proliferative and inflammatory changes to the glomerular structure. Antigen-antibody complexes form in the blood and become trapped in the glomerular capillaries, inducing an inflammatory response. Glomerulonephritis can present as either a nephrotic syndrome with heavy proteinuria and edema, or a nephritic syndrome with hematuria and decreased kidney function. Treatment involves managing symptoms, preserving kidney function, and treating complications early.
This document provides an outline for a presentation on acute liver failure (ALF). It begins with definitions of ALF and classifications of fulminant vs subfulminant hepatic failure. It then covers anatomy and blood supply of the liver, epidemiology, etiology, pathophysiology, clinical features, diagnostic evaluation, treatment, complications, and prognosis of ALF. Key points include that ALF results from massive liver cell necrosis and loss of synthetic function, common causes are acetaminophen overdose, viral hepatitis, and unknown etiology. Presentation may include jaundice, encephalopathy, and coagulopathy. Treatment involves supportive care, identifying and treating any underlying cause, and consideration of liver transplantation in severe
1. Chronic Kidney Disease (CKD) is defined as kidney damage or reduced kidney function lasting over 3 months as measured by GFR <60 mL/min/1.73m2 and/or albuminuria.
2. CKD is a major public health problem and leading cause of ESRD. Diabetes and hypertension are the leading causes of CKD.
3. The kidneys maintain homeostasis through filtration, reabsorption, secretion and other functions. Progressive loss of nephrons in CKD disrupts this balance and leads to physiological changes and clinical manifestations.
Brief explanation of each *refer harrison textbook for details causes of TIN
Acute interstitial nephritis
Chronic interstitial nephritis
Reflux nephropathy
Papillary necrosis
Sickle-cell nephropathy
Chronic Kidney Disease, CKD, Nephrology, Dee Evardone
This document provides an overview of chronic kidney disease (CKD). It defines CKD as the presence of kidney damage or decreased kidney function for three or more months. Key points include:
- CKD is defined based on evidence of kidney damage through structural abnormalities found on biopsy, imaging, or urine tests, or decreased glomerular filtration rate (GFR) below 60 mL/min/1.73m2.
- Common causes of CKD include diabetes, hypertension, glomerulonephritis, cystic kidney diseases, and vascular diseases.
- The document outlines clinical and laboratory manifestations of CKD and approaches to evaluating and managing patients with CKD.
Henoch-Schönlein purpura (HSP) is a vasculitis disorder typically seen in children that involves small vessel inflammation of the skin, gastrointestinal tract, kidneys, and joints. It is characterized by purpuric rash, abdominal pain, arthritis, and potential kidney involvement. While usually self-limiting, long term kidney damage can occur in some cases. Treatment focuses on symptom relief and monitoring for complications. Prognosis is generally good but recurrence and long term kidney issues are possible.
Polycystic kidney disease can be autosomal dominant or recessive. Autosomal dominant PKD is caused by mutations that result in multiple bilateral cysts in the kidneys and liver, and those with a parent with the disease have a 50% chance of developing it. Diagnosis involves family history, imaging showing cysts, and ultrasound or MRI. There is no treatment to prevent cyst growth, but blood pressure and infections should be controlled. Autosomal recessive PKD requires both parents to have the disease, and is diagnosed through ultrasound showing large cystic kidneys and liver fibrosis. Treatment focuses on intensive care, dialysis, and transplantation as survival into adulthood is now possible.
Glomerulonephritis is an inflammation of the glomerular capillaries in the kidney. It can be caused by an immunological reaction that results in proliferative and inflammatory changes to the glomerular structure. Antigen-antibody complexes form in the blood and become trapped in the glomerular capillaries, inducing an inflammatory response. Glomerulonephritis can present as either a nephrotic syndrome with heavy proteinuria and edema, or a nephritic syndrome with hematuria and decreased kidney function. Treatment involves managing symptoms, preserving kidney function, and treating complications early.
This document provides an outline for a presentation on acute liver failure (ALF). It begins with definitions of ALF and classifications of fulminant vs subfulminant hepatic failure. It then covers anatomy and blood supply of the liver, epidemiology, etiology, pathophysiology, clinical features, diagnostic evaluation, treatment, complications, and prognosis of ALF. Key points include that ALF results from massive liver cell necrosis and loss of synthetic function, common causes are acetaminophen overdose, viral hepatitis, and unknown etiology. Presentation may include jaundice, encephalopathy, and coagulopathy. Treatment involves supportive care, identifying and treating any underlying cause, and consideration of liver transplantation in severe
1. Chronic Kidney Disease (CKD) is defined as kidney damage or reduced kidney function lasting over 3 months as measured by GFR <60 mL/min/1.73m2 and/or albuminuria.
2. CKD is a major public health problem and leading cause of ESRD. Diabetes and hypertension are the leading causes of CKD.
3. The kidneys maintain homeostasis through filtration, reabsorption, secretion and other functions. Progressive loss of nephrons in CKD disrupts this balance and leads to physiological changes and clinical manifestations.
Acute tubular necrosis (ATN) is a type of acute kidney injury where there is severe or prolonged ischemia or exposure to nephrotoxins that injure the tubular epithelium, particularly in the proximal tubule and medullary thick ascending limb. ATN is characterized by tubular cell swelling, vacuolation, necrosis and sloughing of epithelial cells. The injury is caused by mechanisms like ATP depletion, oxidative stress, calcium overload and inflammation. Clinically, ATN presents with decreased urine output and rising creatinine over days. The diagnosis is supported by urine studies showing sodium greater than 40 mmol/L and muddy brown casts. Treatment is supportive with fluid management and treating the underlying cause.
Polycystic kidney disease is caused by mutations in genes located on chromosomes 16p13.3 and 4q21. The kidneys become massively enlarged due to the growth of multiple cysts filled with fluid. Patients may be asymptomatic for years until renal insufficiency develops. Symptoms can include pain, bleeding, and high blood pressure as the cysts enlarge and damage the kidney tissue. Complications include liver and heart cysts as well as brain aneurysms. While the condition progresses slowly over decades, it ultimately leads to kidney failure and often death from heart or brain related issues.
HIV-associated nephropathy (HIVAN) is a kidney disease characterized by proteinuria, kidney damage, and focal segmental glomerulosclerosis that primarily affects people with HIV. It was first reported in 1984 and is most common in African Americans. The introduction of antiretroviral therapy has decreased the incidence of end-stage renal disease due to HIVAN. HIV infection of renal epithelial cells directly contributes to HIVAN pathogenesis, and the kidneys may serve as an important viral reservoir even when viral loads are undetectable in blood. Treatment with antiretroviral therapy, ACE inhibitors, and steroids can help reduce progression of kidney disease in patients with HIVAN.
Hemolytic uremic syndrome (HUS) is a disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. It is most commonly caused by infections from Shiga toxin-producing bacteria like E. coli O157:H7. The Shiga toxin damages endothelial cells and causes blood clots to form in the kidneys. Treatment involves fluid replacement, dialysis, and plasma exchange to support kidney function and replace lost blood cells. While HUS prognosis is generally good, some children may have long term kidney damage or rarely die from severe complications.
This document discusses chronic kidney disease (CKD) in pediatrics. It defines CKD as kidney damage lasting at least 3 months as determined by structural abnormalities and/or a glomerular filtration rate below 60 mL/min/1.73m2. The stages of CKD are described based on GFR. Common causes in children include congenital abnormalities and glomerulonephritis. The pathogenesis involves hyperfiltration injury and other factors like proteinuria that accelerate kidney damage. Management aims to address complications through careful monitoring, nutrition, treatment of mineral bone disorders, and controlling blood pressure and electrolyte abnormalities.
NEPHRITIC SYNDROME / APSGN IN CHILDREN Sajjad Sabir
This document provides information about Acute Poststreptococcal Glomerulonephritis (APSGN). It begins by describing the features of acute nephritic syndrome which is characterized by gross hematuria, edema, hypertension, and renal insufficiency. It then discusses the pathology, clinical manifestations, diagnosis, and management of APSGN. APSGN is caused by a previous streptococcal infection and results in immune complex deposition in the glomeruli. It presents abruptly with hematuria, edema, hypertension, and sometimes renal insufficiency. Treatment focuses on supporting kidney function and controlling blood pressure while the patient recovers over 6-8 weeks. Prognosis is generally good with complete recovery in over 95
This document discusses HIVAN (HIV Associated Nephropathy) and TDF (tenofovir disoproxil fumarate) induced nephropathy. HIVAN occurs in advanced HIV disease and causes rapid progression to end-stage renal disease. It predominantly affects young black males and has a distinct histology. TDF is an antiretroviral medication that can accumulate in kidney cells and impair mitochondrial DNA, potentially leading to proximal tubular dysfunction or Fanconi syndrome. The document provides statistics on HIVAN and outlines the pathophysiology, clinical presentation, and recommendations regarding both conditions.
This document provides guidelines for the management of nephrotic syndrome. It defines nephrotic syndrome as having massive proteinuria, edema, hypoalbuminemia, and hypercholesterolemia. The causes can be primary/idiopathic or secondary to conditions like post-streptococcal glomerulonephritis. Initial investigations include blood and urine tests. Corticosteroids are the main treatment and most cases achieve remission within 4 weeks, though frequent relapses require additional immunosuppressants like cyclophosphamide. Complications are managed based on symptoms, and renal biopsy may be needed for resistant cases to guide specific therapy.
THE KIDNEY: TUBULAR & TUBULOINTERSTITIAL DISEASESDr. Roopam Jain
This document discusses various tubular and tubulointerstitial diseases of the kidney. It describes acute tubular necrosis caused by ischemic or toxic injury and its pathogenesis. It also discusses various inflammatory tubulointerstitial diseases including acute and chronic pyelonephritis, tuberculous pyelonephritis, myeloma nephropathy, and nephrocalcinosis. For each disease, it provides details on etiology, pathogenesis, clinical features, complications and histopathological findings.
This document provides information on autoimmune hepatitis, including:
- It is a chronic hepatitis of unknown etiology that can progress to cirrhosis. It is characterized by the presence of autoimmune antibodies and evidence of hepatitis.
- The two main types are type 1, associated with ANA/SMA positivity, and type 2, associated with LKM1 positivity.
- Treatment involves immunosuppressive drugs like prednisone, either alone or in combination with azathioprine. The goal is to induce and maintain remission.
- Remission is defined as resolution of symptoms and normalization of liver tests and histology. Treatment is then tapered slowly to maintain remission.
Pediatric urinary tract infections (UTIs) are common in children, especially girls under the age of 1. Left untreated, UTIs can cause renal scarring and long-term kidney damage. Diagnosis involves urine tests to check for white blood cells and bacteria. Treatment depends on symptoms and severity but often involves antibiotics and hydration. Follow up is important to monitor for recurrent UTIs and issues like vesicoureteral reflux, as both increase risk of permanent kidney damage if not addressed.
Portal-systemic encephalopathy is a brain disorder caused by liver dysfunction that allows toxins to reach the brain. It is characterized by alterations in mental status, neurological abnormalities, and distinctive EEG changes. The main underlying mechanism involves increased levels of ammonia in the bloodstream from the gut that are normally processed by the liver. Treatment focuses on reducing ammonia production in the colon through medications like lactulose and restricting protein intake. Prognosis depends on the underlying liver disease and can range from fully treatable acute episodes to chronic and potentially fatal cases.
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by low platelet counts and bruising. It most commonly affects children ages 1-4 years old within 4 weeks of a viral infection. An autoantibody develops against platelets, causing their destruction by the spleen. Most cases of childhood ITP are mild and resolve spontaneously within 6 months. Treatment involves observation for mild cases or corticosteroids, IVIG, or anti-D therapy for more severe cases. Splenectomy is reserved for chronic or uncontrolled cases.
The patient is a 20-year-old male with sickle cell disease who presents with several chronic and acute complications. He has a history of delayed puberty, joint pain, weakness and cough. Examination reveals decreased growth, severe anemia, leg ulcers, enlarged spleen and fever. Laboratory tests show hemoglobin of 8g/dL and reticulocyte count of 25%. The most probable cause of the patient's problems is sickle cell disease and its associated complications. The patient is at risk for further complications such as acute chest syndrome, stroke and infection due to his condition.
Approach to the Patient with Renal DiseasePatrick Carter
This document provides an overview of renal disease for medical students. It defines key terms related to renal function and urine findings. It describes tools for detecting renal disease including history, physical exam, urinalysis, and bloodwork. It discusses uremic syndrome and its effects on multiple organ systems. It differentiates between acute and chronic renal failure, nephritic and nephrotic syndrome based on causes, labs, and physical findings. The goal is to review approaches for evaluating and classifying patients with possible renal disease.
This document discusses a case scenario involving a 50-year-old male patient with diabetes and chronic kidney disease (CKD) who is admitted with urosepsis and acute kidney injury (AKI). Over the course of his hospital stay, the patient's kidney function declines and he requires renal replacement therapy. The document poses questions at various points in the case and provides answers regarding evaluating and managing the patient's AKI. It emphasizes identifying reversible causes, preventing progression through fluid management, and considering RRT for severe AKI.
This document summarizes a clinical case conference on acute interstitial nephritis (AIN). It discusses the history, causes, diagnosis, prognosis and treatment of AIN. Experimental evidence suggests drug-induced AIN results from an immune reaction against renal antigens triggered by certain drugs. Retrospective studies indicate corticosteroid therapy may improve outcomes in AIN, though prospective trials are still needed.
Tubulointerstitial nephritis involves inflammatory reactions in the renal tubules and interstitium. It can be primary, secondary to other renal diseases, idiopathic, reactive to infections, or infectious itself. Acute tubular necrosis is characterized by tubular epithelial cell death due to ischemia or toxins and can cause acute kidney injury. Chronic tubulointerstitial nephritis develops over months or years and is associated with progressive loss of kidney function. It has many etiologies including drugs, infections, obstructive nephropathy, and autoimmune diseases.
Acute tubular necrosis (ATN) is a type of acute kidney injury where there is severe or prolonged ischemia or exposure to nephrotoxins that injure the tubular epithelium, particularly in the proximal tubule and medullary thick ascending limb. ATN is characterized by tubular cell swelling, vacuolation, necrosis and sloughing of epithelial cells. The injury is caused by mechanisms like ATP depletion, oxidative stress, calcium overload and inflammation. Clinically, ATN presents with decreased urine output and rising creatinine over days. The diagnosis is supported by urine studies showing sodium greater than 40 mmol/L and muddy brown casts. Treatment is supportive with fluid management and treating the underlying cause.
Polycystic kidney disease is caused by mutations in genes located on chromosomes 16p13.3 and 4q21. The kidneys become massively enlarged due to the growth of multiple cysts filled with fluid. Patients may be asymptomatic for years until renal insufficiency develops. Symptoms can include pain, bleeding, and high blood pressure as the cysts enlarge and damage the kidney tissue. Complications include liver and heart cysts as well as brain aneurysms. While the condition progresses slowly over decades, it ultimately leads to kidney failure and often death from heart or brain related issues.
HIV-associated nephropathy (HIVAN) is a kidney disease characterized by proteinuria, kidney damage, and focal segmental glomerulosclerosis that primarily affects people with HIV. It was first reported in 1984 and is most common in African Americans. The introduction of antiretroviral therapy has decreased the incidence of end-stage renal disease due to HIVAN. HIV infection of renal epithelial cells directly contributes to HIVAN pathogenesis, and the kidneys may serve as an important viral reservoir even when viral loads are undetectable in blood. Treatment with antiretroviral therapy, ACE inhibitors, and steroids can help reduce progression of kidney disease in patients with HIVAN.
Hemolytic uremic syndrome (HUS) is a disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. It is most commonly caused by infections from Shiga toxin-producing bacteria like E. coli O157:H7. The Shiga toxin damages endothelial cells and causes blood clots to form in the kidneys. Treatment involves fluid replacement, dialysis, and plasma exchange to support kidney function and replace lost blood cells. While HUS prognosis is generally good, some children may have long term kidney damage or rarely die from severe complications.
This document discusses chronic kidney disease (CKD) in pediatrics. It defines CKD as kidney damage lasting at least 3 months as determined by structural abnormalities and/or a glomerular filtration rate below 60 mL/min/1.73m2. The stages of CKD are described based on GFR. Common causes in children include congenital abnormalities and glomerulonephritis. The pathogenesis involves hyperfiltration injury and other factors like proteinuria that accelerate kidney damage. Management aims to address complications through careful monitoring, nutrition, treatment of mineral bone disorders, and controlling blood pressure and electrolyte abnormalities.
NEPHRITIC SYNDROME / APSGN IN CHILDREN Sajjad Sabir
This document provides information about Acute Poststreptococcal Glomerulonephritis (APSGN). It begins by describing the features of acute nephritic syndrome which is characterized by gross hematuria, edema, hypertension, and renal insufficiency. It then discusses the pathology, clinical manifestations, diagnosis, and management of APSGN. APSGN is caused by a previous streptococcal infection and results in immune complex deposition in the glomeruli. It presents abruptly with hematuria, edema, hypertension, and sometimes renal insufficiency. Treatment focuses on supporting kidney function and controlling blood pressure while the patient recovers over 6-8 weeks. Prognosis is generally good with complete recovery in over 95
This document discusses HIVAN (HIV Associated Nephropathy) and TDF (tenofovir disoproxil fumarate) induced nephropathy. HIVAN occurs in advanced HIV disease and causes rapid progression to end-stage renal disease. It predominantly affects young black males and has a distinct histology. TDF is an antiretroviral medication that can accumulate in kidney cells and impair mitochondrial DNA, potentially leading to proximal tubular dysfunction or Fanconi syndrome. The document provides statistics on HIVAN and outlines the pathophysiology, clinical presentation, and recommendations regarding both conditions.
This document provides guidelines for the management of nephrotic syndrome. It defines nephrotic syndrome as having massive proteinuria, edema, hypoalbuminemia, and hypercholesterolemia. The causes can be primary/idiopathic or secondary to conditions like post-streptococcal glomerulonephritis. Initial investigations include blood and urine tests. Corticosteroids are the main treatment and most cases achieve remission within 4 weeks, though frequent relapses require additional immunosuppressants like cyclophosphamide. Complications are managed based on symptoms, and renal biopsy may be needed for resistant cases to guide specific therapy.
THE KIDNEY: TUBULAR & TUBULOINTERSTITIAL DISEASESDr. Roopam Jain
This document discusses various tubular and tubulointerstitial diseases of the kidney. It describes acute tubular necrosis caused by ischemic or toxic injury and its pathogenesis. It also discusses various inflammatory tubulointerstitial diseases including acute and chronic pyelonephritis, tuberculous pyelonephritis, myeloma nephropathy, and nephrocalcinosis. For each disease, it provides details on etiology, pathogenesis, clinical features, complications and histopathological findings.
This document provides information on autoimmune hepatitis, including:
- It is a chronic hepatitis of unknown etiology that can progress to cirrhosis. It is characterized by the presence of autoimmune antibodies and evidence of hepatitis.
- The two main types are type 1, associated with ANA/SMA positivity, and type 2, associated with LKM1 positivity.
- Treatment involves immunosuppressive drugs like prednisone, either alone or in combination with azathioprine. The goal is to induce and maintain remission.
- Remission is defined as resolution of symptoms and normalization of liver tests and histology. Treatment is then tapered slowly to maintain remission.
Pediatric urinary tract infections (UTIs) are common in children, especially girls under the age of 1. Left untreated, UTIs can cause renal scarring and long-term kidney damage. Diagnosis involves urine tests to check for white blood cells and bacteria. Treatment depends on symptoms and severity but often involves antibiotics and hydration. Follow up is important to monitor for recurrent UTIs and issues like vesicoureteral reflux, as both increase risk of permanent kidney damage if not addressed.
Portal-systemic encephalopathy is a brain disorder caused by liver dysfunction that allows toxins to reach the brain. It is characterized by alterations in mental status, neurological abnormalities, and distinctive EEG changes. The main underlying mechanism involves increased levels of ammonia in the bloodstream from the gut that are normally processed by the liver. Treatment focuses on reducing ammonia production in the colon through medications like lactulose and restricting protein intake. Prognosis depends on the underlying liver disease and can range from fully treatable acute episodes to chronic and potentially fatal cases.
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by low platelet counts and bruising. It most commonly affects children ages 1-4 years old within 4 weeks of a viral infection. An autoantibody develops against platelets, causing their destruction by the spleen. Most cases of childhood ITP are mild and resolve spontaneously within 6 months. Treatment involves observation for mild cases or corticosteroids, IVIG, or anti-D therapy for more severe cases. Splenectomy is reserved for chronic or uncontrolled cases.
The patient is a 20-year-old male with sickle cell disease who presents with several chronic and acute complications. He has a history of delayed puberty, joint pain, weakness and cough. Examination reveals decreased growth, severe anemia, leg ulcers, enlarged spleen and fever. Laboratory tests show hemoglobin of 8g/dL and reticulocyte count of 25%. The most probable cause of the patient's problems is sickle cell disease and its associated complications. The patient is at risk for further complications such as acute chest syndrome, stroke and infection due to his condition.
Approach to the Patient with Renal DiseasePatrick Carter
This document provides an overview of renal disease for medical students. It defines key terms related to renal function and urine findings. It describes tools for detecting renal disease including history, physical exam, urinalysis, and bloodwork. It discusses uremic syndrome and its effects on multiple organ systems. It differentiates between acute and chronic renal failure, nephritic and nephrotic syndrome based on causes, labs, and physical findings. The goal is to review approaches for evaluating and classifying patients with possible renal disease.
This document discusses a case scenario involving a 50-year-old male patient with diabetes and chronic kidney disease (CKD) who is admitted with urosepsis and acute kidney injury (AKI). Over the course of his hospital stay, the patient's kidney function declines and he requires renal replacement therapy. The document poses questions at various points in the case and provides answers regarding evaluating and managing the patient's AKI. It emphasizes identifying reversible causes, preventing progression through fluid management, and considering RRT for severe AKI.
This document summarizes a clinical case conference on acute interstitial nephritis (AIN). It discusses the history, causes, diagnosis, prognosis and treatment of AIN. Experimental evidence suggests drug-induced AIN results from an immune reaction against renal antigens triggered by certain drugs. Retrospective studies indicate corticosteroid therapy may improve outcomes in AIN, though prospective trials are still needed.
Tubulointerstitial nephritis involves inflammatory reactions in the renal tubules and interstitium. It can be primary, secondary to other renal diseases, idiopathic, reactive to infections, or infectious itself. Acute tubular necrosis is characterized by tubular epithelial cell death due to ischemia or toxins and can cause acute kidney injury. Chronic tubulointerstitial nephritis develops over months or years and is associated with progressive loss of kidney function. It has many etiologies including drugs, infections, obstructive nephropathy, and autoimmune diseases.
This document discusses when intensive care unit patients should be referred to renal physicians. It notes key indicators for referral include single organ renal failure requiring ongoing care or abnormal kidney function that requires a renal diagnosis. The document outlines various acute and chronic kidney conditions and diseases that renal physicians evaluate and manage, including acute kidney injury, chronic kidney disease, glomerulonephritis, vasculitis, and issues in transplant patients like acute rejection. It emphasizes the importance of establishing diagnoses and developing management plans for renal patients that may involve specialized treatments.
This document summarizes care of the kidney during rheumatology practice. It discusses renal prostaglandins, chronic kidney disease stages, acute interstitial nephritis, NSAIDs, methotrexate, and leucovorin use for methotrexate overdose. Renal prostaglandins help maintain blood pressure and renal function. NSAIDs can cause acute interstitial nephritis and reduce kidney function. Methotrexate requires dose adjustments for impaired renal function.
Disease affecting tubules and interstitiumessamramdan
This document discusses disease affecting the renal tubules and interstitium. It begins by explaining that tubular injury often also involves the interstitium and can be inflammatory, as seen in interstitial nephritis, or ischemic, as seen in acute tubular necrosis. The document then goes on to describe various specific diseases in more detail, including tubulointerstitial nephritis of infectious and non-infectious origin, acute and chronic pyelonephritis, drug-induced interstitial nephritis, and analgesic nephropathy. It also provides morphological and clinical details of acute tubular necrosis.
1. Tubulointerstitial diseases involve the tubules and interstitium of the kidney to a greater degree than the glomeruli and vasculature. They can be primary or secondary due to progressive glomerular or vascular injury.
2. The tubulointerstitial compartment consists of everything other than the glomeruli and makes up the majority of the mature kidney. Injury can result from toxic insults, infections, drugs, or immunological processes.
3. Acute interstitial nephritis is characterized by infiltration of inflammatory cells like T cells and monocytes into the interstitium, sparing the glomeruli. It is commonly caused by drugs but can also result
1. Acute tubular necrosis is characterized by low epithelial lining, single cell necrosis, and casts in tubule lumens. Regenerative changes include nucleomegaly and mitosis. Ethylene glycol poisoning causes tubule swelling and vacuolization with oxalate crystals.
2. Acute interstitial nephritis shows interstitial inflammation with lymphocytes and macrophages invading tubules. Chronic interstitial nephritis displays tubular atrophy, fibrosis and hyaline casts.
3. Granulomatous interstitial nephritis is defined by granulomas that can be non-necrotizing or necrotizing. Causes include drugs, sarcoidosis
- Acute renal failure (ARF), also known as acute kidney injury (AKI), can have various causes including reduced renal blood flow, intrinsic renal injury, or urinary tract obstruction.
- Common etiologies of intrinsic renal injury include acute tubular necrosis, acute glomerulonephritis, and vascular disease. Acute tubular necrosis accounts for about 50% of cases and can result from ischemia, toxins like medications, or sepsis.
- Evaluation of a patient with suspected ARF includes history, physical exam, urinalysis, serum creatinine and electrolytes to determine the cause and exclude pre-renal or post-renal etiologies which require different management approaches.
Acute renal failure (ARF) is a sudden decrease in kidney function that results in the buildup of waste products in the blood. It can be caused by decreased blood flow to the kidneys, direct kidney damage, or urinary tract obstruction. The most common type is prerenal ARF due to low blood volume or pressure. Symptoms include thirst, dizziness, and reduced urine output. Treatment focuses on correcting the underlying cause, managing fluid balance and dialysis if needed. ARF is usually reversible but can last weeks depending on the severity of the initial insult.
This document discusses the pathophysiology of acute kidney injury (AKI). It covers pre-renal, post-renal and intrinsic renal AKI. For intrinsic renal AKI, it focuses on acute tubular necrosis (ATN). It describes the hemodynamic changes, endothelial dysfunction, inflammatory response and tubular injury that occur in ATN. Hemodynamic changes like renal hypoperfusion can cause ischemia. This results in endothelial activation, leukocyte recruitment and coagulation changes. Tubular injury involves loss of polarity, cytoskeleton disruption and cell death via necrosis or apoptosis. The document provides details on the molecular mechanisms and pathways involved in each step of the pathophysiological process of ATN.
This document defines and discusses acute renal failure (ARF), including its etiology, pathogenesis, investigations, management, and prognosis. ARF is a sudden, usually reversible loss of kidney function developing over days or weeks with reduced urine output. The etiology is divided into pre-renal, renal, and post-renal causes. Pre-renal ARF is due to decreased renal perfusion from conditions like heart failure or blood loss. Renal ARF includes acute tubular necrosis from ischemia or nephrotoxins. Post-renal ARF occurs from urinary tract obstruction. Management involves treating the underlying cause, fluid and electrolyte balance, and potentially renal replacement therapy. Prognosis depends on severity and
best Ckd presentation1 by Dr. sachin kr ranaSachin Rana
Chronic Kidney Disease is defined as a slow loss of renal function over time leading to decreased ability to remove waste from the body. It affects about 26 million people in the US and is increasing due to diabetes and hypertension. Pathophysiology involves a decrease in nephrons leading to adaptive changes that eventually cause glomerular sclerosis and further kidney function decline. Stages are based on Glomerular Filtration Rate from normal to end stage renal disease requiring dialysis. Treatment focuses on controlling hypertension, acidosis, electrolyte abnormalities, secondary effects like anemia and bone disease through diet, medication and potentially dialysis. Dialysis options include peritoneal dialysis with advantages of immediate initiation but risks of peritonitis
This document summarizes recent literature on acute renal failure (ARF). It discusses increasing incidence and mortality of ARF, as well as staging criteria like RIFLE and AKIN. Common causes of ARF include prerenal azotemia, acute tubular necrosis, interstitial nephritis, contrast-induced nephropathy. Treatment focuses on IV fluids, removing triggers, adjusting medications, and initiating dialysis for refractory complications. Prognosis depends on need for dialysis and presence of other organ failures.
1) Patients with cystic fibrosis (CF) are at increased risk of nephrocalcinosis and kidney stones due to enteric hyperoxaluria from antibiotic use and pancreatic insufficiency.
2) Older CF patients may develop proteinuria from renal amyloidosis or diabetic nephropathy.
3) Children with CF are more susceptible to aminoglycoside and NSAID nephrotoxicity due to sodium deficits, requiring careful therapeutic drug monitoring to avoid acute kidney injury.
This document provides an overview of acute renal failure in children. It defines acute renal failure, discusses causes (pre-renal, intrinsic renal, post-renal), pathogenesis, laboratory findings, biomarkers, management including fluid resuscitation, diuretics, electrolyte abnormalities, nutrition, and indications for dialysis. Management is aimed at treating the underlying cause and maintaining fluid, electrolyte and acid-base balance until renal function recovers.
The Pathophysiology Of Acute Renal FailureBayu_F_Wibowo
The document discusses acute renal failure and describes its three distinct phases:
1) Prerenal failure occurs when decreased blood flow to the kidneys leads to hypoperfusion and excess nitrogenous waste in the blood. Common causes include dehydration, heart failure, and hemorrhage.
2) Intrarenal failure involves direct damage to the kidney structure from toxins, inflammation, or ischemia. Necrosis can result from nephrotoxins or lack of blood flow and oxygen.
3) Postrenal failure is due to bilateral obstruction of urine outflow from the bladder, ureters, or urethra. Common causes of obstruction include enlarged prostate, tumors, blood
The document discusses various types of glomerular and tubulointerstitial diseases:
1. Glomerular diseases are caused by damage to the glomerulus and can manifest as nephritic syndrome, nephrotic syndrome, or hematuria. Common glomerular diseases include minimal change disease, membranous nephropathy, and focal segmental glomerulosclerosis.
2. Tubulointerstitial diseases involve damage to the renal tubules and interstitium. Acute interstitial nephritis is often caused by drug reactions while chronic interstitial nephritis can result from various insults like drugs, infections, toxins, and inherited conditions.
3
This document discusses acute renal failure (ARF), also known as acute kidney injury (AKI). It defines ARF, discusses its epidemiology and causes. The main causes of ARF are pre-renal (decreased blood flow/volume), renal (damage within the kidneys), and post-renal (obstruction of urine flow). The most common form of intrinsic ARF is acute tubular necrosis, often due to ischemia or nephrotoxins. Diagnosis involves lab tests of kidney function and urine analysis. Treatment focuses on identifying and reversing the underlying cause, maintaining fluid/electrolyte balance, and potentially initiating renal replacement therapy like dialysis.
1) Acute renal failure (ARF) is common in hospitalized patients and associated with high morbidity and mortality. It is often multifactorial, with identifiable risk factors.
2) The main causes of ARF are pre-renal (prerenal azotemia), acute tubular necrosis, and acute glomerulonephritis. Diagnosis involves laboratory and urinalysis evaluation.
3) Treatment of ARF focuses on supportive care like fluid management and avoiding further insults, as well as dialysis if needed. Prevention prioritizes maintaining euvolemia and avoiding nephrotoxins.
This document discusses acute renal failure (ARF), including its causes, diagnosis, and treatment. ARF can be prerenal, intrinsic renal, or post-renal in etiology. Common causes include acute tubular necrosis from hypotension or nephrotoxins, contrast nephropathy, and rhabdomyolysis. Diagnosis involves lab tests of serum creatinine and electrolytes, urinalysis, and urine indices. Treatment focuses on supportive care, reversing underlying causes, and dialysis for refractory complications like hyperkalemia or volume overload. Prevention prioritizes fluid balance, blood pressure control, and avoiding nephrotoxins.
08 Al Ghonaim Approach To Acute Renal FailureDang Thanh Tuan
The document discusses acute renal failure (ARF), including its definition, epidemiology, etiology, diagnosis, and treatment. ARF can be pre-renal, renal, or post-renal in origin. The most common cause is acute tubular necrosis, often from hypotension, sepsis, or nephrotoxins. Diagnosis involves lab tests of kidney function and urinalysis. Treatment focuses on fluid management, avoiding nephrotoxins, and possibly dialysis.
08 Al Ghonaim Approach To Acute Renal Failureguest2379201
The document discusses acute renal failure (ARF), including its definition, epidemiology, etiology, diagnosis, and treatment. ARF can be pre-renal, renal, or post-renal in etiology. The most common cause is acute tubular necrosis, often from hypotension, sepsis, or nephrotoxins. Diagnosis involves lab tests of kidney function and urinalysis. Treatment focuses on fluid management, avoiding nephrotoxins, and possibly dialysis.
The document discusses acute kidney injury (AKI), including its causes, diagnosis, and management. It provides details on prerenal, intrinsic, and postrenal forms of AKI. For prerenal AKI, management focuses on correcting the underlying cause, such as volume depletion, and restoring intravascular volume through fluid resuscitation. For intrinsic AKI, identifying and removing nephrotoxic agents is important. Dialysis may be needed for severe AKI with fluid/electrolyte imbalance or uremia.
This document provides an overview of acute renal failure (ARF), also known as acute kidney injury (AKI). It defines ARF, discusses epidemiology and etiology. For etiology, it distinguishes between pre-renal, renal, and post-renal causes of ARF and lists examples for each. It describes the clinical features, diagnosis, and management of ARF, including treatment and indications for renal replacement therapy. ARF is generally reversible if the underlying cause is addressed promptly. Differentiating between pre-renal, renal and post-renal ARF involves considering history, physical exam findings, lab tests and urine analysis.
Cirrhosis is a diffuse process characterized by liver necrosis and fibrosis that converts the normal liver architecture into abnormal nodules lacking lobular organization. It has many causes including alcohol, viral hepatitis, fatty liver disease, and genetic disorders. Clinically, it manifests as asymptomatic or symptoms like vomiting and weight loss. Complications arise from portal hypertension and include ascites, variceal bleeding, hepatic encephalopathy, and hepatorenal syndrome. Diagnosis involves liver function tests, imaging, and biopsy. Treatment focuses on managing complications and the underlying cause. For end-stage disease, liver transplantation may be required.
22 - Acute and chronic kidney failure.pptxStewardBwalya1
Most medical students graduate without knowing the diagnosis and management of acute and chronic kidney failure. Renal units requires you to have a thorough knowledge. So this presentation will assist you to have such knowledge
Azotemia is a medical condition characterized by abnormally high levels of nitrogen-containing compounds in the blood. It is usually caused by reduced kidney function and glomerular filtration rate. There are several potential causes of azotemia including prerenal issues like low blood volume, renal issues like acute tubular necrosis, and postrenal issues like urinary tract obstruction. The document discusses various lab tests and clinical findings that can help distinguish between these different underlying causes of azotemia and determine if the reduced kidney function is acute or chronic. Treatment depends on the specific cause but aims to improve kidney function and manage complications.
AKI is common in ICU patients and is associated with high mortality. It is defined based on changes in serum creatinine and urine output. The RIFLE criteria is commonly used for classification. Causes include prerenal, intrinsic renal and post renal factors. Treatment involves identifying and treating the underlying cause, fluid resuscitation, and renal replacement therapy like intermittent hemodialysis or continuous renal replacement therapy as needed. Prevention strategies focus on ensuring adequate perfusion and minimizing nephrotoxins. Outcomes remain poor despite treatment.
1. A patient history and physical examination are crucial for assessing the cause of acute kidney injury (AKI). Laboratory tests can help distinguish between pre-renal, intrinsic renal, and post-renal causes of AKI.
2. Common causes of intrinsic AKI include acute tubular necrosis, acute interstitial nephritis, and glomerular diseases. Acute tubular necrosis can be ischemic or nephrotoxic in origin.
3. Evaluation of AKI involves renal function tests, urine analysis, fractional excretion of sodium, and other tests. Imaging such as ultrasound or CT scan may be used when the underlying cause is unclear.
Acute renal failure (ARF) is defined as a rapid reduction in kidney function resulting in build-up of waste products. It can be prerenal (functional), renal (structural), or postrenal (obstruction). Common causes include decreased blood flow, nephrotoxins, and urinary tract obstruction. Patients may present with edema, electrolyte abnormalities, and uremic symptoms. Diagnosis involves urine and blood tests. Treatment focuses on treating the underlying cause, fluid management, and sometimes dialysis.
In this presentation I have tried to cover renal disorder associated with vascular pathology of kidney. Classification, various disorder in detail with histopathology images H&E and special stains and clinical presentations. Hope it helps understanding the entity better.
This document provides an overview of cirrhosis and its complications. It defines cirrhosis as a chronic liver disease characterized by diffuse fibrosis and nodular regeneration. The main causes are chronic viral hepatitis, alcohol, and non-alcoholic fatty liver disease. Complications include portal hypertension, ascites, hepatic encephalopathy, and hepatorenal syndrome. Diagnosis involves clinical evaluation, labs, imaging, and sometimes biopsy. Treatment focuses on managing complications, addressing the underlying cause, and potentially liver transplantation for decompensated cirrhosis.
Cirrhosis can lead to several serious complications including ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, portal hypertension, variceal bleeding, hepatorenal syndrome, and hepatocellular carcinoma. The document outlines the pathophysiology, clinical presentation, diagnostic approach, and treatment options for each of these common complications of cirrhosis. It provides detailed guidance on managing ascites, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome.
Cirrhosis is a diffuse process characterized by liver necrosis and fibrosis that converts the normal liver architecture into abnormal nodules. It has many causes including viral hepatitis, alcohol, autoimmune conditions, and genetic disorders. Cirrhosis can lead to complications from portal hypertension such as variceal bleeding and ascites. It is diagnosed based on clinical findings, lab tests, imaging, and may require liver biopsy. Treatment focuses on managing complications and potentially liver transplantation.
Cirrhosis is a diffuse process characterized by liver necrosis and fibrosis that converts the normal liver architecture into abnormal nodules lacking normal structure. It has many causes including viral hepatitis, alcohol, autoimmune conditions, and genetic disorders. Complications of cirrhosis arise from portal hypertension and liver insufficiency, leading to variceal bleeding, ascites, encephalopathy, and jaundice. Cirrhosis is diagnosed based on clinical signs, lab tests, imaging, and may involve liver biopsy. Management focuses on treating complications and screening for hepatocellular carcinoma.
1) Procedural sedation is used for many medical procedures and aims to provide analgesia, amnesia, and reduce anxiety while maintaining airway reflexes and spontaneous breathing.
2) While pulse oximetry became standard in the 1980s, capnography has emerged as the new gold standard for monitoring procedural sedation as it can detect respiratory issues that oximetry may miss.
3) Overlake Hospital implemented capnography monitoring for all procedural sedations after reviewing evidence and determining it was more effective for patient safety than relying on respiratory therapists to continuously monitor each procedure.
The evolution of pediatric mechanical ventilatorsDang Thanh Tuan
1. Mechanical ventilators have evolved from simple analog machines to sophisticated microprocessor-controlled devices with advanced modes of ventilation.
2. Early ventilators were open-loop controlled while modern ventilators use various closed-loop and dual-loop control schemes to better match ventilation to patient needs.
3. The newest generations of ventilators use proportional assist, automatic tube compensation, adaptive support ventilation, and other advanced modes that aim to provide more patient-synchronized support and facilitate weaning. However, further research is still needed to fully understand the outcomes of these newer ventilation strategies.
The document discusses various methods of patient monitoring during anesthesia, including their purposes, advantages, and limitations. It covers monitoring vital signs, standards for basic anesthesia monitoring according to the ASA, techniques like non-invasive blood pressure monitoring, ECG, pulse oximetry, capnography, and invasive arterial line monitoring. Key aspects emphasized are integrating multiple monitoring methods to evaluate oxygenation, ventilation, and circulation.
The document discusses the introduction and clinical applications of volumetric capnography (VCO2) at one hospital. It provides an agenda for the topics covered, which include VCO2 management, clinical applications, and data from the University of Tennessee Medical Center's experience using VCO2. Key applications discussed are ventilation management, monitoring changes in perfusion, optimization of positive end-expiratory pressure, and assisting with ventilator weaning trials. The University of Tennessee Medical Center saw decreases in length of mechanical ventilation, ventilator days, and re-intubation rates after implementing VCO2 monitoring.
18 basics of pediatric airway anatomy, physiology and managementDang Thanh Tuan
The document provides an overview of pediatric airway anatomy, physiology, and management. It discusses the differences between pediatric and adult airways, including a more rostral larynx, relatively larger tongue, angled vocal cords, differently shaped epiglottis, and funneled larynx in children. It also reviews normal airway management techniques like bag-mask ventilation and various airway devices, as well as complications from intubation. The goal is to protect, adequately ventilate, and oxygenate the pediatric airway.
The document discusses the use of capnography for non-intubated patients experiencing trouble breathing. It describes how capnography can help identify and monitor conditions like bronchospasm from asthma or COPD by examining patterns in exhaled carbon dioxide levels. Specific capnographic signatures are presented for different respiratory conditions including asthma attacks, COPD exacerbations, congestive heart failure, and hypoventilation states. Case studies demonstrate how capnography can track changes in a patient's condition before and after treatment.
Capnography can be used to summarize 3 key applications for intubated patients:
1) It can confirm correct endotracheal tube placement and detect displacement. Characteristic waveforms indicate proper vs displaced placement.
2) During CPR, it can assess the effectiveness of chest compressions by correlating end-tidal CO2 levels with cardiac output and blood flow.
3) It provides an early indicator of return of spontaneous circulation through a rapid rise in CO2 levels, earlier than other signs like pulse or blood pressure. It also aids the decision to cease resuscitation efforts based on CO2 levels.
Capnography measures exhaled carbon dioxide (CO2) to provide real-time monitoring of ventilation, unlike pulse oximetry which monitors oxygen saturation in the blood and is slower to detect changes. A normal capnographic waveform has four phases: 1) dead space, 2) ascending, 3) alveolar plateau, and 4) descending. The end-tidal CO2 value reflects the highest CO2 concentration in exhaled air and typically ranges from 35-45mmHg. Capnography can immediately detect conditions that impact ventilation such as hypoventilation, hyperventilation, and bronchospasm based on changes to the waveform shape, frequency, and CO2 values.
This document provides an overview of capnography, which is a technology that objectively measures ventilation by detecting exhaled carbon dioxide. It can be used for both intubated and non-intubated patients to continuously monitor ventilation and the patient's ABCs. The document reviews the history of capnography, from its initial use in operating rooms to new portable technologies suitable for emergency medical services. It also outlines the clinical applications of capnography such as verifying endotracheal tube placement and monitoring treatment effectiveness.
Dr. Ajmal Eusuf discusses the importance and benefits of capnography monitoring in the ICU. Capnography can be used to confirm proper endotracheal tube placement, monitor ventilation, and detect various respiratory issues. While capnography is standard practice in operating rooms and recommended by guidelines, only about half of UK ICUs currently use it as a mandatory monitoring tool. Adopting capnography as routine bedside monitoring in the ICU would help compliance with protocols and better patient care, especially for critically ill patients who are sicker than those in operating rooms.
The document discusses two options for capnography monitoring from ZOLL - the CAPNOSTAT 3 mainstream CO2 sensor and the LoFlo sidestream CO2 module. It provides details on the benefits of each, such as the CAPNOSTAT sensor's accuracy and resistance to contaminants, and the LoFlo module's interchangeability and low 50ml/min sampling rate. The document emphasizes that both provide reliable, accurate CO2 monitoring and waveforms for assessing patient ventilation.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
3. Differentiating ARF vs.
Chronic Renal Failure (CRF)
1) History
2) Oliguria = ARF; acute CRF decompensation
3) Renal ultrasound
• Normal or large = acute
• CRF – small (unless PKD, diabetes, amyloid)
4) ARF =Unstable azotemia (↑ or ↓ over days)
5) Anemia – unreliable for ARF vs. CRF
6) ↑PO4, ↑K+, metabolic acidosis, ↑uric acid –
little diagnostic value
7) Urinalysis – no value unless normal
suggesting pre-renal azotemia
4. Pre-Renal Azotemia
Definition:
A reduction in glomerular filtration rate (GFR)
due to a ↓ glomerular capillary pressure
Diagnosis:
Characteristic clinical setting and urinary
findings
Response to the correction of the presumptive
pre-renal state
6. Pre-Renal Azotemia: Renal
Manifestations
1) Na+ avidity
2) Relatively normal urinalysis
3) Relatively normal serum bicarbonate
4) High BUN/creatinine ratio (not always)
5) High urine osmolality (typically >600
mosm/kg)
7. Pre-Renal Azotemia:
Confounding Diagnostic
Variables
1) A low urine Na+ is not unique – Found in:
• Non-oliguric ATN, especially contrast-induced
• Early urinary tract obstruction
• Acute glomerulonephritis
2) Diuretic use can obfuscate the urine Na+
and urine osmolality
3) Jaundice – muddy brown granular casts
4) Poor dietary intake lowers the BUN/Cr ratio
8. Hepatorenal Syndrome (HRS)
Definition: “Irreversible” pre-renal azotemia in
the setting of end-stage hepatic disease
Pathogenesis:
1) Unrelenting renal vasoconstriction induced
by unknown mediators
2) Renin/angiotensis, endothelin, NO,
prostanoids, endotoxin, ↑sympathetic tone
all implicated; none proven and may reflect
secondary phenomena
9. HRS: Differential Diagnosis
1) Rule out volume depletion by volume
challenge
2) Rule out combined hepatic and renal
epithelial injury
3) Rule out ATN (which is common in the
HRS patients)
10. HRS: Therapy
1) Portal-systemic shunts: acute, but not long-
term benefits
2) Paracentesis: no proven benefit; may
precipitate ARF
3) Vasodilator therapy: no proven benefit
4) Dialysis:
• IF a possibility of hepatic functional recovery
• IF there is a likelihood of ATN (high urine Na+;
urine sediment not helpful)
5) Hepatic transplantation
11. Obstructive Nephropathy
1) Incidence: ≈ 5-10% ARF cases
2) Causes: in part segregates according to
age:
• Children: anatomic (urethral valves,
ureteral-vesicle or ureteral-pelvic
stenoses)
• Young adults: stones; retroperitoneal
processes (tumor, infections)
• Elderly: GU tumors (bladder, cervical);
BPH
15. Urinary Tract Obstruction
Diagnosis
4) Renal CT:
• Obtain if high index of suspicion with
dubious ultrasound
• Can help localize the site of obstruction
5) Retrograde pyelogram:
The gold standard: diagnostic and often
leads to immediate therapy (i.e., stints)
16. Urinary Tract Obstruction:
Treatment and Prognosis
1) Drainage
• Foley catheter
• Retrograde pyelography/stints
• Percutaneous nephrostomy
2) Treat Underlying Disease
3) Prognosis depends on:
• Chronicity (relatively good if < 1 week; little if >
12 weeks; but highly variable)
• Coincidental diseases (e.g., UTI)
4) Rate of recovery
• Much within 48-72 hours
• Most within 2 weeks
17. Acute Glomerulonephritis
(GN) / Glomerulopathy
1) Incidence: ≈5-10% of cases of ARF
2) Setting:
• Idiopathic
• Post-infectious
• Collagen vascular disease
• Flair of chronic GN (e.g., IgA
nephropathy)
18. Acute GN
3) Pathogenesis
• Direct interference with glomerular
capillary function
• Altered tubular function
• Protein cast formation
• Tubular injury 2° glomerular bleeding
• Potential hemodynamic component to the
ARF (diuretics, NSAIDs, ACE inhibitors)
• “Nephrosarca”: ARF in minimal change
disease
19. Acute GN
4) Diagnosis:
• RBC casts (not always)
• Heavy proteinuria (not always, e.g.
IgA nephropathy)
• Lack of other compelling diagnoses
• Renal biopsy
29. Causes of Drug-Induced AIN
• Quinolones (ciprofloxacin)
• Anti-tuberculous agents – rifampin,
INH, ethambutol
• Sulfonamides: antibiotics (Bactrim);
diuretics (furosemide, thiazides)
• Miscellaneous: over 200 drugs
implicated; most not proven
• Allopurinol, cimetidine, dilantin (proven)
30. NSAID-Associated Interstitial
Nephritis
1) Onset: Days to months after initiating
therapy
2) Presentation:
• Heavy proteinuria/nephrotic syndrome
(85% ARF cases)
• ARF without heavy proteinuria
• Fever, rash, eosinophilia uncommon
31. NSAID-Associated Interstitial
Nephritis
3) Diagnosis:
• Characteristic presentation
• Consider other NSAID associated renal
syndromes (hemodynamic and ischemic ARF)
• Consider trial of drug withdrawal prior to biopsy
• Biopsy
• Interstitial edema, infiltration with lympocytes, rarely
granulomas
• Negative immunofluorescence
• Foci of ATN
32. NSAID-Associated Interstitial
Nephritis
4) Treatment:
• Stop agents
• ?? Benefit of steroids
5) Prognosis:
• Generally reversible after weeks (up to a
year)
• May cause chronic renal
insufficiency/ESRD (unlike NSAID-
induced hemodynamic ARF)
33. Urinary Eosinophils:
Diagnostic Utility
1) Suggestive of allergic interstitial nephritis
2) False Negatives
• NSAID associated AIN
• Use of Wright stain, not Hansel stain
3) False Positives
• UTI, especialy prostatitis
• RPGN – RBCs, heavy proteinuria
• Atheroembolic renal disease
4) Significance
• 1-5% considered positive
• Consistent with but not diagnostic of AIN
• Interpret in context of clinical setting
34. Acute InterstitialNephritis
Treatment
1) Treat underlying disease
• Infections
• Withdraw offending agent
2) Trial of corticosteroids, particularly for
allergic interstitial nephritis
• 1mg/kg/day or 2mg/kg/day QOD
• If no response in 1-2 weeks, biopsy
• If no response in 4-6 weeks, cyclophosphamide
3) Results
• Reversal of real failure
• No randomized trials proving steroid efficacy
35. Chinese Herb Nephropathy
1) Chinese herbs for weight reduction
• Aristolochic acid has been implicated in some,
not all cases
• Some contain NSAIDs
2) Only some users affected
• Women > Men
• Batch to batch variation
• Individual variations in metabolism?
3) Presentation/course
• Often rapidly progresive real dysfunction
• May → irrevesible renal failure even after
withdrawal
36. Chinese Herb Nephropathy
4) Diagnosis:
• Clinical setting
• Typical tubulointerstitial disease
presentation (little proteinuria, no RBC
casts)
• Biopsy: tubular destruction, interstitial
inflammation/fibrosis: glomerulosclerosis
5) Therapy:
• Withdraw agents
• Steroids may be efficacious (1mg/kg x 1
month; followed by taper)
37. Intratubular Obstruction
Associated ARF
A. Crystalluria associated ARF
1) Ethylene glycol (oxalate crystals)
• Osmolar gap: measured – calculated>10-15
• Oxalate crystals in urine
• Severe anion gap metabolic acidosis
• Encephalopathy (drunk)
• Pulmonary infiltrates/CHF
• Confirm by blood level (start treatment with a
presumptive diagnosis alcohol/dialysis)
38. Intratubular Obstruction
Associated ARF
A. Crystalluria associated ARF
2) Acute urate nephropathy
• Diagnosis: urate > 18mg/dL due to
overproduction, not uderexcretion
• Correct clinical setting
– Chemotherapy
– Spontaneous tumr lysis syndrome (HIV-associated
Burkitt’s)
3) Medication-induced intratubular
precipitation
• Acyclovir (high dose)
• Methotrexate (high dose)
• Sulfonamides (rare; more likely to cause AIN)
40. Ischemic Acute Renal Failure
1) Definition: Onset of ARF in the aftermath of
relatively modest hypertensive events
2) Morphology
• Sporadic foci of tubular necrosis (<10% cells)
• May involve late proximal tubule, or Henle’s thick
ascending limb
• Sloughing of viable cells into the tubular lumen
• Vascular congestion/neutrophil accumulation
41. Ischemic Acute Renal Failure
3) Pathogenesis of filtration failure:
• Tubular obstruction
• Backleak
• Renal vasoconstriction (2° obstruction)
4) Course: Reversibility is its hallmark
5) Treatment
• Re-establish hemodynamic stability
• Early renal vasodilator/diuretic therapy to abort
ARF
• Supportive management/ early or “prophylactic”
dialysis
43. Common Nephrotoxins
2) Exogenous Nephrotoxins
• Chemotherapeutic agents
• Cisplatin
• High dose methotrexate
• Streptozocin
• Mitomycin C
• Heavy metals
• Radiocontrast agents
• Ethylene Glycol
3) Vasoactive ARF
• ACE inhibitors, NSAIDs, CSA/ FK-506, IL-2,
endotoxin
44. Aminoglycoside
Nephrotoxicity
1) Incidence: Dependent on duration of
treatment (10% and 40% after 7 and 14
days, respectively)
2) Clinical manifestations
• Generally non-oliguric ARF
• ↓Mg++, ↓K+, glycosuria
3) Mechanisms: Proximal tubular active
transport→lysosomal overload
→phospholipidosis altered phospholipase
signallingmechanisms: Proximal tubule
necrosis
45. Aminoglycoside
Nephrotoxicity
4) Risk factors:
• Dose and duration
• Volume depletion/ ↓GFR (prior renal disease;
old age)
• Oter nephrotoxins, concomitant ischemia
5) Prevention
• Appropriate dosing for GFR
• Remove reversible factors
• QD dosing if possible
• Stop ASAP
• Monitor trough levels (but may only represent
insipient renal failure, rather than prevent it)
46. Cyclosporine Nephrotoxicity
1) Spectrum
• Acute vasomotor nephropathy
• Hemolytic Uremic Syndrome
• Chronic obliterative arteriolopathy/stripped
interstitial fibrosis
2) Diagnosis
• Nothing definitive other than clinical setting and
response to dose/withdrawal
• Drug levels only help to support the diagnosis
3) Prevention
• Watch drugs that ↑ cyclosporine level
• Monitor drug trough levels (weak guide)
• Possible benefit of calcium channel blockers
47. Management of ARF
1) Attempt to prevent ARF:
• Reverse volume depletion/renal ischemia
• Stop nephrotoxic agents if possible
2) Attempt to abort ARF:
• Usually only possible with ischemia
• Vasodilator therapy (dopamine ± ANF)
• Diuretic therapy
48. Management of ARF
3) Conservative management:
• Avoid nephrotoxins
• Fluid/electrolyte balance
• Treat underlying illness (the prime determinant
of recovery)
• Nutritional support
4) Dialysis:
• Prophylactic treatment (BUN<120)
• Biocompatible membranes may be preferable
• Intermittent vs. continuous (no compelling
evidence favoring one; individualize treatment)