33 ellabban care of the kidney during daily
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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.
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The history, and physical examination
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Clinical differentiation of major nephrological syndromes.
Establishing possible cause(s).
Finding evidence of associated multisystem disease
Excluding confounding non-glomerular disease (e.g. urological)
Evaluation & grading renal function.
Estimate complication (s)
Report previous management to which the patient was subjected to and its outcome.
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CIN ,third most common cause of AKI.
asymptomatic.
prevention is the one to be emphasised in case of CI-AKI.
Ac nephritic synd
Acute nephritic syndrome is characterized by inflammation of the glomeruli that can damage the basement membrane. It is typically caused by a preceding streptococcal infection. The classic presentation includes hematuria, edema, and hypertension. Workup involves renal function tests, urinalysis showing hematuria and proteinuria, and evidence of prior streptococcal infection via antibody titers. Treatment is symptomatic with diuretics for edema and blood pressure control. Renal biopsy may be needed if atypical or persistent features are present.
Cirrhosis complications
Cirrhosis is a disease where the liver transforms into regenerating nodules surrounded by fibrous bands. Common causes include alcoholism, viral hepatitis, and non-alcoholic steatohepatitis. Complications include portal hypertension, ascites, hepatic encephalopathy, and hepatorenal syndrome. Portal hypertension is defined as a hepatic venous pressure gradient over 5 mmHg and can cause variceal bleeding, ascites, and hypersplenism. Ascites is treated initially with sodium restriction and diuretics, while refractory ascites may require paracentesis, TIPS, or liver transplant. Hepatic encephalopathy is caused by increased ammonia and treated with lactulose and rifaxim
Fibrosis[1]
Cirrhosis results from fibrosis and nodular regeneration of the liver. It leads to increased resistance to blood flow within the liver and portal hypertension. Common complications include variceal bleeding, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, and hepatorenal syndrome. Treatment focuses on managing the complications through medications, dietary changes, paracentesis, and sometimes transplantation. Prognosis depends on disease severity and presence of complications.
Renal-_Nephrotoxic_Drugs.pdf
Nephrotoxic drugs can damage the kidneys by several mechanisms. Certain patient characteristics like older age, pre-existing kidney disease, and volume depletion increase risk. Common nephrotoxic drug classes include antibiotics, chemotherapy drugs, antivirals, NSAIDs, and statins. Drugs may cause acute kidney injury through effects on hemodynamics, tubular toxicity, inflammation, crystal formation, or rhabdomyolysis. Early recognition of rising creatinine and discontinuing the offending drug is important to reverse damage. Preventing nephrotoxicity requires assessing risks, monitoring for injury, and avoiding unnecessary nephrotoxic medications.
Non Glomerular Disease
Tubulointerstitial nephropathy can be acute or chronic and is characterized by inflammation and scarring of the kidney tubules and surrounding tissue. Acute causes are often toxins or ischemia while chronic causes include obstructive uropathy, vesicoureteral reflux, analgesics, and heavy metals. Polycystic kidney disease is a common hereditary condition where numerous cysts develop in the kidneys, often leading to end-stage renal disease. Medullary sponge kidney is a benign condition present from birth that causes kidney cysts and issues like hematuria, urinary tract infections, and kidney stones.
1.primary glomerular diseases
Primary glomerular diseases include various forms of glomerulonephritis and nephrotic syndrome. Acute glomerulonephritis is defined by the sudden onset of hematuria, proteinuria, and red blood cell casts. It is caused by an immunological reaction, often due to a streptococcal infection, that results in inflammation and proliferation in the glomerulus. Symptoms include edema, hypertension, and decreased kidney function. Treatment involves a low sodium diet, fluid restriction, antibiotics, corticosteroids, diuretics, and dialysis if needed. With treatment, most cases of acute glomerulonephritis resolve though some may progress to chronic kidney disease.
Acute Kidney Failure in children.pptx
This document discusses acute kidney injury (AKI) in children. It defines AKI and describes the staging system used to classify it. The causes of AKI are divided into pre-renal, renal, and post-renal. The major causes in each category are outlined. Clinical evaluation involves obtaining history, physical exam, and initial lab tests. Imaging and renal biopsy may also be used for diagnosis. Management focuses on fluid balance, electrolyte control, treating the underlying cause, and providing nutrition. Dialysis is indicated for severe fluid overload, hyperkalemia, acidosis, or neurological symptoms.
Vasculits syndrome
This document discusses several types of vasculitis:
- Wegener's granulomatosis is a necrotizing vasculitis that commonly affects the lungs and kidneys. It is associated with cytoplasmic ANCA and affects small vessels.
- Microscopic polyangiitis is a pauci-immune vasculitis mainly involving small vessels. It commonly causes glomerulonephritis and pulmonary capillaritis.
- Churg-Strauss syndrome is characterized by asthma, eosinophilia, and vasculitis affecting multiple organ systems. It is associated with perinuclear ANCA.
Nephro pathological correlation
This document provides an overview of nephro-pathological correlation and the approach to kidney disease. It discusses the reasons for referral to a nephrologist, major kidney syndromes, indications for renal biopsy, urinalysis findings including hematuria and proteinuria, causes of glomerular and secondary proteinuria, history and exam findings, and laboratory evaluation for nephritic and nephrotic syndrome. Specific diseases discussed include IgA nephropathy, anti-GBM disease, ANCA-associated vasculitis, cryoglobulinemia, infection-related glomerulonephritis, and FSGS.
clinical approach to Rapidly Progressive Glomerulonephritis
This document discusses rapidly progressive glomerulonephritis (RPGN). It begins by describing the original use of the term RPGN and the discovery of anti-glomerular basement membrane (GBM) antibody's role in Goodpasture syndrome. It then discusses three main types of RPGN - anti-GBM antibody disease, immune complex disease, and pauci-immune disease. The document provides details on the clinical presentation, pathogenesis, treatment and prognosis of each type. It highlights that plasmapheresis and immunosuppression can benefit 40-45% of patients with anti-GBM antibody RPGN by preventing progression to end-stage renal disease or death.
Acute Kidney Injury
This document provides an overview of acute kidney injury (AKI), formerly known as acute renal failure. It discusses the definition and epidemiology of AKI and describes the main causes as pre-renal, intrinsic renal, and post-renal. Pre-renal AKI is the most common type and is caused by reduced renal blood flow. The document outlines the diagnostic evaluation, complications, treatment approaches including dialysis indications, and outcomes of AKI. It emphasizes the importance of identifying and eliminating nephrotoxic agents to optimize management of this condition.
Aki
AKI is defined as an increase in serum creatinine concentration within 48 hours or 1.5 times the baseline within 7 days. It can be prerenal, intrinsic, or postrenal. Prerenal AKI is reversible if renal perfusion is optimized through fluid resuscitation and vasopressors. Intrinsic AKI is commonly caused by sepsis, ischemia, nephrotoxins and has a worse prognosis. Treatment focuses on treating the underlying cause, managing complications like fluid overload, and starting renal replacement therapy for severe cases.
Brief Review Of Chemotherapeutic Agents And Renal Failure
The document provides an overview of chemotherapeutic agents that can cause renal failure. Several classes of chemotherapy drugs like cisplatin, carboplatin, cyclophosphamide, ifosfamide, and nitrosoureas are discussed in terms of their mechanisms of nephrotoxicity and clinical manifestations. Strategies for prevention and management of renal toxicity from chemotherapy are also briefly reviewed.
Secondary glomerular disorders.pptx
This document provides an overview of secondary glomerular disorders, including definitions and key details about specific conditions like diabetic nephropathy, hypertensive nephropathy, lupus nephropathy, membranoproliferative glomerulonephritis, post-streptococcal glomerulonephritis, Goodpasture syndrome, dysproteinemias, sickle cell nephropathy, HIV nephropathy, granulomatosis with polyangiitis, and polyarteritis nodosa. It discusses the pathophysiology, clinical features, diagnostics, and management of each condition. Terminology related to glomerular diseases and the structure of the glomerular
Sle complication
- The document discusses lupus nephritis, its incidence, presentation, pathogenesis, classification, and management.
- Renal biopsy is important for assessing disease activity and chronicity to guide treatment, which typically involves immunosuppressants like mycophenolate or cyclophosphamide combined with corticosteroids.
- Prognosis depends on the WHO classification - classes I-II have excellent prognosis while classes IV-VI have poorer renal outcomes if not treated aggressively.
19 Acute Glomerulonephritis
Acute Poststreptococcal Glomerulonephritis (APSGN) is caused by certain strains of Group A streptococci that infect the throat or skin. It presents with hematuria, edema, hypertension, and sometimes acute renal failure. The kidneys show enlarged glomeruli with immune complex deposition on the glomerular basement membrane. Treatment focuses on supportive care with bed rest, salt restriction, diuretics for hypertension or edema, and antibiotics to limit spread of infection. The condition usually resolves spontaneously within a few weeks.
Treatment of Systemic Lupus
Treatment for systemic lupus erythematosus (SLE) should be tailored to each patient based on an assessment of disease activity, damage, and comorbidities. Lupus nephritis, a form of kidney involvement, affects about 1/3 of SLE patients and can lead to end-stage renal disease if not properly treated. Treatment involves immunosuppressive drugs like corticosteroids, cyclophosphamide, mycophenolate, and azathioprine to induce remission based on the class of lupus nephritis determined by renal biopsy. Prognosis is generally good if treatment can normalize kidney function and blood pressure.
Nephrotic syndrome final shivaom
Nephrotic syndrome is defined by heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia. It is caused by damage to the glomerular basement membrane that increases pore size and protein leakage. Loss of protein like albumin leads to edema as serum oncotic pressure decreases. Steroids are first line treatment but some patients are steroid resistant. Kidney biopsy guides treatment, which may include immunosuppressants for steroid resistant forms. Complications include infection, hypercoagulability, and renal failure.
Urinary System
The document discusses urinary tract infections (UTIs), including:
- Causes of UTIs are usually bacteria like E. coli entering the urethra and multiplying in the bladder or kidneys.
- Symptoms include frequent urination, painful burning during urination, and sometimes fever with kidney infections.
- Treatment involves antibiotics chosen based on urine tests identifying the bacteria and sensitivity tests to select the most effective drug.
Similar to 33 ellabban care of the kidney during daily (20)
clinical approach to Rapidly Progressive Glomerulonephritis
clinical approach to Rapidly Progressive Glomerulonephritis
Brief Review Of Chemotherapeutic Agents And Renal Failure
Brief Review Of Chemotherapeutic Agents And Renal Failure
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07 capnography trends in procedural sedation
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.
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20 patient monitoring
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19 introduction of volumetric capnography
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18 basics of pediatric airway anatomy, physiology and management
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17 capnography part4 non-intubated
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.
16 capnography part3 intubated
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.
15 capnography part2 introduction
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.
14 capnography part1 overview
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.
13 icu monitoring standards and capnography
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.
12 mainstream sidestream capnpgraphy
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.
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33 ellabban care of the kidney during daily
- 2. Kidney Diagram Capsule Renal Vein Renal Artery Cortex Pyramid Papilla Calyx Pelvis Ureter Column Medulla Nephron
- 8. 5 Stages of Chronic Kidney Disease ( K/DOQI) define CKD as The presence of kidney damage or a reduction in the GFR for > 3 months. GFR Description Stage More than 90 Risk factors for kidney disease (e.g., diabetes, high blood pressure, family history, older age. At increased risk More than 90 Kidney damage (protein in the urine) and normal GFR 1 60 to 89 Kidney damage and mild decrease in GFR 2 30 to 59 Moderate decrease in GFR 3 15 to 29 Severe decrease in GFR 4 Less than 15 Kidney failure (dialysis or kidney transplant needed) 5
- 11. TIN are diseases involving tubules and or the interstitium outside the glomerulus. The renal cortex shows a diffuse interstitial, mononuclear infiltrate with intact glomerulus. Tubules in the center of the field are separated by inflammation and edema.
- 33. Thank you
- 34. Thank you