PowerPoint presentation reviewing renal failure. The review discusses both acute and chronic renal failure. Etiology, assessment, diagnosis and treatment are discussed.
This document defines acute kidney injury (AKI), formerly known as acute renal failure (ARF), and discusses its causes, diagnosis, and management. AKI is defined based on increases in serum creatinine and decreases in urine output. The main causes of AKI are pre-renal (decreased renal blood flow), renal (intrinsic kidney injury), and post-renal (urinary tract obstruction). Common etiologies include acute tubular necrosis, glomerulonephritis, and acute interstitial nephritis. Diagnosis involves laboratory and imaging tests. Management focuses on treating the underlying cause, fluid management, and potentially renal replacement therapy. Prognosis depends on the severity and reversibility of the kidney injury
This document provides an overview of acute kidney injury (AKI). It discusses the definition, epidemiology, etiology, pathophysiology, diagnosis and treatment of AKI. Some key points:
- AKI accounts for 5-7% of acute care hospital admissions and 30% of ICU admissions, with mortality rates as high as 50%. It can worsen chronic kidney disease and increase the risk of end-stage renal disease.
- Causes include pre-renal issues like hypovolemia, renal issues like acute tubular necrosis, and post-renal issues like obstruction. Diagnosis involves history, physical exam, lab tests of kidney function and imaging.
- Treatment focuses on optimizing
Disorders of the renal functions, including anatomy and physiology, acute kidney injury, chronic kidney disease, glomerular disease, nephrolithiasis, polyuria, renal acidosis and HIV-associated nephropathy (HIVAN).
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.
This document discusses the evaluation and differential diagnosis of dysuria (painful urination) in adults. It defines dysuria and notes that acute cystitis is a common cause. The pathophysiology involves sensory nerves in the bladder being irritated by chemical or inflammatory stimuli. Common causes of dysuria include urinary tract infections (UTIs), vaginitis, prostatitis, and STIs. The history and physical exam aim to determine timing, location, and associated symptoms. Laboratory tests like urinalysis and cultures can help diagnose a UTI as a cause. Cultures are recommended for complicated cases or when symptoms don't improve with initial treatment.
Acute Kidney Injury (AKI) is a common complication, affecting 5-7% of hospital admissions and 30% of intensive care unit patients. The top causes of AKI in India are diarrheal diseases, sepsis, malaria, drug toxicity, and hospital-acquired injuries. Biomarkers like cystatin C and kidney injury molecule 1 can help detect AKI earlier than creatinine. Treatment involves fluid resuscitation, eliminating nephrotoxins, and renal replacement therapy for complications like electrolyte imbalances or uremia. Outcomes depend on the underlying cause, with pre-renal and post-renal AKI having a better prognosis than intrinsic renal injury.
Chronic pyelonephritis is a chronic inflammation of the renal tubules and interstitium that occurs due to recurrent urinary tract infections and scarring. It most commonly affects children with congenital anomalies or spinal cord injuries and is the leading cause of end-stage renal disease. It is typically caused by either chronic obstructive pyelonephritis due to obstruction of urine outflow, or reflux nephropathy caused by vesicoureteral reflux allowing urine to flow back into the kidneys. Symptoms may include fever, flank pain, and symptoms of chronic renal failure like hypertension. The condition can lead to complications like proteinuria, focal glomerulosclerosis, and papillary necrosis.
This document defines acute kidney injury (AKI), formerly known as acute renal failure (ARF), and discusses its causes, diagnosis, and management. AKI is defined based on increases in serum creatinine and decreases in urine output. The main causes of AKI are pre-renal (decreased renal blood flow), renal (intrinsic kidney injury), and post-renal (urinary tract obstruction). Common etiologies include acute tubular necrosis, glomerulonephritis, and acute interstitial nephritis. Diagnosis involves laboratory and imaging tests. Management focuses on treating the underlying cause, fluid management, and potentially renal replacement therapy. Prognosis depends on the severity and reversibility of the kidney injury
This document provides an overview of acute kidney injury (AKI). It discusses the definition, epidemiology, etiology, pathophysiology, diagnosis and treatment of AKI. Some key points:
- AKI accounts for 5-7% of acute care hospital admissions and 30% of ICU admissions, with mortality rates as high as 50%. It can worsen chronic kidney disease and increase the risk of end-stage renal disease.
- Causes include pre-renal issues like hypovolemia, renal issues like acute tubular necrosis, and post-renal issues like obstruction. Diagnosis involves history, physical exam, lab tests of kidney function and imaging.
- Treatment focuses on optimizing
Disorders of the renal functions, including anatomy and physiology, acute kidney injury, chronic kidney disease, glomerular disease, nephrolithiasis, polyuria, renal acidosis and HIV-associated nephropathy (HIVAN).
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.
This document discusses the evaluation and differential diagnosis of dysuria (painful urination) in adults. It defines dysuria and notes that acute cystitis is a common cause. The pathophysiology involves sensory nerves in the bladder being irritated by chemical or inflammatory stimuli. Common causes of dysuria include urinary tract infections (UTIs), vaginitis, prostatitis, and STIs. The history and physical exam aim to determine timing, location, and associated symptoms. Laboratory tests like urinalysis and cultures can help diagnose a UTI as a cause. Cultures are recommended for complicated cases or when symptoms don't improve with initial treatment.
Acute Kidney Injury (AKI) is a common complication, affecting 5-7% of hospital admissions and 30% of intensive care unit patients. The top causes of AKI in India are diarrheal diseases, sepsis, malaria, drug toxicity, and hospital-acquired injuries. Biomarkers like cystatin C and kidney injury molecule 1 can help detect AKI earlier than creatinine. Treatment involves fluid resuscitation, eliminating nephrotoxins, and renal replacement therapy for complications like electrolyte imbalances or uremia. Outcomes depend on the underlying cause, with pre-renal and post-renal AKI having a better prognosis than intrinsic renal injury.
Chronic pyelonephritis is a chronic inflammation of the renal tubules and interstitium that occurs due to recurrent urinary tract infections and scarring. It most commonly affects children with congenital anomalies or spinal cord injuries and is the leading cause of end-stage renal disease. It is typically caused by either chronic obstructive pyelonephritis due to obstruction of urine outflow, or reflux nephropathy caused by vesicoureteral reflux allowing urine to flow back into the kidneys. Symptoms may include fever, flank pain, and symptoms of chronic renal failure like hypertension. The condition can lead to complications like proteinuria, focal glomerulosclerosis, and papillary necrosis.
1. Acute pyelonephritis is a sudden, severe bacterial infection of the kidneys that commonly affects young women. It is caused by bacteria like E. coli traveling from the bladder to the kidneys.
2. Symptoms include fever over 102°F, flank pain, painful or frequent urination, and other urinary symptoms. Risk factors include female anatomy, kidney stones, diabetes, and other underlying conditions.
3. Diagnosis involves urine and blood tests showing white blood cells and bacteria. Imaging tests can confirm infection in the kidneys. Treatment consists of intravenous or oral antibiotics like ciprofloxacin or trimethoprim/sulfamethoxazole for 5-14 days.
This case study describes a 70-year-old male patient admitted to the hospital with abdominal distention, weakness, decreased appetite, and weight loss. His medical history revealed he was an alcoholic and smoker. Diagnostic tests showed signs of liver damage. Alcoholic liver cirrhosis occurs in stages from fatty liver to inflammation and scarring of the liver. Risk factors include quantity of alcohol consumed, genetics, and malnutrition. Treatment requires stopping alcohol consumption and may include vitamins, diet, and transplantation for severe cases.
Renal hypertension is high blood pressure caused by kidney disease. It can be caused by renal stenosis where the renal arteries narrow, decreasing blood flow to the kidneys, or chronic glomerulonephritis where inflammation damages the glomeruli. This causes increased renal vascular resistance and decreased glomerular filtration, stimulating the renin-angiotensin system which increases blood pressure. Investigations include blood and urine tests, ultrasound, CT scan, and biopsy. Treatments depend on the cause but may include angioplasty, stenting, medications, or controlling blood pressure and protein intake.
This document discusses tubulo-interstitial pathology and chronic glomerulonephritis. It defines acute pyelonephritis, its causes and morphology. It describes chronic pyelonephritis and reflux nephropathy, including forms of chronic pyelonephritis and their gross and microscopic morphology. It also discusses drug-induced tubulo-interstitial nephritis, analgesic nephropathy, causes of chronic glomerulonephritis, and interpreting morphology of chronic glomerulonephritis.
Renal failure is divided into acute renal failure (ARF) and chronic renal failure (CRF). ARF is characterized by rapid onset of renal dysfunction and increased waste products in the blood. It can be caused by issues with blood flow (pre-renal), the kidneys themselves (intra-renal), or urine outflow (post-renal). CRF is a progressive loss of renal function that eventually leads to end-stage kidney disease. It is caused by damage to the glomeruli or tubulointerstitial tissues and develops over four stages with declining kidney function and increasing symptoms of uraemia.
This document discusses heart failure, including its definition, causes, types, and compensatory mechanisms. Heart failure occurs when the heart is unable to pump enough blood to meet the body's needs. It can be caused by intrinsic pump failure, an increased workload on the heart, or impaired filling of the cardiac chambers. The types of heart failure include acute or chronic, right-sided or left-sided, and forward or backward failure. When the heart begins to fail, compensatory mechanisms such as cardiac hypertrophy, dilation, and increased heart rate attempt to maintain adequate blood circulation.
Acute renal failure occurs when the kidneys are unable to excrete waste products from the body, causing them to accumulate in the blood. It can be caused by conditions that decrease renal blood flow or damage the kidneys. Patients are classified as oliguric, excreting less than 500mL of urine per day, or nonoliguric, excreting more than 500mL daily. Risk factors include advanced age, diabetes, heart or liver disease. Diagnosis involves urine and blood tests to check kidney function and imaging tests in some cases. Treatment focuses on treating the underlying cause, managing fluid balance and electrolytes, and dialysis in severe cases.
Acute renal failure is a medical emergency characterized by a rapid deterioration of renal function over hours to days that is often reversible. It accounts for 1% of hospital admissions and complicates around 7% of inpatient episodes, with mortality rates of 5-10% in uncomplicated cases and 50-70% in severe cases involving sepsis or the need for dialysis. Acute renal failure is commonly caused by pre-renal factors that decrease renal perfusion such as hypovolemia, post-renal obstruction of urinary outflow, or intrinsic renal disease including acute tubular necrosis, interstitial nephritis, or glomerular disease. Management involves treating the underlying cause, monitoring fluid balance, and considering
Acute and Chronic Renal Failure. Easy Slides.Anubhav Singh
The document provides information on acute and chronic renal failure. It discusses the etiology, pathophysiology, symptoms, diagnostic tests, and management of acute renal failure. It also covers the introduction, etiology, symptoms, stages, treatment, and prevention of chronic renal failure. The key differences between non-dialysis dependent chronic kidney disease and end-stage renal disease are also outlined.
Chronic glomerulonephritis is a kidney disorder caused by slow, cumulative damage and scarring of the glomeruli, or tiny blood filters in the kidneys, usually due to inflammation. This results in reduced kidney function over time and can lead to chronic kidney disease, end-stage renal disease, cardiovascular disease, renal failure, and death if left untreated. Treatment focuses on slowing disease progression, managing symptoms like high blood pressure and fluid retention, and renal replacement therapy with dialysis or kidney transplantation for kidney failure.
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.
This document provides an overview of acute kidney injury (AKI), formerly known as acute renal failure. It discusses the definition, epidemiology, diagnostic criteria, etiology, pathophysiology, diagnostic evaluation, urine and blood findings, complications, supportive management including nutrition and monitoring, indications for hemodialysis, timing of dialysis initiation, and prognosis. AKI is characterized by sudden impairment of kidney function and retention of waste products. It commonly occurs in hospitalized patients, especially those in the intensive care unit. The most widely used diagnostic criteria are from KDIGO. Common causes include acute tubular necrosis, prerenal azotemia, and acute injury superimposed on chronic kidney disease. Supportive care focuses on fluid
Acute kidney failure occurs when your kidneys suddenly become unable to filter waste products from your blood. When your kidneys lose their filtering ability, dangerous levels of wastes may accumulate, and your blood's chemical makeup may get out of balance
Kidney stones form when dietary minerals in urine become concentrated enough to crystallize. They are typically classified by location and chemical composition, with calcium salts and uric acid being most common. Risk factors include diet, medical conditions, and family history. Stones form through supersaturation when urine is too concentrated for minerals to remain in solution. Symptoms include flank pain, nausea, and blood in urine. Diagnosis involves history, physical exam, and imaging tests like ultrasound or CT. Treatment focuses on resolving underlying causes and preventing stone recurrence.
This document provides information on the clinical management of a patient presenting with jaundice. It begins by defining jaundice and explaining bilirubin metabolism. Jaundice is classified by the type of circulating bilirubin (conjugated or unconjugated) and site of the problem (prehepatic, hepatocellular, or cholestatic/obstructive). The causes, clinical manifestations, appropriate laboratory tests, and imaging studies are described for each type of jaundice to aid in diagnosis and management. A thorough history, physical exam, and targeted lab and imaging workup are recommended to determine the underlying etiology causing a patient's jaundice.
This document discusses the nursing management of patients with renal disorders. It covers assessment of urinary function including common sites of pain and changes in voiding. Diagnostic tests for urinary dysfunction like urinalysis, renal function tests, and radiological studies are described. Urinary tract infections, including risk factors, types, common bacteria, and nursing management are explained. Nephrolithiasis and urolithiasis (kidney and urinary stones) are also briefly discussed.
Acute kidney injury (AKI) is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days.It's most common in those who are critically ill and already hospitalized.
This document discusses edema, including its definition, pathophysiology, common causes, and approaches to diagnosis and management. Edema is caused by increased hydrostatic pressure, decreased colloid osmotic pressure, or increased capillary permeability. Common causes include heart failure, cirrhosis, nephrotic syndrome, and pregnancy. The case scenario describes a patient with fatigue, swelling, and liver enlargement, suggesting heart failure as the most likely diagnosis. Diagnostic testing may include chest x-rays, echocardiograms, and lab tests. Treatment involves reversing the underlying cause, restricting dietary sodium, and using diuretic medications.
This document provides an overview of renovascular disorders (RVD), including:
1. RVD can be classified based on the anatomic location of vascular pathology in the renal arteries, arterioles/microvasculature, or veins.
2. Common causes of RVD include atherosclerotic renal artery stenosis (ARAS), fibromuscular dysplasia, thromboembolic occlusion, and atheroembolic disease.
3. Clinical manifestations of RVD vary and can include hypertension, renal failure, and flash pulmonary edema depending on the extent and timing of vascular occlusion.
4. Diagnosis involves imaging modalities like MRI, CT, ultrasound and angiography. Treatment may
This patient is at high risk for prerenal acute kidney injury secondary to dehydration from her diarrhea. Key things to assess:
- Volume status and hydration status
- Urine output
- Serum creatinine and BUN (to monitor for worsening renal function)
- Stool studies to check for C. difficile (given the nursing home outbreaks)
- Electrolytes to monitor for abnormalities like hypokalemia
- Consider IV fluids for rehydration if volume depleted
The goals of treatment would be rehydration, treatment of any infection if present, and monitoring for worsening kidney function which may require renal replacement therapy like dialysis. Addressing the underlying cause of the diarrhea
The document provides an overview of acute renal failure for medical interns, discussing key points to consider such as causes, classifications, diagnostic testing, management, and prognosis. It classifies acute renal failure into pre-renal, intrinsic renal, and post-renal causes and emphasizes the importance of establishing the cause through history, physical exam, and urine/lab studies to guide treatment and predict outcomes.
1. Acute pyelonephritis is a sudden, severe bacterial infection of the kidneys that commonly affects young women. It is caused by bacteria like E. coli traveling from the bladder to the kidneys.
2. Symptoms include fever over 102°F, flank pain, painful or frequent urination, and other urinary symptoms. Risk factors include female anatomy, kidney stones, diabetes, and other underlying conditions.
3. Diagnosis involves urine and blood tests showing white blood cells and bacteria. Imaging tests can confirm infection in the kidneys. Treatment consists of intravenous or oral antibiotics like ciprofloxacin or trimethoprim/sulfamethoxazole for 5-14 days.
This case study describes a 70-year-old male patient admitted to the hospital with abdominal distention, weakness, decreased appetite, and weight loss. His medical history revealed he was an alcoholic and smoker. Diagnostic tests showed signs of liver damage. Alcoholic liver cirrhosis occurs in stages from fatty liver to inflammation and scarring of the liver. Risk factors include quantity of alcohol consumed, genetics, and malnutrition. Treatment requires stopping alcohol consumption and may include vitamins, diet, and transplantation for severe cases.
Renal hypertension is high blood pressure caused by kidney disease. It can be caused by renal stenosis where the renal arteries narrow, decreasing blood flow to the kidneys, or chronic glomerulonephritis where inflammation damages the glomeruli. This causes increased renal vascular resistance and decreased glomerular filtration, stimulating the renin-angiotensin system which increases blood pressure. Investigations include blood and urine tests, ultrasound, CT scan, and biopsy. Treatments depend on the cause but may include angioplasty, stenting, medications, or controlling blood pressure and protein intake.
This document discusses tubulo-interstitial pathology and chronic glomerulonephritis. It defines acute pyelonephritis, its causes and morphology. It describes chronic pyelonephritis and reflux nephropathy, including forms of chronic pyelonephritis and their gross and microscopic morphology. It also discusses drug-induced tubulo-interstitial nephritis, analgesic nephropathy, causes of chronic glomerulonephritis, and interpreting morphology of chronic glomerulonephritis.
Renal failure is divided into acute renal failure (ARF) and chronic renal failure (CRF). ARF is characterized by rapid onset of renal dysfunction and increased waste products in the blood. It can be caused by issues with blood flow (pre-renal), the kidneys themselves (intra-renal), or urine outflow (post-renal). CRF is a progressive loss of renal function that eventually leads to end-stage kidney disease. It is caused by damage to the glomeruli or tubulointerstitial tissues and develops over four stages with declining kidney function and increasing symptoms of uraemia.
This document discusses heart failure, including its definition, causes, types, and compensatory mechanisms. Heart failure occurs when the heart is unable to pump enough blood to meet the body's needs. It can be caused by intrinsic pump failure, an increased workload on the heart, or impaired filling of the cardiac chambers. The types of heart failure include acute or chronic, right-sided or left-sided, and forward or backward failure. When the heart begins to fail, compensatory mechanisms such as cardiac hypertrophy, dilation, and increased heart rate attempt to maintain adequate blood circulation.
Acute renal failure occurs when the kidneys are unable to excrete waste products from the body, causing them to accumulate in the blood. It can be caused by conditions that decrease renal blood flow or damage the kidneys. Patients are classified as oliguric, excreting less than 500mL of urine per day, or nonoliguric, excreting more than 500mL daily. Risk factors include advanced age, diabetes, heart or liver disease. Diagnosis involves urine and blood tests to check kidney function and imaging tests in some cases. Treatment focuses on treating the underlying cause, managing fluid balance and electrolytes, and dialysis in severe cases.
Acute renal failure is a medical emergency characterized by a rapid deterioration of renal function over hours to days that is often reversible. It accounts for 1% of hospital admissions and complicates around 7% of inpatient episodes, with mortality rates of 5-10% in uncomplicated cases and 50-70% in severe cases involving sepsis or the need for dialysis. Acute renal failure is commonly caused by pre-renal factors that decrease renal perfusion such as hypovolemia, post-renal obstruction of urinary outflow, or intrinsic renal disease including acute tubular necrosis, interstitial nephritis, or glomerular disease. Management involves treating the underlying cause, monitoring fluid balance, and considering
Acute and Chronic Renal Failure. Easy Slides.Anubhav Singh
The document provides information on acute and chronic renal failure. It discusses the etiology, pathophysiology, symptoms, diagnostic tests, and management of acute renal failure. It also covers the introduction, etiology, symptoms, stages, treatment, and prevention of chronic renal failure. The key differences between non-dialysis dependent chronic kidney disease and end-stage renal disease are also outlined.
Chronic glomerulonephritis is a kidney disorder caused by slow, cumulative damage and scarring of the glomeruli, or tiny blood filters in the kidneys, usually due to inflammation. This results in reduced kidney function over time and can lead to chronic kidney disease, end-stage renal disease, cardiovascular disease, renal failure, and death if left untreated. Treatment focuses on slowing disease progression, managing symptoms like high blood pressure and fluid retention, and renal replacement therapy with dialysis or kidney transplantation for kidney failure.
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.
This document provides an overview of acute kidney injury (AKI), formerly known as acute renal failure. It discusses the definition, epidemiology, diagnostic criteria, etiology, pathophysiology, diagnostic evaluation, urine and blood findings, complications, supportive management including nutrition and monitoring, indications for hemodialysis, timing of dialysis initiation, and prognosis. AKI is characterized by sudden impairment of kidney function and retention of waste products. It commonly occurs in hospitalized patients, especially those in the intensive care unit. The most widely used diagnostic criteria are from KDIGO. Common causes include acute tubular necrosis, prerenal azotemia, and acute injury superimposed on chronic kidney disease. Supportive care focuses on fluid
Acute kidney failure occurs when your kidneys suddenly become unable to filter waste products from your blood. When your kidneys lose their filtering ability, dangerous levels of wastes may accumulate, and your blood's chemical makeup may get out of balance
Kidney stones form when dietary minerals in urine become concentrated enough to crystallize. They are typically classified by location and chemical composition, with calcium salts and uric acid being most common. Risk factors include diet, medical conditions, and family history. Stones form through supersaturation when urine is too concentrated for minerals to remain in solution. Symptoms include flank pain, nausea, and blood in urine. Diagnosis involves history, physical exam, and imaging tests like ultrasound or CT. Treatment focuses on resolving underlying causes and preventing stone recurrence.
This document provides information on the clinical management of a patient presenting with jaundice. It begins by defining jaundice and explaining bilirubin metabolism. Jaundice is classified by the type of circulating bilirubin (conjugated or unconjugated) and site of the problem (prehepatic, hepatocellular, or cholestatic/obstructive). The causes, clinical manifestations, appropriate laboratory tests, and imaging studies are described for each type of jaundice to aid in diagnosis and management. A thorough history, physical exam, and targeted lab and imaging workup are recommended to determine the underlying etiology causing a patient's jaundice.
This document discusses the nursing management of patients with renal disorders. It covers assessment of urinary function including common sites of pain and changes in voiding. Diagnostic tests for urinary dysfunction like urinalysis, renal function tests, and radiological studies are described. Urinary tract infections, including risk factors, types, common bacteria, and nursing management are explained. Nephrolithiasis and urolithiasis (kidney and urinary stones) are also briefly discussed.
Acute kidney injury (AKI) is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days.It's most common in those who are critically ill and already hospitalized.
This document discusses edema, including its definition, pathophysiology, common causes, and approaches to diagnosis and management. Edema is caused by increased hydrostatic pressure, decreased colloid osmotic pressure, or increased capillary permeability. Common causes include heart failure, cirrhosis, nephrotic syndrome, and pregnancy. The case scenario describes a patient with fatigue, swelling, and liver enlargement, suggesting heart failure as the most likely diagnosis. Diagnostic testing may include chest x-rays, echocardiograms, and lab tests. Treatment involves reversing the underlying cause, restricting dietary sodium, and using diuretic medications.
This document provides an overview of renovascular disorders (RVD), including:
1. RVD can be classified based on the anatomic location of vascular pathology in the renal arteries, arterioles/microvasculature, or veins.
2. Common causes of RVD include atherosclerotic renal artery stenosis (ARAS), fibromuscular dysplasia, thromboembolic occlusion, and atheroembolic disease.
3. Clinical manifestations of RVD vary and can include hypertension, renal failure, and flash pulmonary edema depending on the extent and timing of vascular occlusion.
4. Diagnosis involves imaging modalities like MRI, CT, ultrasound and angiography. Treatment may
This patient is at high risk for prerenal acute kidney injury secondary to dehydration from her diarrhea. Key things to assess:
- Volume status and hydration status
- Urine output
- Serum creatinine and BUN (to monitor for worsening renal function)
- Stool studies to check for C. difficile (given the nursing home outbreaks)
- Electrolytes to monitor for abnormalities like hypokalemia
- Consider IV fluids for rehydration if volume depleted
The goals of treatment would be rehydration, treatment of any infection if present, and monitoring for worsening kidney function which may require renal replacement therapy like dialysis. Addressing the underlying cause of the diarrhea
The document provides an overview of acute renal failure for medical interns, discussing key points to consider such as causes, classifications, diagnostic testing, management, and prognosis. It classifies acute renal failure into pre-renal, intrinsic renal, and post-renal causes and emphasizes the importance of establishing the cause through history, physical exam, and urine/lab studies to guide treatment and predict outcomes.
This document discusses glomerular disease and glomerulonephritis. It begins by defining glomerular disease and glomerulonephritis, noting that glomerulonephritis is a type of glomerular disease involving inflammation of the glomeruli. It then discusses the main clinical presentations of glomerular disease, including nephrotic syndrome, acute glomerulonephritis, and asymptomatic urinary abnormalities. The causes, symptoms, investigations, and management of various glomerular diseases are subsequently outlined. Throughout, examples are provided of specific diseases like post-streptococcal glomerulonephritis, membranous nephropathy, and crescentic glomerulone
This document provides an overview of pediatric nephrology topics including haematuria (blood in the urine), renal failure, proteinuria, urinary tract infections, and congenital anomalies. It discusses evaluation and causes of haematuria including glomerular diseases like post-streptococcal glomerulonephritis. Acute and chronic renal failure are summarized along with their etiologies, clinical manifestations, diagnosis, and management. Dialysis options for end-stage renal failure are also briefly covered.
An abrupt (within 48hr) reduction in kidney function currently defined as an absolute increase in serum creatinine of either >0.3 mg/dL or a percentage increase of >50% or a reduction in UOP (documented as oliguria of <0.5 ml/kg/hr for >6hr)
This document provides an overview of acute kidney injury (AKI), chronic kidney disease (CKD), end-stage renal disease (ESRD), and their treatment and management. It discusses the pathophysiology, stages, symptoms, complications, medical and surgical interventions, and nursing care for each condition. Dialysis methods like hemodialysis and peritoneal dialysis are explained in detail. Surgical procedures for the kidneys like nephrectomy and transplantation are also summarized.
This document discusses renal function tests and their importance in assessing kidney function and detecting impairment. It describes various tests including urine analysis, blood tests of creatinine and urea, and glomerular function tests. Common indications for evaluating renal function are listed, such as older age, diabetes, and hypertension. The document also outlines approaches to interpreting test results and diagnosing different kidney conditions like acute injury, nephritic syndrome, and nephrotic syndrome.
13 Evaluation And Management Of Acute Renal FailureDang Thanh Tuan
The document discusses evaluation and management of acute renal failure (ARF). It defines ARF as a rapid decline in kidney function over hours to weeks. ARF can be prerenal, intrinsic renal, or postrenal. Prerenal ARF is caused by reduced blood flow to the kidneys and is often reversible. Intrinsic renal ARF involves direct kidney damage from conditions like acute tubular necrosis. Postrenal ARF occurs when urine outflow is blocked. Management involves treating underlying causes, preventing further injury, managing complications conservatively, and initiating renal replacement therapy if needed.
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 summarizes renal support in patients with hepatic disease. It defines hepatorenal syndrome as renal failure that develops in patients with advanced liver disease due to alterations in renal physiology. HRS is diagnosed when renal dysfunction occurs in the absence of other identifiable kidney problems. The document outlines risk factors, types, diagnostic criteria, and management approaches for HRS, including prevention through infection control and treatment with vasoconstrictors, renal support, and liver transplantation.
This document presents a case study of a 55-year-old female patient admitted with abdominal distention and leg swelling over the past month. Her history and examination findings are detailed. Investigations show signs of cirrhosis and portal hypertension likely related to hepatitis B. She develops renal impairment and a renal biopsy reveals diffuse proliferative glomerulonephritis. Further tests confirm hepatitis B virus infection is the cause of her kidney disease. She is diagnosed with hepatitis B virus related diffuse proliferative glomerulonephritis and treated accordingly.
The kidneys play an important role in removing waste and regulating various functions in the body. Chronic kidney disease occurs when the kidneys become damaged and can no longer filter blood properly. It has stages from mild to severe and can progress to end-stage renal disease where dialysis or transplant is needed to survive. Treatment focuses on managing symptoms, slowing progression, and replacing kidney function through dialysis or transplant for end-stage disease.
Acute renal failure is a medical emergency characterized by a rapid deterioration of renal function over hours to days. It is often reversible. It accounts for 1% of hospital admissions and complicates around 7% of inpatient episodes, with mortality rates of 5-10% in uncomplicated cases and 50-70% in severe cases involving sepsis or the need for dialysis. Causes include pre-renal factors reducing renal perfusion (40-70% of cases), intrinsic renal disease (10-50% of cases), and post-renal urinary outflow obstruction (10% of cases). Management focuses on treating the underlying cause, monitoring fluid balance, and considering dialysis for uraemic patients. Comp
1. The document provides an overview of renal anatomy and physiology, clinical manifestations of renal diseases, methods for estimating renal function, and common renal disease syndromes.
2. Key aspects of renal anatomy discussed include the structure and function of nephrons, the glomerular filtration barrier, and countercurrent exchange mechanisms.
3. Common clinical signs of renal diseases include edema, hypertension, flank pain, urinary abnormalities, and changes in estimated glomerular filtration rate.
4. Major renal disease syndromes covered are nephrotic syndrome, nephritic syndrome, acute renal failure, and chronic renal failure.
04 Differential Diagnosis Of Acute Renal Failureguest2379201
The document provides an overview of the differential diagnosis of acute renal failure (ARF). It discusses various causes that can lead to prerenal ARF including volume depletion, liver disease, heart failure, renal arterial disease, perinatal issues in newborns. It also covers intrinsic renal failure due to tubular diseases, interstitial diseases, glomerular diseases, vascula diseases, and nephrotoxins. Post-renal ARF due to urinary tract obstruction is also summarized. The document provides details on evaluation and laboratory findings that can help in differential diagnosis of ARF.
04 Differential Diagnosis Of Acute Renal FailureDang Thanh Tuan
The document provides an overview of the differential diagnosis of acute renal failure (ARF). It discusses various causes that can lead to prerenal ARF including volume depletion, liver disease, heart failure, renal arterial disease, hemorrhage, and asphyxia in newborns. Intrinsic renal failure can be caused by tubular diseases, interstitial diseases, glomerular diseases, or vascula diseases. Acute tubular necrosis is described as the most common cause. Post-renal ARF can result from urinary tract obstruction. Laboratory findings that can aid in diagnosis are also summarized.
04 Differential Diagnosis Of Acute Renal FailureDang Thanh Tuan
The document provides an overview of the differential diagnosis of acute renal failure. It discusses prerenal, intrinsic renal, and postrenal causes of acute renal failure. Prerenal causes include volume depletion, advanced liver disease, congestive heart failure, and renal arterial disease. Intrinsic renal causes include tubular diseases, interstitial diseases, glomerular diseases, and vascula diseases. Postrenal causes involve urinary obstruction.
Similar to Acute and Chronic Renal Failure - A Review (20)
Gastric Perforation From Peptic Ulcer Disease - A Review of the Surgical Trea...Joseph A. Di Como MD
A PowerPoint presentation reviewing gastric perforation for peptic ulcer disease and a review of the surgical treatment options. Intended for medical professionals and students.
'PowerPoint presentation reviewing the literature regarding traumatic splenic injury. Intended for medical professionals and students interested in surgery. For educational purposes only.
This document discusses definitions of hypotension after traumatic brain injury (TBI) and management strategies. It summarizes several studies that identify optimal systolic blood pressure thresholds for defining hypotension in TBI patients of different ages, and find that aggressive fluid resuscitation is recommended to treat hypotension and improve outcomes for severe TBI patients. Maintaining a systolic blood pressure above 110 mmHg is important to prevent secondary brain injuries and reduced mortality.
This document provides a brief review of colorectal cancer including epidemiology, risk factors, clinical presentation, screening, diagnosis, and treatment options. It notes that globally, colorectal cancer is the third most commonly diagnosed cancer in males and second in females. Screening is recommended for average risk individuals beginning at age 50. Treatment typically involves surgical resection as the only curative option, and may be combined with chemotherapy or radiation therapy depending on the stage of cancer.
Shock: A review of hypovolemic, septic, cardiogenic and neurogenic shock.Joseph A. Di Como MD
A review of different types of shock encountered in patients. Hypovolemic, septic, cardiogenic and neurogenic shock. We review etiology, pathophysiology, diagnosis, treatment and how to differentiate between them.
A PowerPoint review focusing on hepatic angiosarcomas. Designed for surgical residents but likely useful for any medical profession, student or patient. Specifically, we discuss epidemiology, clinical presentation, pathology, etiology and treatment.
A PowerPoint presentation covering the basics of liver function tests. Specifically, which tests are ordered, what they represent and how they can reflect a certain diagnosis.
Albumin, INR, Bilirubin, AST, ALT, Alkaline phosphatase, GGT
Inflammatory Bowel Disease (Crohns disease and ulcerative colitis)Joseph A. Di Como MD
This document discusses the medical and surgical management of inflammatory bowel disease. It outlines the main drug therapies used for ulcerative colitis and provides indications for when surgery is necessary, such as treatment failure or complications like obstruction or hemorrhage. It also describes how patients should be prepared for surgery, including correcting medical issues and withdrawing immunosuppressants. The key types of operations for Crohn's disease of the small bowel are resections and strictureplasty, with the latter aimed at avoiding short bowel syndrome. Complications of strictureplasty can include hemorrhage, restricture, or fistula/abscess/leak.
Soft tissue sarcomas, treatment (surgical, radiation, chemotherapy)Joseph A. Di Como MD
This document discusses soft tissue sarcomas (STS), a rare type of cancer that arises in connective tissues like muscles or fat. It notes that STS account for about 1% of adult cancers in the US, with most occurring in extremities or trunk. Risk factors include radiation exposure, certain chemicals, and genetic conditions. STS are classified and graded based on cell type and differentiation. Treatment typically involves surgical resection with clear margins, sometimes combined with radiation or chemotherapy depending on stage, grade, and location. Prognosis depends on stage and grade, with 5-year survival rates ranging from 54-65% after complete resection of primary retroperitoneal sarcomas.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
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.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
2. Assessment of Renal Function
Glomerular Filtration Rate (GFR)
= the volume of water filtered from the plasma per unit of
time.
Gives a rough measure of the number of functioning
nephrons
Normal GFR:
Men: 130 mL/min./1.73m2
Women: 120 mL/min./1.73m2
Cannot be measured directly, so we use creatinine and
creatinine clearance to estimate.
3. Assessment of Renal Function (cont.)
Creatinine
A naturally occurring amino acid, predominately found in skeletal
muscle
Freely filtered in the glomerulus, excreted by the kidney and readily
measured in the plasma
As plasma creatinine increases, the GFR exponentially decreases.
Limitations to estimate GFR:
Patients with decrease in muscle mass, liver disease, malnutrition,
advanced age, may have low/normal creatinine despite underlying
kidney disease
15-20% of creatinine in the bloodstream is not filtered in glomerulus, but
secreted by renal tubules (giving overestimation of GFR)
Medications may artificially elevate creatinine:
Trimethroprim (Bactrim)
Cimetidine
4. Assessment of Renal Function (cont.)
Creatinine Clearance
Best way to estimate GFR
GFR = (creatinine clearance) x (body surface area in m2
/1.73)
Ways to measure:
24-hour urine creatinine:
Creatinine clearance = (Ucr x Uvol)/ plasma Cr
Cockcroft-Gault Equation:
(140 - age) x lean body weight [kg]
CrCl (mL/min) = ——————————————— x 0.85 if
Cr [mg/dL] x 72 female
Limitations: Based on white men with non-diabetes kidney disease
Modification of Diet in Renal Disease (MDRD) Equation:
GFR (mL/min./1.73m2) = 186 X (SCr)-1.154 X (Age)-0.203 X (0.742 if female) X
(1.210 if African-American )
5. Major causes of Kidney Failure
Prerenal Disease
Vascular Disease
Glomerular Disease
Interstitial/Tubular Disease
Obstructive Uropathy
6. Prerenal Disease
Reduced renal perfusion due to volume depletion
and/or decreased perfusion
Caused by:
Dehydration
Volume loss (bleeding)
Heart failure
Shock
Liver disease
7. Vascular Disease
Acute
Vasculitis – Wegener’s granulomatosis
Thromboembolic disease
TTP/HUS
Malignant hypertension
Scleroderma renal crisis
Chronic
Benign hypertensive nephrosclerosis
Intimal thickening and luminal narrowing of the large and small renal arteries and the
glomerular arterioles usually due to hypertension.
Most common in African Americans
Treatment:
Hypertension control
Bilateral renal artery stenosis
should be suspected in patients with acute, severe, or refractory hypertension who also have
otherwise unexplained renal insufficiency
Treatment:
Medical therapy, surgery, stents.
8. Glomerular Disease
Nephritis
Inflammation seen on histologic exam
Active sediment: Red cells, white cells, granular casts, red cell
casts
Variable degree of proteinuria (< 3g/day)
Nephrotic
No inflammation
Bland sediment: No cells, fatty casts
Nephrotic range proteinuria (>3.5 g/day)
Nephrotic syndrome = proteinuria + hyperlipidemia + edema
18. Obstructive Uropathy
Obstruction of the urinary flow anywhere from the
renal pelvis to the urethra
Can be acute or chronic
Most commonly caused by tumor or prostatic
enlargement (hyperplasia or malignancy)
Need to have bilateral obstruction in order to have
renal insufficiency
19. Chronic Kidney Disease= a GFR of < 60 for 3 months or more.
Most common causes:
Diabetes Mellitus
Hypertension
Management:
Blood pressure control!
Diabetic control!
Smoking cessation
Dietary protein restriction
Phosphorus lowering drugs/ Calcium replacement
Most patients have some degree of hyperparathyroidism
Erythropoietin replacement
Start when Hgb < 10 g/dL
Bicarbonate therapy for acidosis
Dialysis?
20. Stages of Chronic Kidney Disease
Stage Description GFR (mL/min/1.73 m2)
1 Kidney damage with normal or
increased GFR
≥ 90
2 Kidney damage with mildly
decreased GFR
60-89
3 Moderately decreased GFR 30-59
4 Severely decreased GFR 15-29
5 Kidney Failure < 15
21. Acute Renal Failure
An abrupt decrease in renal function sufficient to
cause retention of metabolic waste such as urea and
creatinine.
Frequently have:
Metabolic acidosis
Hyperkalemia
Disturbance in body fluid homeostasis
Secondary effects on other organ systems
22. Acute Renal Failure
Most community acquired acute renal failure (70%) is
prerenal
Most hospital acquired acute renal failure (60%) is
due to ischemia or nephrotoxic tubular epithelial
injury (acute tubular necrosis).
Mortality rate 50-70%
23. Risk factor for acute renal failure
Advanced age
Preexisting renal parenchymal disease
Diabetes mellitus
Underlying cardiac or liver disease
24. Urine Output in Acute Renal failure
Oliguria
= daily urine output < 400 mL
When present in acute renal failure, associated with a
mortality rate of 75% (versus 25% mortality rate in non-
oliguric patients)
Most deaths are associated with the underlying disease process
and infectious complications
Anuria
No urine production
Uh-oh, probably time for dialysis
25. Most common causes of ACUTE Renal
Failure
Prerenal
Acute tubular necrosis (ATN)
Acute on chronic renal failure (usually due to
ATN or prerenal)
Obstructive uropathy
Glomerulonephritis/Vasculitis
Acute Interstitial nephritis
Atheroemboli
26. Assessing the patient with acute renal
failure
History:
Cancer?
Recent Infections?
Blood in urine?
Change in urine output?
Flank Pain?
Recent bleeding?
Dehydration? Diarrhea? Nausea? Vomiting?
Blurred vision? Elevated BP at home? Elevated sugars?
27. Assessing the patient with acute renal
failure (cont.)
Family History:
Cancers?
Polycystic kidney disease?
Meds:
Any non-compliance with diabetic or hypertensive
meds?
Any recent antibiotic use?
Any NSAID use?
29. Assessing the patient with acute renal
failure – Laboratory analysis
Fractional excretion of sodium:
(UrineNa+ x PlasmaCreatinine)
FENa= ______________________ x 100
(PlasmaNa+ x UrineCreatinine)
FENa < 1% → Prerenal
FENa > 2% Epithelial tubular injury (→ acute tubular
necrosis), obstructive uropathy
If patient receiving diuretics, can check FE of urea.
30. Assessing the patient with acute renal
failure -- Radiology
Renal Ultrasound
Look for signs of hydronephrosis as sign of obstructive
uropathy.
31. Assessing the patient with acute renal
failure – Urinalysis
Hematuria
Non-glomerular:
Urinary sediment: intact red blood cells
Causes:
Infection
Cancer
Obstructive Uropathy
Rhabdomyolysis
myoglobinuria; Hematuria with no RBCs
Glomerular:
Urine sediment: dysmorphic red blood cells, red cell casts
Causes:
Glomerulonephritis
Vasculitis
Atheroembolic disease
TTP/HUS (thombotic microangiopathy)
32. Assessing Patient with Acute Renal Failure –
Urinalysis (cont.)
Protein
Need microscopic urinalysis to see microabluminemia
Can check 24-hour urine protein collection
Nephrotic syndrome - ≥ 3.5 g protein in 24 hours
Albuminuria
Glomerulonephritis
Atheroembolic disease
(TTP/HUS) Thrombotic microangiopathy
Nephrotic syndrome
Tubular proteinuria
Tubular epithelial injury (acute tubular necrosis)
Interstitial nephritis
33. Assessing patient with acute renal failure –
Urinary Casts
Red cell casts Glomerulonephritis
Vasculitis
White Cell casts Acute Interstitial
nephritis
Fatty casts Nephrotic
syndrome, Minimal
change disease
Muddy Brown casts Acute tubular
necrosis
34. Assessing patient with acute renal failure –
Renal Biopsy
If unable to discover cause of renal disease, renal
biopsy may be warranted.
Renal biopsy frequently performed in patient’s with
history of renal transplant with worsening renal
function.
35. Treatment of Acute Renal Failure
Treat underlying cause
Blood pressure
Infections
Stop inciting medications
Nephrostomy tubes/ureteral stents if obstruction
Treat scleroderma renal crisis with ACE inhibitor
Hydration
Diuresis (Lasix)
Dialysis
Renal Transplant
36. Indications for Hemodialysis
Refractory fluid overload
Hyperkalemia (plasma potassium concentration >6.5 meq/L) or
rapidly rising potassium levels
Metabolic acidosis (pH less than 7.1)
Azotemia (BUN greater than 80 to 100 mg/dL [29 to 36
mmol/L])
Signs of uremia, such as pericarditis, neuropathy, or an
otherwise unexplained decline in mental status
Severe dysnatremias (sodium concentration greater than 155
meq/L or less than 120 meq/L)
Hyperthermia
Overdose with a dialyzable drug/toxin