1. The patient is experiencing acute kidney injury (AKI) as evidenced by his elevated urea and creatinine levels, which were previously normal.
2. The underlying mechanism is likely pre-renal AKI caused by the nephrotoxic effects of the ACE inhibitor (Lisinopril) medication prescribed for his hypertension. ACE inhibitors can cause afferent arteriole vasoconstriction leading to reduced kidney perfusion and function.
3. Management includes discontinuing the ACE inhibitor, optimizing his blood pressure with another class of antihypertensive medication, and monitoring his kidney function and fluid status.
Acute kidney injury is common among hospitalized patients. It affects some 3–7% of patients admitted to the hospital and approximately 25–30% of patients in the intensive care unit.
Acute kidney injury is common among hospitalized patients. It affects some 3–7% of patients admitted to the hospital and approximately 25–30% of patients in the intensive care unit.
hepatorenal syndrome is a one of the complication of cirrhosis of liver. It causes hepatic decompensation of liver. It has high risk of mortality. HRS has two types and type 1 usually present as a acute kidney injury. so, at first HRS should exclude from AKI. HRS type 2 present as a refractory ascites. As this has worst prognosis, only valuable management is liver transplantation.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
2. case
• 55 y old male visiting ER complaining of headache, he
was recently diagnosed to hypertensive and his
primary care physician prescribed for him Lisinopril tab
10 mg/ day, his general exam was normal , Bp 160/90
mmHg, PR 77b/m, cardiovascular and respiratory exam
were normal, you ordered routine investigation which
came , urea 55 mg/dl, createnine 1.8mg/dl, CBC,LFT,
RBS all were normal , he had routine investigations
which were normal 2 weeks ago
1. What is wrong with his lab?
2. What is underlying mechanism?
3. How to manage him?
3. AKI
• Previously known as acute renal failure
• there is a sudden and often reversible loss of
renal function, which develops over days or
weeks and is often accompanied by a
reduction in urine volume
5. Pathophysiology of AKI
• pre-renal: when perfusion to the kidney is
reduced
• renal : when the primary insult affects the
kidney itself
• post-renal: when there is obstruction to urine
flow at any point from the tubule to the
urethra
6. Pre-renal AKI
• A reduction in perfusion reduces GFR
• If not corrected leads to kidney injury namely
acute tubular necrosis (ATN)
• Histologically, the kidney shows:
inflammatory changes, focal breaks in the tubular
basement membrane and interstitial edema
Dead tubular cells may also be shed into the
tubular lumen, leading to tubular obstruction.
7. Renal AKI
• Tubular damage is the dominant feature
• Profound alteration in renal microcirculation
• Nephrotoxic drugs can cause ATN or allergic
interstitial nephritis
• Other common cause is Glomerulonephritis
8. Post-renal
• Obstruction to the renal tract leads to
elevation of intraluminal ureteral pressure
transmitted to the nephrons after prolonged
obstruction, with a subsequent fall in GFR
• If obstruction not relieved leads to a drop in
renal flow via Thromoxane A2 & Angiotensin II
this leads to chronic kidney injury
9. Clinical Features
• Early recognition and intervention is
important in AKI
• In ER Check RFT, BP, Pulse, T
• Risk assessment for AKI
– Coexistent diseases DM, liver disease
– Nephrotoxic drug ACE I & NSAIDS
– Previous measurements of RFT is of great value
• If createnine found to be high (acute, acute on
chronic or sign of CKD
10. Pre-renal
• Look for signs of hypovolemia:
– low BP, Orthostatic hypotension
– Tachycardia, cold extremity
– Delayed capillary refill > 3s
• Look for signs of sepsis
• Uncorrected renal hypoperfusion causing pre-
renal azotaemia may progress to ATN.
11. Renal
• Patient GMN presents with hematuria and
proteinuria
• Clinical features of underlying diseases, e.g.
SLE
• History of ACE I , PPI, NSAIDS
12. Post-renal
• Examine to look for distended bladder
• USS to look for hydronephrosis
• Medical history of renal stones, malignancy,
and BPH
• History of urine retention
13. Categories Of AKI
• Various criteria have been proposed to classify
AKI and to help identify high-risk patients,
guide treatment and provide information
regarding prognosis
• The most commonly used are the KDIGO, AKIN
and RIFLE criteria.
14.
15. Management
1. Hemodynamic status:
• Assess fluid status as this will determine fluid
prescription:
If hypovolaemic: optimize systemic haemodynamic
status with fluid challenge and inotropic drugs if
necessary Once euvolaemic, match fluid intake to
urine output plus an additional 500 mL to cover
insensible losses
If fluid-overloaded: prescribe diuretics (loop diuretics
at high dose will often be required); if the response is
unsatisfactory, dialysis may be required
16. 2-hyperkalemia And Acidosis
• Administer calcium resonium to stabilise
myocardium and glucose and insulin to correct
hyperkalaemia if K+ > 6.5 mmol/L as a holding
measure until a definitive method of removing
potassium is achieved (dialysis or restoration
of renal function)
• Consider administering sodium bicarbonate
(100 mmol) to correct acidosis if H+ is > 100
nmol/L (pH < 7.0)
17. Rest Of Management
• Discontinue potentially nephrotoxic drugs and
reduce doses of therapeutic drugs according to
level of renal function
• Ensure adequate nutritional support
• Consider proton pump inhibitors to reduce the
risk of upper gastrointestinal bleeding
• Screen for intercurrent infections and treat
promptly if present
• In case of urinary tract obstruction, drain lower or
upper urinary tract as necessary
18. Renal Placement Therapy
• Decision for RRT is made on individual basis
• Weighing risks versus benefits
• The two main options for RRT in AKI are
intermittent haemodialysis and CRRT
• Peritoneal dialysis is also an option if
haemodialysis is not available
21. case
• 55 y old male visiting ER complaining of headache, he
was recently diagnosed to hypertensive and his
primary care physician prescribed for him Lisinopril tab
10 mg/ day, his general exam was normal , Bp 160/90
mmHg, PR 77b/m, cardiovascular and respiratory exam
were normal, you ordered routine investigation which
came , urea 55 mg/dl, createnine 1.8mg/dl, CBC,LFT,
RBS all were normal , he had routine investigations
which were normal 2 weeks ago
1. What is wrong with his lab?
2. What is underlying mechanism?
3. How to manage him?
22. Answers
1. AKI due nephrotoxic drug ACE I
2. ACI mediated glomerular afferent
vasoconstriction leading to decrease GFR
3. Optimize his high BP change to another class
of anti- hypertensive drug