pathophysiology of acute and chronic renal failure - Bestha Chakrapani associate professor Deparrtment of Balaji college of pharmacy , ananthapuramu-515004
Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine. Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood.
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.
pathophysiology of acute and chronic renal failure - Bestha Chakrapani associate professor Deparrtment of Balaji college of pharmacy , ananthapuramu-515004
Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine. Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood.
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.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Acute kidney failure happens when your kidneys suddenly lose the ability to eliminate excess salts, fluids, and waste materials from the blood. Acute kidney failure is also called acute kidney injury or acute renal failure. It's common in people who are already in the hospital. It may develop rapidly over a few hours.
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
Nephrotic syndrome may be caused by primary (idiopathic) renal disease or by a variety of secondary causes. Patients present with marked edema, proteinuria, hypoalbuminemia, and often hyperlipidemia.
Nephrotic syndrome is a primary glomerular disease characterized by the following:
Marked increase in protein in the urine (proteinuria)
Decrease in albumin in the blood (hypoalbuminemia)
Edema (The swelling (edema), can be most noticeable on the face, around the eyes, around the feet and ankles, and in the belly area (or the abdomen).
High serum cholesterol and low-density lipoproteins (hyperlipidemia)
Nephrotic syndrome is a clinical disorder characterized by marked increase of protein in the urine ( proteinuria ), decrease in albumin in the blood (hypoalbuminemia ),edema, & excess lipids in the blood ( hyperlipidemia )
Pathophysiology
Nephrotic syndrome can occur with almost any intrinsic renal disease or systemic disease that affects the glomerulus.
Although generally considered a disorder of childhood, nephrotic syndrome does occur in adults, including the elderly. Causes include:
Chronic glomerulonephritis
Diabetes mellitus with intercapillary glomerulosclerosis
Amyloidosis of the kidney
Systemic lupus erythematosus
Multiple myeloma and renal vein thrombosis.
NSAIDs
Pre eclampsia
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Acute kidney failure happens when your kidneys suddenly lose the ability to eliminate excess salts, fluids, and waste materials from the blood. Acute kidney failure is also called acute kidney injury or acute renal failure. It's common in people who are already in the hospital. It may develop rapidly over a few hours.
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
Nephrotic syndrome may be caused by primary (idiopathic) renal disease or by a variety of secondary causes. Patients present with marked edema, proteinuria, hypoalbuminemia, and often hyperlipidemia.
Nephrotic syndrome is a primary glomerular disease characterized by the following:
Marked increase in protein in the urine (proteinuria)
Decrease in albumin in the blood (hypoalbuminemia)
Edema (The swelling (edema), can be most noticeable on the face, around the eyes, around the feet and ankles, and in the belly area (or the abdomen).
High serum cholesterol and low-density lipoproteins (hyperlipidemia)
Nephrotic syndrome is a clinical disorder characterized by marked increase of protein in the urine ( proteinuria ), decrease in albumin in the blood (hypoalbuminemia ),edema, & excess lipids in the blood ( hyperlipidemia )
Pathophysiology
Nephrotic syndrome can occur with almost any intrinsic renal disease or systemic disease that affects the glomerulus.
Although generally considered a disorder of childhood, nephrotic syndrome does occur in adults, including the elderly. Causes include:
Chronic glomerulonephritis
Diabetes mellitus with intercapillary glomerulosclerosis
Amyloidosis of the kidney
Systemic lupus erythematosus
Multiple myeloma and renal vein thrombosis.
NSAIDs
Pre eclampsia
Chronic renal failure or chronic kidney disease management, pharmacist role, medical management objectives, goals of the therapy .
What are the risk factors of chronic renal failure, clinical manifestations of chronic renal failure, renal failure complications, pathophysiology of chronic renal failure.
Brief Information regarding the disorders of the genitourinary system. This presentation involves the disorders of the urinary system including Chronic Kidney Disease, Congenital problems related to the urinary system, and renal cancers.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
2. ACUTE RENAL FAILURE
PRESENTED BY:-
Mr. JITENDRA KUMAR DAS
Msc NURSING 1ST YEAR
College of Nursing , VIMSAR, BURLA
Sambalpur
3. Kidney failure or renal failure is the partial
or complete impairment of kidney function.
It results in an ability to excrete metabolic
waste products and water.
Renal failure can be acute, with sudden
onset of symptom, or chronic, occurring
gradually over time.
Once renal failure occurs, it requires
immediate management and treatment.
4. Acute renal failure/acute kidney failure/acute
kidney injury occurs when the kidneys
suddenly become unable to filter waste
products from blood and unable to maintain
fluid and electrolyte balance in the body.
It usually marked by decreased glomerular
filtration rate (GRF), increase concentrations
of blood urea nitrogen (BUN), and creatinine
and the urine output is less than 400ml per
day(oliguria).
5.
6. Three categories of causes can lead to acute renal failure.
Prerenal failure:-
prerenal failure is the most common type of acute renal
failure(60%-70% of all cases).
Prerenal (before the kidney) failure is associated with a
condition that slows blood flow to the kidneys.
Prerenal failure can be caused by the following condition:-
Blood or fluid loss due to dehydration, diarrhea, vomiting,
hemorrhage, burn, excessive use of diuretics.
Decrease cardiac output from heart disease such as
myocardial infarction, congestive heart failure, heart attack.
If the blood vessel carrying blood to the kidneys is blocked
or get constricted.
Liver failure.
7. Intrarenal(inside structured of kidney) failure:-
It is the structural damage to the kidney or to the
glomeruli, kidney tubules and nephrons in side
kidney.
Disease and conditions that damage the kidneys and
may lead to acute kidney failure include:-
Prolonged renal ischemia.
Blood clots or cholesterol deposits in the veins and
arteries in and around the kidneys.
Infection- glomerulonephritis, pyelonephritis
Hemolytic uremic syndrome(HUS)
Medication such as certain chemotherapy drugs,
antibiotics and dyes used during imaging tests.
8. Postrenal failure:-
Postrenal (after the kidney) failure is a condition the
block the passage of urine out of the body (urinary
obstructions) and can lead to acute kidney injury
include:-
Kidney stone
Cancer of the urinary tract organs or structures near
the urinary tract
Bladder stone
Enlarged prostate
Blood clot
Bladder cancer
Urethral obstruction
9. Acute kidney failure almost always occurs in
connection with another medical condition or event.
Conditions that increase risk of acute kidney failure
include:-
Being hospitalized, especially for a serious condition
that requires intensive care.
Advanced age
Blockage in the blood vessels in arms or legs
Diabetes
High blood pressure
Heart failure
Kidney disease
Liver disease
10. Sudden and complite loss of kidney
functions
Sodium and fluid retention which leads to
edema
Damaged tubules cannot coserve sodium normally which
activates renin angiotension- aldosterone system.
Failure of renal circulation and glomerular or
tubular dysfunction
Due to etiologycal factor such as prerenal,
intrarenal and post renal failure
11. ACUTE RENAL FAILURE (ARF)
Increase circulatory over load and sodium
retention
Increase serum creatinine, BUN level and
retention of other metabolic waste
Oliguria
Sudden and complete loss of kidney
functions
12. The following symptom may occur with acute
kidney failure. Some people have no symptoms, in
the early stage-
Decrease urine output, although occasionally
urine output remains normal.
Fluid retention, causing swelling in your legs,
ankles and feet.
Patient may appear critically ill or lethargic.
Dark colored urine.
Skin and mucous membrane are dry from
dehydration.
Anemia and platelet dysfunction.
13. Oligurea or anuria.
Shortness of breath.
Feeling dizzy when standup.
Cardiac problem such as tachycardia and
dysrhythmia.
Fluid electrolyte imbalance- fluid overload,
hyperkalemia, hyponatremia, hypocalcaemia and
hypermagnesemia.
Drowsiness, confusion
Seizure and coma
14. History and physical evaluation
Urine output measurement
Urine test- decrease amount of sodium in urine
and high potassium level
Blood test- shows elevated blood urea nitrogen
(BUN), Serum creatinine and potassium levels,
also shows decrease level of hemoglobin levels
and Ph.
Imaging tests- ultrasonography , KUB
radiography, renal scan, CT
Kidney biopsy
15. Fluid buildup- ARF may lead to a
buildup of fluid in the lungs, which
can cause shortness of breath
Chest pain
Muscle weakness
Permanent kidney damage
Death
16. ARF is often difficult to predict or
prevent. But may reduce the risk of
ARF by taking care of the kidneys.
Regular consultation with the doctors
who are having diabetes or high blood
pressure.
Make a healthy life style.
17. Treatment for acute kidney failure involves
identifying the illness or injury that originally
damaged kidneys.
Once the cause is found, the goal of treatment is
to correct or treat the cause of kidney failure,
restore kidney function and prevent fluid and
waste from building up in the body while the
kidneys heal and prevent or treat any
complications caused by acute renal failure.
18. Drugs are used to reduce the blood pressure
(antihypertensive); diuretics (drug that increase
urine output) are used in some cases to
increase blood flow unless oliguria is present.
Low dose dopamine (1-3g/kg) is often used to
dilate the renal arteries.
Sodium polystyrene sulfonate (kayexalate);
cation- exchange resins orally or by retention
enema is administered to reduce elevated
potassium level (hyperkalemia).
19. Calcium or glucose/insulin will be given
through a vein to help avoid dangerious
increases in blood potassium level.
Administered intravenous sodium bicarbonate
for more sever hyperkalemia symptoms and for
the correction of acidosis and elevated
phosphate level.
Antibiotic may be needed to treat associated
infection (predominantly only antibiotic
excreted by the lever are used if there is no
liver disease.
20. Fluid replacement must be done very carefully to avoid
fluid overload and dehydration.
Accurate measurement of urine output is essential to
prevent volume of overload.
Intravenous solutions must be carefully selected
according to the patient’s fluid and electrolyte status.
Treat hyperkalemia with glucose and insulin, calcium
gluconate, sodium polystyrene sulfonate or dialysis.
Replace lost fluids, such as water , blood, and plasma,
and restore blood flow to the kidneys.
In case of prerenal ARF caused by dehydration or blood
loss, for example, kidney function may quickly return to
normal after fluid and blood level are corrected.
21. A high calorie diet that’s low in protein, sodium
and potassium is usually prescribed to meet
the metabolic needs of a patient in renal
failure.
Potassium intake usually restricted to 40 to 60
mEq/day and sodium is usually restricted to 2
g/day.
Low –potassium food include apples, cabbage,
carrots, green beans, grapes and strawberries.
22. If the patient’s kidneys
do not respond to
treatment, and
adequate kidney
function dose not
return, they will need to
undergo dialysis.
Dialysis is a process
used to remove fluid
and uremic waste
products from the body
when the kidneys are
unable to do so.
23. Measure and record intake and output, including body
fluids, such as wound drainage, nasogastric output
and diarrhea. Weight the patient daily.
Measure blood pressure at various times during the
day with patients in supine, sitting, and standing
positions.
Monitor BUN, creatinine, and electrolyte. Monitor ABG
levels as necessary to evaluate acid base balance.
Watch for symptoms of hyperkalemia and ecg
change.
Follow strict aseptic technique while caring for patient
with renal failure because patient is highly susceptible
to infection.
24. Watch for cardiac dysrhythmias and heart failure
from hyperkalemia, electrolyte imbalance, or fluid
overload. Have resuscitation equipment available
in case of cardiac arrest.
If the patient requires hemodialysis, check the
blood access site every 2 hours for patency and
signs of clotting. Weight the patient before
dialysis.
During dialysis monitor vital signs, clotting time,
blood flow, function of the vascular access site
and arterial and venous pressure.
25. 1.Excess fluid volume related to renal failure
evidenced by oliguria, tissue edema, and weight
gain.
Intervention:-
Accurately record intake and output chart.
Monitor urine specific gravity.
Weight daily at same time of day on same scale.
Assess skin, face, dependent area for edema.
Auscultate lung and heart sounds.
26. 2.Imbalance nutrition less thyan body requirements
related to protein catabolism, dietary restriction as
evidenced by weakness and weight change.
Intervention:-
Assess and document dietary intake.
Provide frequent, small feedings.
Weight daily.
Provide high calorie, low to moderate protein diet.
Maintain proper electrolyte balance by strictly
monitoring levels.
27. 3.Risk for infection related to invasive procedures,
as evidenced by high temperature.
Intervention:-
If possible avoid invasive procedures.
Use aseptic technique when caring and
manipulating IV and invasive lines.
Provide routine catheter care.
Monitor vital signs.
Monitor WBC count.
28. 4.Knowledge deficiency related to lack of exposure
evidenced by questioning for information.
Intervention:-
Explain the renal function.
Discuss renal dialysis or transplantation if these
are likely options for the future.
Answer the patient questioning politely about the
disease condition.
29.
30. The topic ARF is summarized by introduction,
definition, etiology, risk factors,
pathophysiology, clinical manifestation,
diagnostic evaluation, complication, prevention,
medical management, nursing management,
nursing diagnosis.
31. Administration of mesenchymal stem cells (MSCs)
improves recovery of acute kidney injury (AKI).
Result:-
They found that MSC-MV are able to stimulate in
vitro proliferation and apoptosis resistance of
TEC. In additional, microvesicle(MVs) were found
to accelerate in vivothe morphological and
functional recovery of AKI by inducing tubular cell
proliferation.
32. What is AKI, write down the
etiology and management
of ARF?
33. From this topic we gain the
knowledge about ARF/AKI/AKF. And
understand about the treatments of
ARF. And know the nurses role of
ARF and can manage a ARF
patient.
34. Brunner and Suddarth’s.(2016), Text book of medical
surgical nursing; 12th edition: publish by. Lippincott Williums
and wilkins, page no.
Javed Ansari and Davinden kaur.(2011), Text book of
medical surgical nursing volume-ii; 1st edition: publish by pee
vee, page no. 427-430
Lewis.Bucher, Heitkempeer, Harding, Kwong.(2017),
Roberts medical surgical nursing, assessment and
management of clinical problems; 3rd south asia edition:
publish by RELX India pvt.ltd , new delhi; page no. 657-666
https://en.wikipedia.org/wiki/ARF
https://www.mayoclinic.org/diseases-conditions/kidney-
failure/symptoms-causes/syc