Chronic kidney disease (CKD) is defined as decreased kidney function over a period of three months or more. It can cause complications such as anemia, metabolic acidosis, hyperkalemia, and cardiovascular disease as kidney function declines. Treatment involves managing the underlying cause, restricting dietary intake of sodium, potassium, and phosphorus, treating complications pharmacologically, and potentially performing long-term dialysis or kidney transplantation for end-stage renal disease. Nursing care focuses on fluid management, dietary modifications, treatment of complications, and health education.
chronic kidney disease, diagnosis, management, prognosis, complications, renal replacement therapy, when to initiate hemodialysis, complication of hemodialysis, mortality and morbility.
Chronic kidney disease (CKD) means your kidneys are damaged and can't filter blood the way they should. The disease is called “chronic” because the damage to your kidneys happens slowly over a long period of time.
Chronic kidney disease (CKD) consists of a spectrum of different pathophysiologic processes associated with abnormal kidney function, and a progressive decline in glomerular filtration rate (GFR).
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.
MEANING
Sudden and often temporary loss of kidney function.
DEFINITION
Acute renal failure (ARF) is an abrupt and sudden reduction in renal function resulting in the inability to excrete metabolic wastes and maintain proper fluid & electrolyte balance.
• It usually associated with oliguria (less than 500ml/day), no oliguria (greater than 800ml/day) or anuria (less than 50ml/day).
• BUN &creatinine values are elevated.
Etiology
ARF can be further divided into pre-renal, intra renal and post renal etiologies.
1) Pre- Renal causes
Are those that decrease effective blood flow to the kidney and cause a decrease in the glomerular filtration rate (GFR). Both kidneys need to be affected as one kidney is still more than adequate for normal kidney function.
Volume depletion resulting from:
• Hemorrhage
• Renal losses (diuretics, osmotic diuresis)
• Gastrointestinal losses (vomiting, diarrhea, nasogastric suction)
Impaired cardiac efficiency resulting from:
• Myocardia infraction
• Heart failure
• Dysrhythmias
• Cardiogenic shock
Vasodilation resulting from:
• Sepsis
• Anaphylaxis
• Antihypertensive medications or other medications that cause vasodilation.
2) Intrarenal causes
Refers to disease processes which directly damage the kidney itself. It can be due to one or more of the kidney’s structures including the glomeruli, kidney tubules or the interstitium.
Prolonged renal ischemia resulting from:
• Pigment nephropathy (associated with the breakdown of blood cells containing pigments that in turn occlude kidney structures)
• Myoglobinuria (trauma, crush injuries, burns)
• Hemoglobinreuria (transfusion reaction, hemolytic anemia)
Nephrotoxic agents such as:
• Aminoglycoside antibiotics (gentamycin, tobramycin)
• Radiopaque contrast agents
• Heavy metals (lead, mercury)
• Solvents and chemicals (ethylene glycol, carbon tetrachloride, arsenic)
• NSAIDS
• ACE inhibitors
Infections processes such as:
• Acute pyelonephritis
• Acute glomerulonephritis
3) Post renal causes
Refers to mechanical obstruction of urinary outflow, between the kidney and the urethral meatus, which includes urethral and bladder neck obstruction due to:
Calculi formation
Benign prostatic hyperplasia
Tumors
Strictures
Trauma (to back, pelvis or perineum)
Blood clots
Pathophysiology
The kidneys receive approximately one fourth of cardiac output; therefore, they are very sensitive to alteration in perfusion. Most cases of ARF are caused by ischemia episode. The pathophysiology of ARF is not completely understood.
PrerenalARF, is the result of impaired blood flow that leads to hypo perfusion of the kidney which causes decreased oxygen delivery that leads to hypoxemia and ischemia due to damage the kidney and glomerular filtration rate (GFR) decreases that leads to electrolyte imbalance and increased tubular reabsorption of sodium and water.
Intrarenal ARF is the result of actual parenchymal damage to the glomeruli or kidney
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.
chronic kidney disease, diagnosis, management, prognosis, complications, renal replacement therapy, when to initiate hemodialysis, complication of hemodialysis, mortality and morbility.
Chronic kidney disease (CKD) means your kidneys are damaged and can't filter blood the way they should. The disease is called “chronic” because the damage to your kidneys happens slowly over a long period of time.
Chronic kidney disease (CKD) consists of a spectrum of different pathophysiologic processes associated with abnormal kidney function, and a progressive decline in glomerular filtration rate (GFR).
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.
MEANING
Sudden and often temporary loss of kidney function.
DEFINITION
Acute renal failure (ARF) is an abrupt and sudden reduction in renal function resulting in the inability to excrete metabolic wastes and maintain proper fluid & electrolyte balance.
• It usually associated with oliguria (less than 500ml/day), no oliguria (greater than 800ml/day) or anuria (less than 50ml/day).
• BUN &creatinine values are elevated.
Etiology
ARF can be further divided into pre-renal, intra renal and post renal etiologies.
1) Pre- Renal causes
Are those that decrease effective blood flow to the kidney and cause a decrease in the glomerular filtration rate (GFR). Both kidneys need to be affected as one kidney is still more than adequate for normal kidney function.
Volume depletion resulting from:
• Hemorrhage
• Renal losses (diuretics, osmotic diuresis)
• Gastrointestinal losses (vomiting, diarrhea, nasogastric suction)
Impaired cardiac efficiency resulting from:
• Myocardia infraction
• Heart failure
• Dysrhythmias
• Cardiogenic shock
Vasodilation resulting from:
• Sepsis
• Anaphylaxis
• Antihypertensive medications or other medications that cause vasodilation.
2) Intrarenal causes
Refers to disease processes which directly damage the kidney itself. It can be due to one or more of the kidney’s structures including the glomeruli, kidney tubules or the interstitium.
Prolonged renal ischemia resulting from:
• Pigment nephropathy (associated with the breakdown of blood cells containing pigments that in turn occlude kidney structures)
• Myoglobinuria (trauma, crush injuries, burns)
• Hemoglobinreuria (transfusion reaction, hemolytic anemia)
Nephrotoxic agents such as:
• Aminoglycoside antibiotics (gentamycin, tobramycin)
• Radiopaque contrast agents
• Heavy metals (lead, mercury)
• Solvents and chemicals (ethylene glycol, carbon tetrachloride, arsenic)
• NSAIDS
• ACE inhibitors
Infections processes such as:
• Acute pyelonephritis
• Acute glomerulonephritis
3) Post renal causes
Refers to mechanical obstruction of urinary outflow, between the kidney and the urethral meatus, which includes urethral and bladder neck obstruction due to:
Calculi formation
Benign prostatic hyperplasia
Tumors
Strictures
Trauma (to back, pelvis or perineum)
Blood clots
Pathophysiology
The kidneys receive approximately one fourth of cardiac output; therefore, they are very sensitive to alteration in perfusion. Most cases of ARF are caused by ischemia episode. The pathophysiology of ARF is not completely understood.
PrerenalARF, is the result of impaired blood flow that leads to hypo perfusion of the kidney which causes decreased oxygen delivery that leads to hypoxemia and ischemia due to damage the kidney and glomerular filtration rate (GFR) decreases that leads to electrolyte imbalance and increased tubular reabsorption of sodium and water.
Intrarenal ARF is the result of actual parenchymal damage to the glomeruli or kidney
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.
Acute kidney injury (AKI), also known as acute renal failure (ARF), is a sudden episode of kidney failure or kidney damage that happens within a few hours
CKD is a condition in which the kidneys are damaged and cannot filter blood as well as they should. Because of this, excess fluid and waste from blood remain in the body and may cause other health problems, such as heart disease and stroke.
This includes a comprehensive study of Renal Failure - both AKI & CKD (ESRD). It is very helpful for those who are managing the clients with renal failure.
Renal failure and its homeopathy treatment in Chembur, Mumbai, India Shewta shetty
"Treatment & remedies for renal failure and its homeopathy treatment.Personalised online consultancy & treatments provided at our clinic by efficient panel of doctors in our center at mumbai,Bombay,Chembur, India.Contact us."/>
Acute Kidney Failure is a sudden reduction in kidney function that results in nitrogenous wastes accumulating in the blood.
Chronic renal failure is a Progressive, irreversible deterioration in renal function in which the body’s ability to maintain metabolic, fluid and electrolyte balance fails resulting in Uremia and Azotemia.
Definition, Etiology, Risk Factors, Stages, Clinical Manifestations, Management, Surgical Management, Prevention, Complications. Nursing Management
Similar to Chronic kidney disease and its management (20)
Extracorporeal membrane oxygenation, also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an
adequate amount of gas exchange or perfusion to sustain life. The technology for ECMO is largely derived from cardiopulmonary bypass, which provides shorter-term support with arrested native circulation.
This intervention has mostly been used on children, but it is seeing more use in adults with cardiac and respiratory failure. ECMO works by removing blood from the person's body and artificially removing the carbon dioxide and oxygenating red blood cells. Generally, it is used either post-cardiopulmonary bypass or in late stage treatment of a person with profound heart and/or lung failure, although it is now seeing use as a treatment for cardiac arrest in certain centers, allowing treatment of the underlying cause of arrest while circulation and oxygenation are supported.
Normal cell metabolism depends on the maintenance of blood pH within very narrow limits (7.35-7.45).
Even relatively mild excursions outside this normal pH range can have deleterious effects. ABG is most frequently performed on critically ill patients to assess acid base status of patients.
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.
continuous or intermittent monitoring of heart activity, generally by electrocardiography, with assessment of the patient's condition relative to their cardiac rhythm.
The inflammation of the heart muscles, such as myocarditis, the membrane sac which surrounds the heart called as pericarditis, and the inner lining of the heart or the myocardium, heart muscle as endocarditis are known as the inflammatory heart diseases.
India has launched 11 five year plans so far and 12th is in progress.DescriptionThe NITI Aayog is a policy think tank of the Government of India, established with the aim to achieve Sustainable Development Goals and to enhance cooperative federalism by fostering the involvement of State Governments of India in the economic policy-making process using a bottom-up approach.
Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.
Cardiac monitoring generally refers to continuous or intermittent monitoring of heart activity, generally by electrocardiography, with assessment of the patient's condition relative to their cardiac rhythm.
Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement — is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
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This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
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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
2. What is CKD ?
It is a term that encompasses all degrees of decreased renal
function, from damaged–at risk through mild, moderate, and severe
chronic kidney failure.
CRF
4. A Global health awareness campaign focusing on the importance of the
kidneys and reducing the frequency and impact of kidney disease and its
associated health problems worldwide.
10. DEFINITION
CKD is a condition in which there is either kidney damage or a decreased
glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 for at least 3
months.
Whatever the underlying etiology, once the loss of nephrons and reduction of
functional renal mass reaches a certain point, the remaining nephrons begin a
process of irreversible sclerosis that leads to a progressive decline in the GFR.
The Kidney Disease
Outcomes Quality
Initiative (KDOQI) of
the National Kidney
Foundation (2002)
12. CRITERIA FOR ESTABLISHMENT OF CKD
•Albuminuria (albumin excretion> 30 mg/24hror albumin: creatinine ratio > 30
mg/g [> 3 mg/mmol])
Urine sediment abnormalities
Electrolyte and other abnormalities due to tubular disorders
Histologic abnormalities
Structural abnormalities detected by imaging
History of kidney transplantation
15. CLINICAL MANIFESTATIONS
• Patients with CKD stages 1-3 are generally asymptomatic
• sodium and water imbalance
Peripheral edema
Pulmonary edema
Hypertension
Congestive heart failure
• Hyperkalemia due to either extracellular shift of potassium (as in
acidemia) or lack of insulin in DM.
• Metabolic acidosis
Malaise
Potentially fatal cardiac arrhythmias
16. CLINICAL MANIFESTATIONS
• Proteinuria
Protein-energy malnutrition
Loss of lean body mass
Muscle weakness
• Azotemia (nitrogen in blood) and Uremia (urea in blood)
Uremic frost (Due to its high systemic circulation, urea is excreted in eccrine sweat at high
concentrations and crystallizes on skin as the sweat evaporates)
Pericarditis: Can be complicated by cardiac tamponade, possibly resulting in death if
unrecognized
Encephalopathy: Can progress to coma and death
Peripheral neuropathy, usually asymptomatic
Restless leg syndrome
17. CLINICAL MANIFESTATIONS
Gastrointestinal symptoms: Anorexia, nausea, vomiting, diarrhea
Skin manifestations: Dry skin, pruritus, ecchymosis
Fatigue, increased somnolence, failure to thrive
Malnutrition
Sexual dysfunction such as Erectile dysfunction, decreased libido, amenorrhea
Coagulopathies (Platelet dysfunction with tendency to bleed)
Hyperphosphatemia
18. CLINICAL MANIFESTATIONS
Hypocalcemia due to 1,25 dihydroxyvitamin D3 deficiency
Secondary hyperparathyroidism
Renal osteodystrophy
Vascular calcification
Left ventricular hypertrophy
Calciphylaxis (calcium accumulates in small blood vessels of the fat and skin
tissues)
Abnormalities in bone turnover, mineralization, volume, linear growth, or strength
Renal osteodystrophy (defective bone development)
19. CLINICAL MANIFESTATIONS
Reduction in erythropoietin
Anemia
Fatigue
Reduced exercise capacity
Impaired cognitive and immune function
Reduced quality of life
Development of cardiovascular disease
New onset of heart failure or the development of more severe heart failure
Increased cardiovascular mortality
20. DIAGNOSIS
• History
• Physical examination
• Urine
Volume: Usually less than 400 mL/24 hr (oliguria) or urine is absent (anuria).
Color: Abnormally cloudy urine may be caused by pus, bacteria, fat, colloidal
particles, phosphates, or urates. Dirty, brown sediment indicates presence of
RBCs, hemoglobin, myoglobin, porphyrins.
21. DIAGNOSIS
Specific gravity: Less than 1.015 (fixed at 1.010 reflects severe renal damage).
Osmolality: Less than 350 mOsm/kg is indicative of tubular damage, and
urine/serum ratio is often 1:1.
Blood
• BUN/Creatinine: GFR and creatinine clearance decrease while serum creatinine
(more sensitive indicator of renal function) and BUN levels increase. Creatinine
level of 12 mg/dL suggests ESRD. A BUN of >25 mg/dL is indicative of renal
damage.
• CBC: Anemia is present. Hemoglobin usually less than 7–8 g/dL.
• RBCs: Life span of red blood cells decreased because of erythropoietin
deficiency & azotemia.
22. DIAGNOSIS
• Proteins (especially albumin): Decreased serum level may reflect protein loss via
urine, fluid shifts, decreased intake, or decreased synthesis because of lack of
essential amino acids.
• Serum osmolality: Higher than 285 mOsm/kg; often equal to urine.
• sodium: May be low (if kidney “wastes sodium”) or normal (reflecting dilutional
state of hypernatremia).
• Potassium: Elevated related to retention and cellular shifts (acidosis) or tissue
release (RBC hemolysis). In ESRD, ECG changes may not occur until potassium
is 6.5 mEq or higher. Potassium may also be decreased if patient is on
potassium-wasting diuretics or when patient is receiving dialysis treatment.
23. DIAGNOSIS
• Magnesium, phosphorus: Elevated.
• Calcium/phosphorus: Decreased.
• ABGs: pH decreased. Metabolic acidosis (less than 7.2) occurs because of loss
of renal ability to excretehydrogen and ammonia or end products of protein
catabolism.
• Antinuclear antibodies (ANA) to screen for for systemic lupus erythematosus
• Cytoplasmic and perinuclear pattern antineutrophil cytoplasmic antibody (C-
ANCA and P-ANCA) levels: Positive findings are helpful in the diagnosis of
granulomatosis with polyangiitis (Wegener granulomatosis); a positive P-ANCA
result is also helpful in the diagnosis of microscopic polyangiitis
24. DIAGNOSIS
• KUB x-rays: Demonstrates size of kidneys/ureters/bladder and presence of obstruction
(stones).
• Retrograde pyelogram: Outlines abnormalities of renal pelvis and ureters.
• Renal arteriogram: Assesses renal circulation and identifies extravascularities, masses.
• Voiding cystourethrogram: Shows bladder size, reflux into ureters, retention.
• Renal ultrasound: Determines kidney size and presence of masses, cysts, obstruction in
upper urinary tract.
• Renal biopsy: May be done endoscopically to examine tissue cells for histological
diagnosis.
• Renal endoscopy, nephroscopy: Done to examine renal pelvis; flush out calculi,
hematuria; and remove selected tumors.
• ECG: May be abnormal, reflecting electrolyte and acid-base imbalances.
• X-ray of feet, skull, spinal column, and hands: May reveal demineralization/ calcifications
resulting from electrolyte shifts associated with CRF
26. NON PHARMACOLOGICAL MANAGEMENT
• oxygen support if required.
• restrict dietary protein to less than 40gm/day. Restrict sodium and
potassium, phosphate intake
• Water and electrolyte balance: Daily fluid intake should be
according to previous urine output+600
• Daily weight monitoring
• General health advice
27. PHARMACOLOGICAL MANAGEMENT
• Treatment of underlying condition (eg: Diabetes mellites,
hypertension, autoimmune diseases etc)
• Treatment of fluid overload: Diuretics (Furosemide oral/IV 40-120mg
daily
• Treatment of hypocalcaemia- calcium citrate 1g/day, Vitamin D
supplement; 2 tablets (800IU) once daily.
• phosphorus binders to treat hyperphosphatemia- Phosphate
binders
• Treatment of hyperkalemia
28. PHARMACOLOGICAL MANAGEMENT
• calcium acetate/ calcium carbonate 2 capsules orally with food.
• Antihypertensive and cardiovascular agents (digoxin and dobutamine) manage
hypertension. They have also been found to reduce the risk of major
cardiovascular events such as myocardial infarction, stroke, heart failure, and
death from cardiovascular disease. The goal of BP< 130/80mmHg. ACE inhibitors
such as lisinopril, oral, 5-40 mg daily or ramipril, oral, 2.5-10mg daily. ARBs such
as losartan, oral, 25-100mg daily or valsartan, oral 80-160mg daily.
• Statins to treat hypercholesterolemia
• Anti-seizure agents (IV diazepam or phenytoin) are used for seizures
• Replacement of Erythropoietin (Epogen) is used to treat anemia associated
ESRD. A target hemoglobin level of 9–12 g/dL is recommended. Inj Erythropoietin
50-100 units IV/SC 3 times weekly. Tab Ferrous sulphate 200mg 3 times daily
29. PHARMACOLOGICAL MANAGEMENT
• Replacement of Calcitriol
• 10% calcium gluconate, IV, 10-20ml over 2-5 minutes.
• Regular insulin, IV, 10 units in 50-100 ml glucose 50%.
• Treatment of pruritis
• Capsaicin cream or cholestyramine
• Treatment of bleeding
• Desmopressin 0.3 mcg/kg IV over 15-30 mins
• Nutritional therapy. Dietary intervention includes careful regulation of protein
intake, fluid intake to balance fluid losses, sodium intake to balance sodium
losses, and some restriction of potassium.
• Dialysis (Haemodialysis or Peritoneal Dialysis)
30. SURGICAL MANAGEMENT
• The renal artery of the new kidney, previously branching from the
abdominal aorta in the donor, is often connected to the external iliac
artery in the recipient.
• The renal vein of the new kidney, previously draining to the inferior
vena cava in the donor, is often connected to the external iliac vein
in the recipient
• The donor ureter is anastomosed with the recipient bladder.
33. CONCLUSION
Chronic kidney disease results in worse all-cause mortality which increases as kidney
function decreases. While renal replacement therapies can maintain people
indefinitely and prolong life, the quality of life is negatively affected. Kidney
transplantation increases the survival of people with stage 5 CKD when compared to
other options; however, it is associated with an increased short-term mortality due to
complications of the surgery.
34. BIBLIOGRAPHY
Brunner and Sudharth’s Text book of Medical Surgical Nursing, Vol I, 11th edition. Lippincott Williams and Wilkins, 2008
Black, M Joyce, Medical Surgical Nursing: Clinical ManageMent of positive outcomes, Vol I, 8th edition, Saunders and
Elsevier publications, 2009
Lewis, Medical Surgical Nursing: Assessment and Management Of Clinical Problems, 6th edition, mosby
publications,2004
https://emedicine.medscape.com/article/318436-overview (Assessed on 09/08/2019)
https://www.hindawi.com/journals/jir/2018/2180373/ abs (Assessed on 11/08/2019)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6315879 (Assessed on 11/08/2019)
https://en.wikipedia.org/wiki/Chronic_kidney_disease (Assessed on 05/08/219)