Drugs and the kidney
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The document discusses drugs and their effects on the kidney. It covers normal kidney function, methods of assessing renal function, how drugs are processed by the kidneys, diuretics, nephrotoxic drugs, and prescribing considerations for patients with kidney disease. Key points include how different drug classes like loop diuretics and thiazides work at different sites in the nephron to cause diuresis, risks of nephrotoxicity from NSAIDs, aminoglycosides and contrast agents, and dosing adjustments needed in renal impairment.
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1. Diuretics are drugs that cause increased excretion of water and sodium in urine. They are classified based on their mechanism and efficacy as high ceiling loop diuretics, medium efficacy thiazides, weak carbonic anhydrase inhibitors, and potassium-sparing diuretics.
2. Loop diuretics like furosemide inhibit sodium reabsorption in the ascending loop of Henle. Thiazides like hydrochlorothiazide act in the distal convoluted tubule. Carbonic anhydrase inhibitors inhibit the enzyme carbonic anhydrase.
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ANAESTHESIA FOR PATIENT WITH LIVER DISEASE.pdf
Anesthesia for patients with liver disease can be challenging, as all the drugs we give metabolize through liver.
ANAESTHESIA FOR PATIENTS WITH RENAL FAILURE.pptx
The document discusses renal failure and its implications for anesthesia. It describes the functions of the kidneys and defines acute kidney injury and chronic kidney disease. For patients with renal impairment, pre-operative optimization is important, including fluid management and electrolyte correction. Regional anesthesia is preferred over general anesthesia when possible due to better hemodynamic stability. Careful monitoring is needed during and after surgery to watch for fluid overload, electrolyte abnormalities, and other complications.
Acute Kidney Dysfunction
The document discusses acute kidney dysfunction (AKD) in intensive care unit patients. It defines AKD and describes the RIFLE criteria for classifying its severity. Common risk factors for AKD include hypovolemia, hypotension, and exposure to nephrotoxins. The document outlines prevention and treatment strategies and notes that mortality is high for patients requiring renal replacement therapy for AKD.
ALCOHOLIC LIVER DISEASE
This document discusses alcoholic liver disease (ALD). It notes that ALD ranges in severity from fatty liver to alcoholic hepatitis to cirrhosis. Risk factors include the amount of alcohol consumed daily and genetically. Diagnosis involves blood tests like GGT and liver biopsy. Severe alcoholic hepatitis has high short-term mortality and is treated with corticosteroids or pentoxifylline to reduce inflammation. Prognosis can be predicted using scores like Maddrey DF and management involves lifestyle changes like abstaining from alcohol and adequate nutrition.
Digoxin toxicity
Digoxin toxicity is caused by digoxin, a plant-derived cardiac glycoside used to treat heart conditions. It has a narrow therapeutic window, so toxicity can easily occur. Common signs of toxicity include arrhythmias such as heart block or tachycardia. Management involves discontinuing digoxin, treating arrhythmias, correcting electrolyte imbalances, and using digoxin antibody fragments for severe toxicity. Factors like renal impairment, hypokalemia, and drug interactions can precipitate or worsen digoxin toxicity.
Anaesthetic implications of chronic kidney disease and transplantation
This document discusses chronic kidney disease (CKD) and renal transplantation. It notes that CKD affects over 8% of the population in the UK and many require long-term renal replacement therapy. Mortality rates are higher for those on dialysis compared to transplant recipients. The objectives are to discuss CKD complications, anesthesia considerations for CKD and transplantation, pertinent pharmacology, and immunosuppression drugs. CKD is progressive loss of renal function that is staged based on glomerular filtration rate. Complications include anemia, cardiovascular issues, acid-base abnormalities, and more. Treatment focuses on slowing progression to renal failure through blood pressure control and replacement therapies.
Acute renal failure patho physiology & anaesthetic management
The document discusses acute renal failure (ARF), also known as acute kidney injury (AKI). It defines ARF as the deterioration of renal function over hours to days, resulting in the kidneys' inability to excrete waste and maintain fluid/electrolyte homeostasis. The diagnostic criteria for ARF include a rapid rise in creatinine or reduction in urine output. ARF is classified based on urine output and can be prerenal, intrinsic renal, or postrenal in etiology. Anesthetic management of patients with ARF requires special considerations for fluid balance, electrolytes, drugs, and prevention of further kidney injury.
Sepsis
This document summarizes recent developments in the diagnosis and management of sepsis based on a journal article. It discusses definitions of sepsis, previous diagnostic and treatment approaches, current best practices like the STOP sepsis bundle, and potentially time-sensitive treatments such as antibiotics, hemodynamic support, low tidal volume ventilation, steroids, glucose control, and drotrecogin alfa. The challenges of early diagnosis and prognostic factors are also reviewed.
Onconephrology shield the kidney while fighting cancer , dr ayman seddik
This document discusses kidney diseases that can occur in patients with cancer or undergoing cancer treatment. It begins by defining onconephrology as the field of nephrology dealing with kidney complications of cancer. Common reasons a nephrologist may be consulted include kidney diseases that predate or develop during cancer, new glomerular diseases, obstructive nephropathy, tubular damage, thrombotic microangiopathy, radiation nephropathy, tumor invasion of the kidney, tumor lysis syndrome, and electrolyte disorders. Kidney complications discussed in more depth include acute kidney injury, cancer-associated glomerulopathy, chemotherapy-associated tubulointerstitial nephritis, hypercalcemia of
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Multiple tablet poisoning Toxicology CME MOHANAVEL.pptx
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Anaesthetic implications of chronic kidney disease and transplantation
Anaesthetic implications of chronic kidney disease and transplantation
Acute renal failure patho physiology & anaesthetic management
Acute renal failure patho physiology & anaesthetic management
Onconephrology shield the kidney while fighting cancer , dr ayman seddik
Onconephrology shield the kidney while fighting cancer , dr ayman seddik
More from raj kumar
The umbilical cord
The umbilical cord connects the fetus to the placenta and measures approximately 50 cm in length and 2 cm in diameter at term. It contains one vein that carries oxygenated blood to the fetus and two arteries that carry deoxygenated blood away. The cord inserts into the placenta near its center in most cases. Abnormalities can include abnormal insertion points, short or long length, knots, torsion, hematoma, or having a single umbilical artery instead of two.
The placenta
The placenta develops from fetal and maternal tissues to function as the respiratory, nutritive, excretory, barrier and endocrine organ of pregnancy. It transfers oxygen, nutrients and waste between the mother and fetus. The placenta can develop abnormalities in its shape, size, position or adhesion to the uterine wall which may cause complications like preterm birth or hemorrhage. Placental lesions like infarcts may also occur due to conditions like hypertension.
The foetal membranes
The document discusses the fetal membranes, which include the chorion and amnion. The chorion is the outer membrane that is attached to the placenta and uterine wall. The amnion lines the chorion and encloses the fetus and amniotic fluid. The amniotic fluid provides protection and nutrition for the fetus, and aids in temperature regulation and movement. It is composed primarily of water, carbohydrates, proteins and minerals. The amniotic fluid circulates continuously, with production from the fetal membranes, fetal urine and transudation from maternal and fetal blood.
Physiology of reproduction
The document summarizes the key stages in human reproduction from fertilization through early pregnancy development. It describes how sperm mature and are capacitated in the female reproductive tract. Upon ovulation, sperm meet and fertilize the ovum in the fallopian tubes. The zygote then undergoes cell division and develops into a blastocyst that implants in the uterus. The trophoblast cells of the blastocyst invade the uterine lining and develop into a placenta to exchange nutrients and waste with the mother's blood. Major developmental milestones in early pregnancy include chorion, amnion and decidua formation.
Minor complaints during pregnancy
The document discusses several minor complaints that may occur during pregnancy, including gingivitis, ptyalism, heartburn, constipation, hemorrhoids, varicosities, dyspnea, urinary symptoms, leucorrhea, leg cramps, paraethesia, and backache. For each complaint, the causes and recommended treatments are provided.
Diagnosis of pregnancy
This document discusses the diagnosis of pregnancy over three trimesters. In the first trimester, common symptoms include missed periods, morning sickness, frequent urination, and breast changes. Signs include enlarged, soft breasts and uterus, and a softer, purplish cervix. Pregnancy tests detect human chorionic gonadotropin in urine or blood. Ultrasounds can visualize the gestational sac after 4-5 weeks. In the second trimester, symptoms decrease while the abdomen enlarges and fetal movement is felt. Signs include skin changes and palpable fetal parts. The third trimester confirms pregnancy through palpation of fetal parts and auscultation of the fetal heart.
Antenatal care
Antenatal care involves regular checkups during pregnancy to monitor the health of the mother and baby. Checkups include exams, tests, and education on nutrition, exercise, hygiene, warning signs and avoiding risks. The goals are to prevent or treat complications, detect issues, and ensure healthy development. Women receive more frequent exams as their due date approaches, and are instructed on a nutritious diet, moderate exercise, adequate rest, hygienic practices, and when to seek medical help if problems arise.
Postpartum mood disorders
The document discusses postpartum mood disorders, including prevalence, risk factors, screening tools, diagnosis, and treatment options. It notes that postpartum mood disorders range from mild and temporary postpartum blues to more severe postpartum depression and postpartum psychosis. Screening tools like the Edinburgh Postnatal Depression Scale can help identify at-risk women. Treatment involves psychosocial therapies and may include antidepressant medication depending on severity. A multidisciplinary approach is important to address biological, psychological and social factors.
Normal and abnormal puerperium
Uterine fibroids are benign smooth muscle tumors that develop in the uterus. They are the most common solid pelvic tumors, affecting 20-25% of women during their reproductive years. Fibroids can vary in size and location, and may cause heavy menstrual bleeding, pelvic pressure or pain. Treatment options include observation, medical therapy to reduce estrogen levels, or surgical removal of fibroids.
Version
Version refers to changing the fetal lie or position in the uterus. There are three main types: external cephalic version, internal podalic version, and bipolar podalic version. External cephalic version involves manipulating the fetus externally to convert a breech presentation to head-first. Internal podalic version is performed under anesthesia when the cervix is fully dilated to grasp the fetus's feet and convert a transverse lie to breech. Bipolar podalic version uses both internal and external manipulation through a partially dilated cervix for special circumstances. Complications can include fetal distress, premature separation of the placenta, and maternal hemorrhage.
Vacuum extraction (ventouse)
Vacuum extraction is a method to assist in childbirth using suction from a cup placed on the baby's head to help with traction during contractions. There are different types of cups including metal, soft, and bird's cups. Vacuum extraction is indicated when forceps cannot be used and has advantages over forceps like less need for anesthesia and less compression force applied. Complications can include maternal lacerations and cervical injuries or fetal issues like cephalhematomas and scalp lacerations.
Symphysiotomy
Symphysiotomy is a surgical procedure that divides the symphysis pubis bone to widen the pelvis during childbirth. It is indicated when cephalopelvic disproportion makes vaginal delivery difficult or dangerous but cesarean section is not available or advised. The procedure involves making a small incision above the pubic bone and gradually separating the joint using a scalpel. Complications can include bleeding, injury to nearby organs, infection, and long-term issues like incontinence or an unstable pelvis.
Forceps delivery
This document discusses obstetric forceps, which are metal instruments used to extract a baby's head during delivery. It describes different types of forceps and their proper application techniques. Forceps are indicated for prolonged second stage of labor, maternal distress, or fetal distress. Correct application involves inserting one blade along each side of the baby's head. Potential complications include laceration, hemorrhage, nerve injury, or problems for the baby such as skull fractures. Failure to deliver with forceps may require removal and assessment to determine if cesarean section is needed.
Episiotomy
This document discusses episiotomy, which is an incision made in the perineum during childbirth to widen the vaginal opening. It can help prevent tearing and complications. The two main types are median and mediolateral episiotomies. Median episiotomies involve a midline incision while mediolateral incisions extend laterally towards the ischial tuberosity. Episiotomies are usually performed when the vaginal opening is distended during crowning to prevent stretching injuries. They are sutured closed after delivery.
Caesarean section
The document discusses Caesarean section, including indications, types, procedure, complications, and mode of delivery in subsequent pregnancies. A Caesarean section is a surgical procedure to deliver one or more babies through incisions in the abdomen and uterus. The rate of Caesarean sections has increased from 5% in 1970 to 25% in 1990 due to factors such as abandoning difficult procedures in favor of C-sections and increased use for breech births. Complications can include hemorrhage, infections, and injuries to the mother or baby.
Normal labour
Normal labour involves the spontaneous expulsion of a single, mature fetus through the birth canal within 3-18 hours without complications. It occurs when hormonal and mechanical factors cause the cervix to efface and dilate in stages from 3cm to full 10cm dilation. Labour proceeds through four stages: 1) cervical dilation, 2) expulsion of the fetus, 3) expulsion of the placenta, and 4) recovery. The fetus descends through the birth canal with increased flexion to facilitate delivery of the head.
Anatomy of the foetal skull
The fetal skull consists of three parts: the vault, face, and base. The vault is made up of the frontal, parietal, and occipital bones which are separated by sutures. The face extends from the chin to the nose. Fontanelles are soft spots located where sutures meet which are important for assessing fetal position and flexion. The skull has various longitudinal and transverse diameters used to determine which will engage and pass through the birth canal during delivery.
Anatomy of the female pelvis
The female pelvis is divided into the false pelvis and true pelvis. The true pelvis is further divided into the pelvic inlet, cavity, and outlet. The document describes the boundaries and diameters of each region including the anatomical transverse diameter of 13cm at the inlet. It also discusses the pelvic planes and axes, and the Caldwell-Moloy classification of pelvic types including the gynaecoid, anthropoid, android, and platypelloid pelvis.
Active management of normal labour
This document outlines the active management of normal labour in 4 stages: antenatal preparation, first stage (history, exam, procedures), second stage (delivery of baby), third stage (delivery of placenta), and fourth stage (postpartum care of mother and baby). The goal is a healthy delivery with minimal effects. Key procedures include monitoring contractions/fetal heart with a partogram, positioning, nutrition, analgesia, perineal support, and immediate newborn care.
Thyrotoxicosis in pregnancy
Thyrotoxicosis in pregnancy can cause complications like abortion and preterm labour. Clinical features include weight loss, heat intolerance, tremors, and fast heart rate. It is treated with antithyroid drugs like propylthiouracil or carbimazole. Epilepsy in pregnancy commonly presents as grand mal seizures, which are treated with phenobarbitone or phenytoin along with folic acid. Rhesus isoimmunization occurs when an Rh-negative mother develops antibodies against Rh-positive blood from her baby. It can be prevented by giving the mother anti-D immunoglobulin after delivery or pregnancy events involving blood transfer from baby to mother. Affected babies may require monitoring, phot
More from raj kumar (20)
Drugs and the kidney
- 1. Drugs and the Kidney www.freelivedoctor.com
- 6. Serum Creatinine and GFR Serum creatinine Glomerular filtration rate (GFR) www.freelivedoctor.com
- 9. The nephron and electrolyte handling www.freelivedoctor.com
- 21. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) The ALLHAT Collaborative Research Group Sponsored by the National Heart, Lung, and Blood Institute (NHLBI) www.freelivedoctor.com
- 22. Cumulative Event Rates for the Primary Outcome (Fatal CHD or Nonfatal MI) by ALLHAT Treatment Group Chlorthalidone Amlodipine Lisinopril www.freelivedoctor.com Years to CHD Event 0 1 2 3 4 5 6 7 Cumulative CHD Event Rate 0 .04 .08 .12 .16 .2 RR (95% CI) p value A/C 0.98 (0.90-1.07) 0.65 L/C 0.99 (0.91-1.08) 0.81
- 23. Overall Conclusions Because of the superiority of thiazide-type diuretics in preventing one or more major forms of CVD and their lower cost, they should be the drugs of choice for first-step antihypertensive drug therapy. www.freelivedoctor.com
- 42. From Knauf & Mutschler Klin. Wochenschr. 1991 69:239-250 70% 20% 5% 4.5% 0.5% Volume 1.5 L/day Urine Na 100 mEq/L Na Excretion 155 mEq/day 100% GFR 180 L/day Plasma Na 145 mEq/L Filtered Load 26,100 mEq/day CA Inhibitors Proximal tubule Loop Diuretics Loop of Henle Thiazides Distal tubule Antikaliuretics Collecting duct Thick Ascending Limb www.freelivedoctor.com
- 45. N N SO 2 NH 2 SO 2 NH 2 NH 2 NH 2 NH 2 SO 2 NH 2 Cl Cl SO 2 NH 2 SO 2 NH 2 Cl SO 2 NH 2 N C N SO 2 Prontosil Sulfanilamide p-chlorobenzene sulfonamide 1,3 disulfonamide 6 cholrobenzene Cholrothiazide www.freelivedoctor.com
- 47. General Structure of Thiazide Diuretics www.freelivedoctor.com
- 48. Inhibition of high-affinity 3 H-metolazone binding by ions www.freelivedoctor.com Ion % Control NaF 143±9 LiCl 4±1 NaCl 20±0.5 KCl 44±2 Choline chloride 36±7 NaBr 24±2 NaI 25±1 KI 12±2 Na acetate 82±5 K acetate 95±5 Disodium sulfate 152±22 Dipotassium sulfate 118±12 Trisodium citrate 112±5
- 49. Correlation of the daily clinical doses of thiazide diuretics with their affinity for high-affinity 3 H-metolazone binding sites in rat kidney. Correlation coefficient r=0.7513. www.freelivedoctor.com
- 52. Schematic drawing of temporal changes in mean arterial pressure (MAP), total peripheral vascular resistance (TPR), cardiac output (CO) and plasma volume (PV) during thiazide treatment of a hypertensive subject www.freelivedoctor.com
- 71. Maximum Doses of Loop Diuretics www.freelivedoctor.com Clinical Condition Dose of furosemide (mg) intravenous Oral Renal Insufficiency 0 < Cl Cr < 50 80 160 Renal Insufficiency Cl Cr < 20 200 400 Nephrotic Syndrome 120 240 Cirrhosis 40 80 Congestive Heart Failure 40-80 80-160