Copyright by Dr. Thuzar Win
Department of Medicine
University of Medicine - 2, Yangon
Feel free to request to take it down this slide if you are copyright owner.
pathophysiology of acute and chronic renal failure - Bestha Chakrapani associate professor Deparrtment of Balaji college of pharmacy , ananthapuramu-515004
Copyright by Dr. Thuzar Win
Department of Medicine
University of Medicine - 2, Yangon
Feel free to request to take it down this slide if you are copyright owner.
pathophysiology of acute and chronic renal failure - Bestha Chakrapani associate professor Deparrtment of Balaji college of pharmacy , ananthapuramu-515004
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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.
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.
2.
Homeostasis: acidbase, BP
Excrete urea, toxins,
water
Produce
Erythropoetin
(hormone that
stimulates RBC
production)
Produce Renin (reninangiotensin system
regulates BP)
Convert Vitamin D
into useable form
Think about the
nursing implications
of each!
3. Two thirds of all chronic
kidney disease is
related to other
chronic illnesses.
Diabetes (43%)
Hypertension (23%)
1)
Why and how do each
of these conditions
damage the kidney?
2) What can be done to
prevent or manage
these underlying
conditions?
4.
Nephrotoxic Drugs:
-Aminoglycosides: Ex. gentamycin,
tobramycin, amikacin, neomycin
-Amphotericin B
-Vancomycin
Chronic use of NSAIDS (especially cardiac
patients and patients with cirrhosis)
Patients with Creat > 2.0 who receive
radiopaque contrast dye
5.
Glomerular filtration rate (GFR) is a test used to
check how well the kidneys are working.
Specifically, it estimates how much blood passes
through the tiny filters in the kidneys, called
glomeruli, each minute.
The GFR test measures how well your kidneys are
filtering a waste called creatinine, which is
produced by the muscles.
When the kidneys aren't working well, creatinine
builds up in the blood.
Normal results range from 90 - 120
mL/min/1.73 m2
6.
Lab values – Measuring kidney function
Serum Creatinine
◦ Creatinine is a product of creatine metabolism from
muscle dependent of muscle mass
◦ Creatinine is eliminated primarily by glomerular
filtration (GFR). As GFR , serum creatinine .
◦ Doubling of creatinine suggests a 50% drop in GFR
(estimated).
8.
Characteristic of glomerular injury from
diabetets, infections, renal toxins, immune
disorders.
Excretion of 3.5 g or more of protein in the
urine per day.
Loss of serum proteins and sodium retention
9.
Glomerular capillaries are damaged Leads
to increased permeability to proteins
Decreased osmotic pressure leads to
proteinuria, hypoalbuminemia, and edema.
MAY LEAD TO RENAL FAILURE…..PREVENTION
OF CAUSES IS CRITICAL!!!
10.
Progressive loss of renal function
Associated with systemic disease such as
hypertension, diabetes mellitus, intrinsic
kidney disease.
Diabetes (40%), Hypertension (25%), and
Glomerulonephritis (10%)
Kidney damage as GFR less than 60
ml/min/1.73m2 for 3 months or more.
12. Management and goals:
Restrict dietary protein
Intensive insulin therapy if needed
Optimize BP control (tight regulation)
◦ Goal for CKD – BP 130/85
◦ Goal for Proteinuria – BP 125/75
Manage hyperlipidemia
◦ Goal of LDL - <100
13. Stage 1: Kidney damage but normal GFR
(>90), “At risk”
Stage 2: Kidney damage with mild decrease in
GFR (60-89), “Chronic Renal Insufficiency” or
CRI
Stage 3: Moderate decrease in GFR (30-59),
CRI or CRF (“Chronic Renal Failure”)
Stage 4: Severe decrease in GFR (15-29), CHF
Stage 5: Kidney Failure, GFR < 15, more than
90% of nephrons have lost function, ESRD
“End Stage Renal Disease”, dialysis or
transplant required to survive.
14. Rapid loss of renal function, progressive azotemia
(accumulation of nitrogenous waste products such
as BUN) and increasing serum creatinine.
Uremia (literally “urine in the blood”) is a condition in which renal
function declines to the point that symptoms develop in multiple
body systems.
Often associated with Oliguria (output less than 400 ml/day)
In 30% of cases there is a normal or increased urinary output
Oliguric patients have a higher mortality rate
Develops over hours or days with progressive elevation of BUN,
creatinine, and K+.
ARF follows severe, prolonged hypotension or hypovolemia or
exposure to a nephrotoxic agent, also can be due to obstruction of
urine outflow.
THINK PREVENTION!!!
16. 1. INITIATING PHASE
Begins at time of insult until S&S seen (hours to
days)
2. OLIGURIC or ANURIC PHASE
Oliguria caused by GFR decrease
Begins 1-7 days after insult depending on cause
Usually lasts usually 10-14 days (may last up to
8 weeks)
Longer the phase, poorer prognosis of renal
recovery
Manifestations are changes in UOP, fluid &
electrolyte balances, & uremia
in serum levels of urea, creatinine, uric acid,
K+ & Mg
17. Acute Renal Failure Stages
3. DIURETIC PHASE
-Gradual increase of UOP can reach 1-2 (or more) L
per day. Nephrons are still not fully functional
-Caused by osmotic diuresis and inability of tubules
to concentrate.
-Recovered ability to excrete wastes, but not
concentrate.
-Monitor for hypokalemia, hyponatremia &
dehydration
-Hypovolemia and hypotension can occur
Lasts 1-3 weeks
-Acid-base, electrolyte and waste product levels
begin to normalize.
18. 4. RECOVERY PHASE
Begins when GFR increases allowing
BUN and creatinine to reach a
plateau and decrease
May still have glycosuria and
decreased ability to concentrate
urine
Major improvements first 1-2
weeks but may take 12 months to
stabilize.
19. May excrete as much as 2L/day
Urine dilute and iso-osmolar
Hypertension and tachypnea and
symptoms of fluid overload are usually
seen
Can see orthostatic hypotension and
dry mucous membranes
Associated with less morbidity and
mortality
20.
Urinalysis
hemoglobin + in
pylonephritis, protein + in
diabetic nephropathy,
glomerulonephritis, WBC
(pyuria) + in infection
•Specific gravity of urine
1.001-1.035
•Sodium levels
-serum: 135-145 mmol/L
-urine (usually 24 hour
collection): 27-287mmol/d
Hematocrit
•Serum Creatinine
.6-1.2 mg/dL
•BUN
8-21, 10-31 if older than 90
•Urine Creatinine & Creatinine
Clearance: Determines extent of
nephron damage (decreased when
50% of nephrons lost)
21. -Treat cause
-Maintain fluid and electrolyte balance
-Prevent infection
-Monitor for arrhythmias (related to K+and
other electrolyte imbalances)
-Maintain nutritional status
Adequate protein (or restriction) depending on
catabolism
Restriction of K+, phosphate, magnesium, and/or
sodium
Dietary fat 30-40% total calories
If necessary, use TPN and/or Ca supplements,
phosphate-binders
22.
Protein: limit protein pre-dialysis (this slows
progression of renal failure). During dialysis,
protein is lost so patient will require more
protein. Concentrate on high value protein
(dairy and meat).
Potassium: limit due to hyperkalemia, especially
if on dialysis.
Salt: restrict use of salt due to renal damage
from ongoing hypertension. (canned goods,
processed foods, “fast foods,”, table salt). Make
sure salt substitute does not contain potassium.
Phosphorus: elevated in patients with renal
disease. (dairy products, yogurt, eggs)
Fluid restriction: carefully follow restrictions
23. ◦
◦
◦
◦
◦
◦
◦
◦
Fluid and electrolyte imbalance
Susceptibility to secondary infections
Anemia
Platelet dysfunction
Gastrointestinal (GI) complications
Uremic encephalopathy
Impaired wound healing
Alteration in urine output
Consider the role of the nurse in the prevention
and management of each of these!
24.
Fluid volume deficit r/t
(name cause or causes)
Fluid volume excess r/t
inability of kidneys to
produce urine
Risk for infection
Disturbed thought
processes
Fatigue
Anxiety
25. Monitor intake & output
Assess vital signs
Daily weights
Evaluate skin turgor,
mucous membranes
◦ Monitor dialysis site
◦ Monitor lab values (UA,
◦
◦
◦
◦
Specific gravity, Sodium
levels, BUN, & Serum
creatinine*)
(*best indicator of renal
function, not altered by other
temporary factors)
◦ Monitor urine (amount,
color, specific gravity,
glucose, protein,
sediment, blood)
◦ Monitor for pain,
bleeding, and neuro
status/seizures
◦ Monitor for murmurs &
dysrhythmias
◦ Prevent infection
◦ Frequent oral care
◦ Monitor lung sounds,
pulmonary toilet
◦ Restrict fluids
◦ Education!
26. • The last stage of kidney failure where GFR is <15. Dialysis or
transplantation required to survive.
•80% of GFR may be lost with few overt changes in body.
•Can survive without dialysis until almost 90% of nephrons are
lost
•Remaining nephrons hypertrophy and compensate.
•When creatinine clearance <15 ml/min (normal 85-135) need
transplant or dialysis to survive.
•ESRD patients are eligible for Medicare Disability.
27. Initially, polyuria (mostly
at night) due to
inability to concentrate
urine
Later, anuria=<
40ml/day
BUN rises (causing nausea,
vomiting, lethargy, fatigue
impaired thought process,
headaches.) Serum
creatinine rises, less so for
older person
Altered carbohydrate
metabolism due to insulin
resistance. Insulin is also
dependent on kidneys for
excretion
Elevated triglycerides:
hyperinsulinemia stimulates
hepatic production of
triglycerides.
Atherosclerotic changes
may worsen
28.
Hyperkalemia can
cause fatal arrhythmias
if >7.0-8.0
Metabolic acidosis
Anemia
Worsening
hypertension
Anorexia, nausea,
vomiting
Uremic breath
Neurologic changes
Renal osteodystrophy
r/t inability to produce
vitamin D so calcium is
released from the
bones
Skin changes: yellow,
dry, pruritis, uremic
frost (rare)
Petechiae and bruising
29. Preserve renal function
Delay need for dialysis or transplant
Alleviate symptoms
Improve body chemistry values
Provide optimal quality of life
Discuss living will and advanced directives
30. Remove end products of protein
metabolism from blood
Maintain a safe concentration of serum
electrolytes
Correct acidosis and replenish bicarbonate
levels
Remove excess fluid from the blood
31.
32. DIALYSIS
CONCEPTS
ULTRAFILTRATION:
Removal of fluid
from blood using
either osmotic or
hydrostatic pressure
DIFFUSION:
Passage of particles
(ions) from an area
of high
concentration to
low concentration.
SEMIPERMEABLE
MEMBRANE has pores
33.
Semi-permeable membrane is the
membrane lining the abdominal cavity
15% of dialysis in the USA, more outside
US
CAPD (Continuous Ambulatory Dialysis)
doesn’t require electricity, drains in and
out with gravity
Advantages: may be done at home, fewer
dietary restrictions, less cardiac stress,
better for diabetic patients, good for
patients with poor vascular access
Disadvantages: peritonitis, requires
surgery to place Tenckhoff catheter,
protein loss, discomfort r/t fluids in
abdomen
34.
35.
Artificial membrane is inside a dialyzer
Best for emergencies (rapid removal of
fluids, urea and creatinine) and CRRT
(Continuous Renal Replacement Therapy)
Life schedule= 3-4 hours, 3x per week
Advantages: effective K+ and triglyceride
removal, less protein loss
Disadvantages: vascular access problems,
extensive equipment needed, hypotension,
dietary and fluid restrictions, decreased
independence
37. -Only skilled dialysis nurses can access a
graft or shunt.
-Although you NEVER USE a fistula or
graft, you must ALWAYS ASSESS them:
FEEL for a THRILL (vibration) LISTEN for a
BRUIT (whooshing sound) In general, do
not cover. Protect from infection.
-If a SQ or IJ catheter has a dressing, use
sterile technique when changing
dressing.
-No BPs, IVs, or labs in arm with access
-Teach family to observe for s/s of
infection
38.
Hypotension
Sepsis: R/T infected access
Disequilibrium Syndrome: due to rapid
changes in blood of urea, sodium, causing
high osmotic gradient in brain resulting in
shift of fluid into brain causing cerebral
edema. (Slow or stop dialysis, infuse saline,
albumin or mannitol to draw fluid from
brain cells back into systemic circulation.)
Blood Loss related to accidental dislocation
of needle or separation of external shunt.
39.
Monitor weight, peripheral edema, BP,
AP, heart sounds
Check access, bruit and thrill
Temperature (fever could indicate infection)
Skin condition
Hold BP meds & meds that can be dialyzed
off (example: water-soluble vitamin
supplements, etc.) Pharmacist can provide
guidance, some drug books have an
appendix listing dialysis safe medications, if
any questions, consult MD
40.
41.
54,000 are on a waiting list
14,000 transplants/year
Waiting time for cadaver transplant: 18
mos. to 4 yrs.
Need immunosuppressive therapy for
life. Common oral medications include:
Steroid (prednisone), Mycophenolate
(MMF, Cellcept), Cyclosporine (CSA),
tacrolimus (Prograf)
Monitor for rejection & infection
Monitor urine output closely. Minimum
post transplant should be 30ml/hr
(720ml/day)
42.
Nursing Alerts
Gerontological Considerations – throughout
chapter
Glomerulonephritis
Nephrotic Syndrome/Nephrosclerosis
Causes, Phases, & Prevention Acute Renal
Failure –Chronic Kidney Disease – clinical
manifestations –Dialysis
Nursing Consideration for the patient with a
kidney transplant