Renal

January 30, 2018 | Author: Anonymous | Category: Science, Health Science, Urology
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Acute Renal Failure At the end of this self study the participant will: • Differentiate between pre, intra and post renal failure • Describe dialysis modes: – Continuous Ambulatory Peritoneal Dialysis (CAPD) – Automated Peritoneal Dialysis (APD) – Hemodialysis

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Kidney Functions • • • •

Excretion of metabolic wastes Acid-base balance Fluid Balance Erythropoietin synthesis (Chronic Renal Failure patients tend towards anemia) – Synthetic erethropoietin was introduced in 1989. Prior to that, CRF patients had RBC levels and oxygen carrying capacity 30-50% of those with healthy kidneys

• Bone Health (CRF patients may have osteodystrophies) – Activates final form of vitamin D 2

Kidney Functions: Regulation of Blood Pressure • Renin - Angiotension - Aldosterone • Renal prostaglandins – All act to increase renal blood flow – Several drug classes especially NSAIDs (primarily ibuprofen) inhibit renal prostaglandins • Can lead to renal failure because they inhibit kidney’s auto-regulation of blood flow 3

Acute Renal Failure • Definition: syndrome resulting in acute deterioration of renal function – Pre-renal failure (70%) (trouble is before the kidney, causing decreased blood flow to the kidney) – Intra-renal failure (25%) (trouble is inside the kidney) – Post-renal failure (5%) (trouble is beyond the kidney, before the urine leaves the body) • Mortality rate 40-70% • Becomes symptomatic with loss of 75% of kidney function • End stage renal disease at 90% functional loss

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Pre-Renal Failure – Decreased perfusion to the kidneys – Renal tubular function is normal – Treatment – identify cause: • Dehydration: Give fluids • Heart failure: Treat the cardiac failure • Third Spacing: Give fluids

– Goal is to prevent necrotic renal damage 5

Third spacing is the body in crisis mode, retaining fluids for when they’re needed in the future. Fluids shift from intravascular to interstitial, in effect causing the patient to become dehydrated

Intra-Renal Failure – Damage to the kidney itself • Acute tubular necrosis – prolonged poor perfusion • Other causes – glomerulonephritis, contrast media, toxins, trauma, rhabdomyolysis – Treatment – remove the cause • Dialysis, strict fluid volume management – Goal is supportive therapy 6

Normal Kidney

Tubular Necrosis

Post-Renal Failure – Obstruction of flow out of the nephrons • Kidney stones, benign prostatic hypertrophy • Diabetic bladder neuropathy • Spinal Cord disease • Atonic bladder • Tumor – Treatment • Remove the obstruction • Nephrostomy Tube 7

Note dilation of ureter and renal pelvis

Electrolytes: Hyponatremia • Dilutional hyponatremia – increased body water - the sodium that is filtered out of blood is not reabsorbed due to kidney failure – ADH is suppressed. High levels of aldosterone are made, increasing sodium excretion – may cause mental status changes or seizures (serum sodium
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