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8 Cards in this Set
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Discussobstructive disorders in terms of their effect on the renal physiology(including prostate hyperplasia), be able to discuss its effect to the renalsystem- what does it do to the renal system? |
The effect that prostratehyperplasia has on the renal system, is that prostrate hyperplasia affects thepart of the prostrate surrounding the top of the urethra and this put pressureon the urethra, and this pressure can weaken the bladder leading to urinaryretention, renal failure or recurrent UTI |
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Discuss Urinary Tract Infection (UTI) risk factors:causes: symptoms: prevention: complication: treatment: |
risk factors: -women (shorter urethra compare to men-which make them more prone to UTI) -advanced age- though young people still get it, the older you get, the more risky you are at developing UTI -Diabetes Mellitus - pregnant women causes: UTI is caused by E.Coli (a bacteria) affecting urethra and bladder symptoms: -A burning feeling when urinating, Frequent urge to urinate, Pain on lower abdomen, Cloudy smelly urine prevention: Eating a well-balanced diet, Wipe from front to back-proper wiping, changing underwear complication:Recurrent infection, Permanent kidney damage treatment: Antibiotics |
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Discuss glomerular disorders risk factors: causes: symptoms: prevention: complication: treatment: |
risk factors: Diabetes Infections History of cancer causes: Infection Drug toxic to kidney Ischemia symptoms: Hematuria Proteinuria Hypertension Edema (fluid retention) with swelling evident in hands, faceand feet prevention: Maintain a healthy weight through diet and exercise Control blood pressure complication: Chronic kidney disease End-stage renal failure treatment: Medication such as Diuretics to reduce fluid retention and bloodpressure medication to control high blood pressure |
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Discuss acute kidney disease (isthe disease where the kidneys lose the ability to filter waster from the blood AKI)- good learning objective for a case study! Be able to discusspre, Intra and post renal failure and RIFLE risk factors:causes: symptoms: prevention: complication: |
risk factors: Being hospitalized Advanced age Blockage in the blood vessels in arms or legs Diabetes High blood pressure Heart failure Kidney diseases causes: - Pre-renal can be due to hypovalemia- a decreased flow of blood to kidney and haemorrhagic blood loss - Intra-renal directdamage to the kidneys Infection, drug-hypersensitivity to drug glomerulonephritis, autoimmune diseases
-Post-renalkidneystonesand prostate hyperplasia symptoms: Decrease glomerular filtration rate Decrease urine output Increase nitrogenous waste in blood such as urea andcreatinine prevention: Allhospitalised patients both on admission and during their admission stay shouldbe assessed regularly for risk of developing AKI complication: High levels of potassium in the blood Muscle weakness paralysis and heart rhythm problems Metabolic acidosis Risk- increased creatinine x1 Injury- increased creatinine x2 Failure- increased creatinine x3 Loss- complete loss of kidney function End-time kidney failure- complete loss of kidney function |
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Discuss chronic kidney disease (the progressive loss of renal function)-good learning objective for a case study! Be able todiscuss CKD on other body systems causes: symptoms: prevention: complication: treatment: |
risk factors: Diabetes High blood pressure Cardiovascular disease Acute Kidney Disease causes: Hypertension Diabetes mellitus Kidney disease Lupus symptoms: Azotemia and Uremia Hypertension Anorexia Nausea Vomiting Constipation Malnutrion and weight loss prevention: Stayat a healthy weight and maintaining normal BP which help prevent other diseasessuch as diabetes complication: angina Worsening heartfailure Left ventricular hypertrophy treatment: a low protein diet to reduce end products of protein metabolism that the kidneys cannot excrete medications such as loop diuretics (frusemide) to to maintain fluid balance and antihypertensive to control blood pressure Be able to discuss CKD effect on other body systems skeletal: reproductive: sexual dysfunction cardiovascular: hypertension endocrine: restricted growth in children GI: anorexia, vomiting renal: hypotension, dcreased or dilute urine |
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Disorders of the renal system- case studies: Case 1 PRERENAL AKD 66 year oldman is admitted to A+E with breathlessness. He has been unwell for a week,coughing up phlegm and having fevers. His past medical history includesdiabetes and hypertension. His medication is metformin, aspirin, ramipril,atenolol and simvastatin. Onexamination he is unwell. His obs are BP 85/50, HR 115, Sats 92% on air, RR 25,Temp 38.3. You hear coarse crackles on the right side of his chest. A CXRconfirms pneumonia.His blood results come back which show Na 130, K4.5, Urea 14.3, Creat 189. The nurse asks you to assess him as he hasn't passedurine since admission Whatis the likely cause for his renal failure? Discussthe lab results. Why are they like this? What riskfactors are evident in this man's case that make him more likely to have renalfailure? |
What is the likely cause for his renal failure? Hypoperfusion/hypovolemia Discussthe lab results. Why are they like this? What does this mean? Urea and creatinine arehigh, indicates renal issues (inability to remove waste products) What riskfactors are evident in this man's case that make him more likely to have renalfailure? • Age • Drugs (ACE, diuretics,NSAIDS) • Hypovolemia/Sepsis • Diabetes |
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Case 2ATN AKD Joyce, age45, was admitted to the emergency room following a major automobile accident inwhich her husband was killed. She had massive abdominal injuries and afractured femur. She was taken immediately to surgery for repair of a laceratedliver and perforated ileum. She had two units of blood during surgery and twounits while she was in the recovery room. The fifth unit of blood wasdiscontinued in ICU because she developed a transfusion reaction. On the day after surgery, her urine outputdeclined to 10-20 ml/hr. Increasing her fluid intake with plasma expanders andblood did not increase her urine output. Lab results indicated an elevatedurinary sodium, BUN 350 mmol/L, and serum creatinine 652pmol/L. Her urine output stabilized at 20-25 ml/hr onthe third day after surgery. Because of a persistently elevated serumpotassium and severe hypertension (BP 190/120), she was started on hemodialysisusing an external cannula. She resented all the “plumbing” in her body andexpressed a desire to die. What is thelikely cause for her renal failure? Discuss thelab results. Why are they like this? What does this mean? Also discuss theurine output. |
What is thelikely cause for her renal failure? Acute tubular necrosis. Common after surgery (40-50% of cases).Has to do with ischemic damage to the nephron. Blood transfusion may also bethe culprit. Discuss thelab results. Why are they like this? What does this mean? Also discuss theurine output.Urine output seems to indicate thatwe are in the “maintenance phase” of AKI, where urine output remains stablewhile BUN and creatinine increase. This can take some weeks to move into therecovery phase.What risk factors are evident in thiswoman's case that make her more likely to have renal failure?Assume hypovolemia due to significantamount of blood givenBlood transfusion (particularly thefact that she reacted to it. |
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Case 3Chronic Renal Failure Franklin(prefers Frank) is a 67 yo retired farm hand. His wife (Maria) has brought himinto hospital because he has been becoming increasingly fatigued. Frank says itis just cause he is getting older. Maria states that Frank has been eatingless, has a tendency to vomit and has been confused at times. Frank thinksthese are unimportant but has been itchy recently.You take afull set of vital signs for Frank and note that the only one of concern is hisBlood pressure which is 166/94.The EDdoctor orders a full set of bloods:serumcreatinine: 330pmol/LBUN 15.8mmol/LSodium: 140mmol/LPotassium: 6 mmol/LHematocrit: 30% What is occurring to this patient? Discuss thelab results. Why are they like this? What does this mean? Howis CKD treated? |
what is occuring to the patient?- chronic renal failure Discuss the lab results. Why are they like this? What does this mean? The creatinine level risesas the filtration of the substance by the kidneys decrease to a great extent. Thisis clear indication of progressive kidney disorder.Franks’s BUN test resultsshow the level to be high. it clearly indicates that the kidneys are not ableto filter the waste products properly.The sodium content of the body is normal and within the limitsFrank’s potassium reading shows 6mmol/L. This shows that it is littlebit on the higher side. It is an indication that there might be kidney problem.In Glenda’s case it is as low as 30 %. This clearly shows the lesservolume of red blood cells in the blood. Kidney disorder leads to decrease inthe volume of RBC in blood. How is CKD treated? Diet,EPO supplementation, ACE inhibitors for hypertension, eventually dialysis,supportive therapy and kidney transplantation (teachers notes) a low protein diet to reduce end products of protein metabolism that the kidneys cannot excrete medications such as loop diuretics (frusemide) to maintain fluid balance and antihypertensive to control blood pressure (my notes) |
