N517 - Renal Lecture

Front 1

Acute Tubular Necrosis (ATN)

Back 1

damage to epithelium of tubular portion of nephron. A "cause" of renal failure

Front 2

Acute Tubular Necrosis (ATN)
causes:

Back 2

A. Nephrotoxic agents
-various antibiotics (sulfonomides, cephalosporins, Tetracyclines) and Ampho B --Overdose of analgesics
-Chemicals such as herbicides
-Street drugs
B. Ischemia
-(hypovolemia, septic shock and cardiogenic shock) all decreasing renal
perfusion and tubules are destroyed

Front 3

Acute Glomerulonephritis
causes:

Back 3

Causes can be:
Group A beta hemolytic strep-strep throat exists and sx surface 2-3 weeks later
Impetigo-infection of the skin
Viral illnesses-URI, mumps, varicella, EBV, Hep B, HIV
Other entities-Lupus, DM, DIC, scleroderma
How? An antigen produces antibody production and endothelial cells proliferate
Leukocytes infiltrate the glomerulus
Thickening of the glomerular membrane with scarring and decreased GFR
Kidneys become large and swollen and ineffective in doing their job

Front 4

Acute Glomerulonephritis
Sx:

Back 4

1.Hematuria
2.Edema -use diuretic therapy
3.Malaise
4.Proteinuria-restrict protein
5.Increases in BUN and creatinine-diet low in protein and high in CHO
6.Anemia
7.Hypertension-antihypertensive therapy
8.Sodium retention-low sodium diet
9.Decreased urine output-fluid restriction
10.Inflammation-use of steroids is controversial
12.Headache
13.Flank pain

Front 5

Chronic Glomerulonephritis
Sx:

Back 5

1.Distended neck veins from fluid retention
2.CHF with cardiomegaly because kidneys aren’t excreting urine
3.Pulmonary edema with crackles heard in the lungs
4.Confusion due to high BUN levels
5,Anemia-no erythropoietin
6,Hypocalcemia-phophates cannot be excreted so phos is increased and calcium is decreased; additionally Vit D which absorbs calcium is not being made by the kidneys
7.Hyperkalemia-unable to excrete potassium

Front 6

Nephrotic Syndrome

Classifed by 4 entities:

Back 6

*Proteinuria
*Hypoalbuminemia
*Edema
*Hyperlipidemia

Front 7

Acute Renal Failure

two major characteristics:

Back 7

1.Oliguria (output below 400 cc/day
2.High serum levels of BUN and creatinine

Front 8

Acute Renal Failure

Causes:

Back 8

1.Prerenal -Originates outside of the kidney and causes impaired blood flow to the kidneys such as: hemorrhage, MI, CHF, cardiogenic shock, or excessive losss of fluid

2.Intrarenal-acute damage to the glomerulus such as infections, injuries, nephro-toxic agents, NSAIDS, ACE inhibitors, DM

3.Postrenal-obstructions which block flow of the kidneys and impair filtration such as tumors, calculi, prostate hypertrophy, blood clots

Front 9

4 Stages of Acute Renal Failure

Back 9

1) Onset Stage

2)Oliguric/Anuric Stage

3)Diuretic Stage

4)Recovery Stage

Front 10

Chronic Renal Failure

3 Stages

Back 10

1)Diminished Renal Reserve
2)Renal Insufficiency
3)ESRD

Front 11

Chronic Renal Failure

S/S

Back 11

1. Fixed osmolality
2. Loss of control to regulate K+ and H+ =acidotic; Kussmaul breathing (extreme hyperventilation)
3. Decreased Ca+ levels and increased Phosphate levels
4. Bone demineralization
5. Uremic frost
6. Hypertension
7. CHF - the leading cause of death in ESRD
8. Uremic pericarditis
9. Anemia
10. Neuro chanqes
-disoriented and lethargic (high BUN)
-twitching & tetany (low Ca++)
11. GI-nausea, vomiting and hiccups because of toxins
12. Hyperkalemia
13. Pts should be maintained on a LOW PROTEIN diet
14. Watch for infection b/c pt is so debilitated

Front 12

What drug reverses the effects of Heparin?

Back 12

Protamine Sulfate
-Binds to and inactivates heparin

Front 13

What drug reverses the effects of warfarin?

Back 13

Vitamin K

Front 14

3 types of rejection for kidney transplant

Back 14

1) Hyperacute (w/in 24-48 hrs)
2) Acute (w/in 1-2 wks)
3) Chronic (months or years)

Front 15

Pyelonephritis
Causes
S/S

Back 15

Causes: Bacterial infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys; associated with reflux; other causes include: tumors, strictures, prostate enlargement.

S/S: fever, chills, leukocytosis, bacteriuria, pyuria, flank pain. Pts may or may not experience dysuria and urinary frequency

Front 16

Urolithiasis
Causes (5)
S/S (3)

Back 16

Causes:
1.infection
2.Urinary stasis
3.immobility (slowing renal drainage)
4.hypercalcemia resulting from hyperparathyroidism, excessive intake of Vit D, multiple myeloma
5.People with 2 or more stones at risk for reoccurrence

S/S:
1.Excruciating pain if destroying nephrons (radiating to testes in men)
2.Pyuria, hematuria
3.N/V b/c nerves supplying kidney also supplies GI
4.Desire to void but very little urine passed

Front 17

Interstitial Cystitis
Cause
S/S

Back 17

Chronic inflammatory condition of the bladder wall

S/S:severe irritable voiding, pain, nocturia, urgency, suprapubic pressure, polyuria

Front 18

The Gold Standard test fo renal calculii is:___

Back 18

CT Scan (w/o dye)