Chapter 21, Chronic renal failure

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  1. gradual, progressive deterioration of kidneys function
    chronic renal failure
  2. Describe the patho of chronic renal failure
    • irreversable
    • declining number of functional nephrons
    • CRF= >50-70% nephron loss
  3. Describe the early stage(decreasing renal reserve) of CRF
    • 60% nephron loss
    • Decreased GFR
    • creatine levels high, but normal
    • BUN normal
    • Asymptomatic
  4. Why is a person with early stage CRF asymptomatic
    remaining nephrons are picking up the slack for filtration
  5. Describe middle stage(renal insufficiency) of CRF
    • 75% nephron loss
    • GFR decreased by 20%
    • elevated BUN and serum creatine
    • Low specific gravity-osmotic diuresis
  6. What is the rationale behind low specific gravity
    remaning nephrons filter increased solute load causing osmotic diuresis, causing low specific gravity
  7. Describe end stage(Uremia) of CRF
    • > 90% nephron loss
    • olguria/ anuria
    • fluid and electrolytes reatained
    • azotemia-nitrogenous waste in blood
    • all organs affected
    • nephrosclerosis
    • chronic bilateral kidney infection/inflammation
    • polycystic kidney disease
  8. What is nephrosclerosis
    • associated with systemic hypertension
    • decreased blood to kidneys
    • increases renin
    • increases BP
  9. What are examples of chronic bilateral kidney infection/inflammations
    • chronic glomerulernephritis
    • severe pyelonephritis
    • diabetes causing diabetic nephropathy
  10. What is polycystic kidney disease
    • inherited
    • cysts repalce renal tissue
  11. What are the signs of CRF
    • anemia, acidosis,azotemia
    • weak, tired, lethargic-acuumulation of nitrogenous waste
    • nausea,vomiting, diarrhea
    • nervous system:confision, drowsy,convulsion, coma
  12. What are early signs of CRF
    • polyuria-excessive water loss
    • Nocturia-excessive night urination
    • high BP
    • anemia-bone marrow depression,decreased erythropietin
    • decreased cellular metabolism
    • anorexia,nausea,fatigue,weight loss,weak,exercise intolerence
  13. What are late signs of CRF
    • olguria/anuria
    • low specific gravity
    • congested heart failure with pulmonary edema
    • arrhythmias-high potassium
    • osteodystrophy
    • uremic frost
    • urine breath
    • neurological signs
    • bone marrow depression
    • cellular metabolism impaired
    • systemic infection-pneumonia
    • anemia,acidosis,azotemia
  14. What are the diagnostic test for CRF
    • history
    • urinalysis-proteinuria& low specific gravity
    • elevated BUN and serum creatine
    • CBC-anemia
    • KUB or IVP- extent of damage
    • serum pH-acidosis
    • Electrolytes-hyponatremia(low blood sodium), hyperkalemia(high potassium), hypocalcemia, hyperphosphatemia
  15. What is the pH of compensatory metabolic acidosis
  16. What are the main indicators of CRF
    anemia, acidosis, azotemia
  17. Describe the patho of ostoedystrophy involving the kidneys
    • kidneys dont activate vitimain D, urin retains phosphate
    • causes hypocalemia & hyperphoaphatemia
    • stimulates parathyroid to release PTH
    • osteoclast release calcium from bone
    • osteodystrophy occurs
  18. What is uremic frost
    Uera and other metobolic waste that can't be excreted by kidneys leave body through skin
  19. What are the complications of CRF
    • increased systemic infections-pneumonia
    • death
    • children have retarded growth
  20. why does CRF cause increased systemic infection
    poor tissue resistance due to anemia
  21. What is the treatment for CRF
    • dialysis
    • kidney transplant
  22. what is the prognosis for CRF
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Chapter 21, Chronic renal failure
Chapter 21, Chronic renal failure
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