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What are the comorbidities for acute renal failure??
–Existing kidney impairment, atherosclerosis, hypertension, diabetes mellitus, heart failure, and liver impairment or failure
What are the types of Actue Renal Failure
- Prerenal Acute renal failure
- Postrenal Acute renal fialure
- Intrarenal Acute renal failure
Prerenal Acute renal failure develops b/c
of diminished perfusion of kidney (decreasee amount of blood that comes into the kidney)
What are things that cause Prerenal Acute renal Failure??d
decrease in blood bolume due to excesive vomitting or diarrhea, excessive burn , excessive hemorrage, over use of diuretics
Postrenal Acute Renal Failure caused by an
obstruction of outflow of urine
Intrarenal Acute Renal Failure is due to
failure of nephrons w/in kidney
What is usually present in Acute Renal Failure
Prolonged prerenal renal failure results in ..??
intrarenal renal failure
Postrenal Acute renal failure obstruction results in ..
results in elevated pressure in Bowman's capsule which impedes in glomerular filtration
Prolonged postrenal renal failure results in
intrarenal renal failure
Intrarenal failure most often the problem is...
w/in the renal tubules, resulting in acute tubular necrosis
Acute tubular necrosis may occur w/ ...
nephrotoxic or ischemic insults
Acute Tubular Necrosis is a combination of ...
ischemia and an inflammatory process
Acute Tubular Necrosis (ATN) in the Distal tubule is the site of
the most apoptotic cell death
What are the Stages of Acute Tubular Necrosis
- Oliguric stage
- Diuretic Stage
- Recovery Stage
what is the Oliguric stage??
w. water retention, hypervolemia leads to edema and hypertension
Diuretic Stage is the ....
beginning of renal recovery, as renal function returns
What is no reversible in all cases w/ diuretic stage ??
Acute renal Failure
Recovery Stage is
Full recovery of renal function and may take a week or as long as a year
Why do you end up w/ water retention w/ ATN??
b/c tubules breaking down and cells slothing off and gettin into tubule and you end up w/ water retention --> leading to no passage of urine
The first stage of ATN is characterized by...
oliguria and progressive uremia
may last 1-2 wks
What is oliguria followed by ???
followed by a diuretic stage that lasts 2-10 days
What happens during the diuretic phase??
urine volume increases by tubular function remains impaired and azotemia continues
How long does the recovery phase last ??
lasing up to 12 months
What is the recovery pahse characterized by ??
characterized by gradual normalization of serum creatinine and BUN
often a degree of renal insufficiency persists
What is monitored with ARF??
- serum creatinine
- calculated creatinine clearance
- retention of metabolic wastes (azotemia/uremia) monitored by BUN
What are the risk factors of Chronic Kidney disease??
Diabetes mellitus and hypertension
- other factors:
- cystic kidney disease
- family hitory of chronic kidney disease
- exposure to toxins
- ethnicity (African american, hispanic)
what happens when the chronic kidney disease progresses
glomerulosclerosis and interstitial inflammation and fibrosis ocurr
in Chronic kidney disease what injury contribute to impairment of renal function
by diminishing the GFR
What are the stages of Chronic Kidney Disease
- Diminished renal reserve
- Renal insufficiency
- End-stage renal disease
What is the Diminished renal reserve stage
you still have functional kidney and is asymptomatic
less than 75% of nephrons have been lost
what happens in Renal insufficiency stage
not getting any filtration, lose of the ability to concentrate urine, no more water being reasbsorbed
- Polyuria and nocturia, due to lost ability to concentrate urine
- 75-90% of nephrons have been lost
What happens in End-stage renal disease??
more than 90% of nephrons have been lost
Azotemia, uremia, anemia, fluid and electroyte imbalances
Transplantation or death are available outcomes
What are the complications of Chronic Kidney Disease??
- Hypertension and cardiovascular disease
- Uremeic Syndrome
- Metabolic Acidosis
- Electrolyte imbalances
- Renal Osteodystrophy
What is markedly increased in chronic kidney disease (CKD)
Hypertension and cardiovascular disease
what complication in CKD affects many organ systems??
Uremic Syndrome (retention of waste products)
What complication in CKD depresses cardiac and central nervous system function ??
Metabolic Acidosis, retention of the acidic waste products of metabolism
What electrolytes are affected in CKD
retention of potassium, phosphate, magnesium
hyperkalemia is the most serious, due to its cardiac effects
What happens in renal Osteodystrophy in CKD
breakdown of bone due to phosphate imbalance
Malnutrition in CKD is caused by
anorexia of uremic syndrome and by chronic illness
Anemia in CKD is caused by ...???
diminished secretion of erythropoietin by kidneys
Chronic kidney diseasae is characterized by a gradual ...
irreversible loss of functional nephrons
Progression of CKD can be monitored by two staging systems
- 1. percentage of nephron loss
- 2. reduction in GFR
What happens to the laboratory values in the stage of decreased renal reserve ???
lab values are normal and the condition is usually asymptomatic
With end-stage renal disease what is markedly elevated??
BUN and creatinine
what can you avoid in acute renal failure to prevent CKD??
What do you want to limit in CKD
limit dietary phosphorus, protein, sodium, and potassium
What kind of drugs are used in CKD
calcium and noncalcium phosphate binding drugs
synthetic erythropoietin to address anemia
drug management for DM, HTN, and hyperlipidemia
What kind of Dialysis is recomended for CKD
- hemodialysis or peritoneal dialysis
- initiated to address the development or uremia
slowing the progression of CKD is ...
the focus intervention until stages 4-5
nutritional needs for pt in fenal failure include
increased calories as well as calcium and vit. supplementation
What is usually restricted in renal failure??
fluid, phosphorus, potassium, sodium, and protein intake
Voiding dysfunction may be
secondary to disorders of the lower urinary tract
due to pathologies affecting the central, autonomic, and peripheral nercous systems
Urge incontinence may be idiopathic or due to
bladder infections that irritate the bladder lining, radiation therapy, tumors or stones in the urinary tract, or central nervous system damage to inhibitory pathways
what results in stress incontinenece ??
weakening of pelvic muscles or intrinsic urethral sphincter dificiency
Mixed incontinence is a ...??
combination of both stress and urge incontinence
What causes overflow incontinence??
Obstruction of the urethra, or an underactive or inactive detrusor muscle
Functional incontinence is related to
physical or environmental limitations in reaching a toilet in time to void
Neurogenic bladder ...
a broad classification of voiding dysfunction in which the specific cause is a pathology that produces a disruption of nercous communication governing micturition
Enuresis is ....
inappropriate wetting of clothing or bedding, w/ the term usually reserved for incontinence in children, particularly at night
What is the primary cause of enuresis
What is the treatment for enuresis
usually behavioral modification w/ or w/o pharmacologic intervention
Neurogenic bladder describes ..
voiding disorders in which the cuase is the disruption of nervous communication governing micturition
Urge incontinence is most common in ...
Stress incontinence is common in
pregnancy, w/ weakening of pelvic muscles
urine lost w/ increases in intra-abdominal pressure
Overflow incontinence is caused by
obstructed urethra, due to enlarged prostate or prolapsed urterus
Bladder cancer is the ____ most common in women and ___ most common in men
8th and 4th
Over 90% of bladder cancers are
transitional cell (urethelial) carcinomas, arising in the lining of bladder
What is the greatest risk of bladder cancer
Bladder cancer treatment typically involves...
radiation, surgery and chemotherapy, which radiation and chemotherapy occuring preoperatively or postoperatively or both
Hematuria could be microscopic so we ....
cant rely on it
Neosplasia increases the chance of ...
bladder cancer is primarily manifested as ....
Dysuria in bladder cancer is ...
The most frequently used invasive test in the diagnosis of bladder cancer is ...
a cystoscopy, w. biopsy of any questionable tissue and washings to free cells for cytologic examination
Treatemtn protocols in bladder cancer are based on ...
- the tumors features:
- type of bladder cancer
- grade and stage
Primary options are surgery, radiation therapy, chemo, immunotherapy
inflammation of urethra
Urethritis may causes
pain, burning, urinary incontinence
Urethritis if due to infection may lead to
Inflammation of bladder lining
Cystitis may result from
bacterial, fungal, or parasitic infections, chemical irritants, foreign bodies (stones), or trauma
what infection in Cystitis is by far the most common cause??
Cystitis common symptoms are..
acute onset of frequency, urgency, dysuria, and pain (suprapubic area)
painful bladder syndrom
chronic condition consisting of bladder pain, urgency, frequency and nocturia
cause is unknown
What are some of the causes of painful bladder syndrome
but correlated w/ alcohol abuse, large number of citrus fruits, tomatos, drinks too much coffee or tea, too much carbonated beverages, chocolate