Chapter 22 Renal failure
-
Upload
rowena-fernandez -
Category
Documents
-
view
225 -
download
0
Transcript of Chapter 22 Renal failure
-
8/7/2019 Chapter 22 Renal failure
1/23
Chapter 22
RENALFAILURE
FERNANDEZ, ROWENA S.
BSP 4A
-
8/7/2019 Chapter 22 Renal failure
2/23
The Urinary Structure
-
8/7/2019 Chapter 22 Renal failure
3/23
Pathophysiology
Renal system is uniquely susceptible to
toxic injury.
In humans, the kidneys receive 20% to25% of the cardiac output despite
weighing only 150g each.
Kidney is metabolically active, containing
several enzyme systems capable of
bioactivating a non-toxic substance into a
toxic compound.
-
8/7/2019 Chapter 22 Renal failure
4/23
ACUTE RENAL FAILURE
occurs when kidney function declinerapidly and the kidney are no longer ableto filter waste products from the blood.
Manifests as an abrupt decline inglomerular filtration rate occurring over aperiod of days or weeks.
This results in an accumulation of water,nitrogenous waste products and othertoxins.
-
8/7/2019 Chapter 22 Renal failure
5/23
-
8/7/2019 Chapter 22 Renal failure
6/23
Classification
of
ACUTE RENAL FAILURE
Prerenal failure
Intrinsic renal failure
Post renal failure
-
8/7/2019 Chapter 22 Renal failure
7/23
Pre-renal failure
Characterized by inadequate bloodcirculation to the kidney w/c leaves themunable to clean the body properly.
Causes: dehydration, heart failure, sepsis,(severe infection), and severe blood loss.
Signs: volume depletion, dizziness, drymucous membrane, tachycardia,orthostatic hypotension, and weight loss.
-
8/7/2019 Chapter 22 Renal failure
8/23
Mechanisms that lead to hypotenion
and decrease renal perfusion:
1. toxin-induced cardiotoxicity resulting in
a lowered cardiac output.
2. toxin-induced vasodilation3. toxin-induced vasoconstriction
4. toxin-induced loss of effective circulatory
volume
-
8/7/2019 Chapter 22 Renal failure
9/23
Substances decreased glomerular
perfusion via intrarenal vascular
effects:
ACE inhibitor
Cyclosporine
Radiocontrast agents
NSAIDs
Mannitol
-
8/7/2019 Chapter 22 Renal failure
10/23
Intrinsic renal failure
Involves damage within both kidneys.
Causes: vascular disease, disease of tubules
and interstitium, and acute tubular necrosis.
Signs and symptoms: fever, rash, flank pain, and
oliguria (decreased urine output), peripheraledema, lethargy, dyspnea.
-
8/7/2019 Chapter 22 Renal failure
11/23
Substances cause Glomerulonephritis:
Heroin abuse
Hydrocarbons
Hydralazine
Halogenated alkanes
D-penicillamine
Methimazole
Captopril
Thiopronine
Gold Mercurous and Mercuric salts
Silicon
-
8/7/2019 Chapter 22 Renal failure
12/23
Substances that cause Direct tubular
toxicity:
Aminoglycosides, Polymyxin, Uranium
Cisplatin, Arsenic, Bismuth
Mithramycin, Chromium, Mycotoxins
Ifosfamide, mercurous and mercuric salts
Streptozotocin, Perchloroethylene, Hydrocarbons
Amphotericin B, Cadmium, Fluorinated Anesthetics
Diethylene glycol, Diquat, Paraquat
Toluene
Carbon tetrachloride
Radiocontrast agent
-
8/7/2019 Chapter 22 Renal failure
13/23
Substances that cause Insterstitial
nephritis:
Allopurinol
B-lactam antibiotics
CimetidineNSAIDs
Rifampin
sulfonamides
-
8/7/2019 Chapter 22 Renal failure
14/23
Postrenal failure
Caused by an acute obstruction that affects the
normal flow of urine out of both kidneys.
Causes: renal injury, retroperitoneal fibrosis,
bladder obstruction.
Signs and symptoms: distended bladder,edema, complain of hesitancy, decreased
urinary flow and abdominal pain.
-
8/7/2019 Chapter 22 Renal failure
15/23
Substances that cause Obstractive
Uropathy due to Tubular
precipitation:
Ethylene glycol metabolites
Acyclovir
Methotrexate
Sulfonamides
-
8/7/2019 Chapter 22 Renal failure
16/23
Laboratory Studies
Microscopic Examination
Blood Urea Nitrogen (BUN)
Serum Creatinine
Urinalysis
Cystoscopy
Voiding Cystourethrography
Intravenous Urography
Renal Ultrasoound
-
8/7/2019 Chapter 22 Renal failure
17/23
Poisoned patient with prerenal failure:
Urinary sodium (UNa+) level less than
20 mEq/L
Urinary osmolality (UOsm) greater than500 mOsm/kg
Urine:plasma creatinine ration (U/PCr)
greater than 40
-
8/7/2019 Chapter 22 Renal failure
18/23
-
8/7/2019 Chapter 22 Renal failure
19/23
Definitive treatment:
PRERENAL FAILURE
Increased chronotropy and inotropy,vasopressor support, fluid resuscitation,
and blood transfusion
-
8/7/2019 Chapter 22 Renal failure
20/23
INTRINSIC RENAL FAILURE
Causative agent should be discontinued.
Life-threatening complications:
Pulmonary edema managed with oxygen,diuretics, and preload and afterload reducers.
Hyperkalemia treatment may include calcium,
insulin and glucose, sodium bicarbonate,
sodium polysterene sulfonate, furosemide, andalbuterol.
-
8/7/2019 Chapter 22 Renal failure
21/23
POSTRENAL FAILURE
Treated by relieving the obstruction.Can be accomplished by Foley catheter
insertion or urologic consultation for
nephrostomy tube placement.
-
8/7/2019 Chapter 22 Renal failure
22/23
Emergent hemodialysis
Reserved for severe volume overload and life
threatening metabolic disturbances.
-
8/7/2019 Chapter 22 Renal failure
23/23
Disposition/Need for Consultants:
Patients with acute renal failure should be
admitted to hospital.
Discharge patients with mild renalinsufficiency and no underlying medical
conditions.
Nephrology consultation in patients with
hyperkalemia, pulmonary or
cadrdiovascular compromise, need for
emergent hemodialysis or renal biopsy for
definitive diagnosis.