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gradual, progressive deterioration of kidneys function
chronic renal failure
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Describe the patho of chronic renal failure
- irreversable
- declining number of functional nephrons
- CRF= >50-70% nephron loss
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Describe the early stage(decreasing renal reserve) of CRF
- 60% nephron loss
- Decreased GFR
- creatine levels high, but normal
- BUN normal
- Asymptomatic
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Why is a person with early stage CRF asymptomatic
remaining nephrons are picking up the slack for filtration
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Describe middle stage(renal insufficiency) of CRF
- 75% nephron loss
- GFR decreased by 20%
- elevated BUN and serum creatine
- Low specific gravity-osmotic diuresis
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What is the rationale behind low specific gravity
remaning nephrons filter increased solute load causing osmotic diuresis, causing low specific gravity
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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
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What is nephrosclerosis
- associated with systemic hypertension
- decreased blood to kidneys
- increases renin
- increases BP
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What are examples of chronic bilateral kidney infection/inflammations
- chronic glomerulernephritis
- severe pyelonephritis
- diabetes causing diabetic nephropathy
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What is polycystic kidney disease
- inherited
- cysts repalce renal tissue
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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
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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
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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
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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
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What is the pH of compensatory metabolic acidosis
7.35
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What are the main indicators of CRF
anemia, acidosis, azotemia
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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
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What is uremic frost
Uera and other metobolic waste that can't be excreted by kidneys leave body through skin
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What are the complications of CRF
- increased systemic infections-pneumonia
- death
- children have retarded growth
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why does CRF cause increased systemic infection
poor tissue resistance due to anemia
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What is the treatment for CRF
- dialysis
- kidney transplant
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what is the prognosis for CRF
poor
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