What are the causes of intrinsic renal failure "ARF"?
- Intrarenal (intrinsic) -- Caused by acutal physical, chemical, hypoxic or immunologic tissue damage to the kidney such as:
- Acute interstitial nephritis, acute glomerular nephritis, vasculitis
- Exposure to nephrotoxins
- Acute tubular necrosis, renal aretery or vein stenosis or thrombosis
- Formation of crystals in nephron tubules
What are the causes of postrenal azotemia?
- Caused by obstruction of the urine collecting system anywhere from the calyces to the urethral meatus (obstruction of the ureter must be bilateral to cause postrenal failure unless only one kidney is functional) such as:
- cancer- ureter/bladder/prostatic/cervical
- bladder atony
- urethral stricture
What are the three access types for hemodialysis?
- 1. Areteriovenous fistula: permanent-connects artery to vein usually in forearm
- 2. Areterivenous graft: permanent- synthetic material tunneled underskin to connect artery to a vein
- 3. Cathetar: temporary- placed in a large central vein such as the internal jugular vein
What are the key concepts for the endocrine system?
- 1. Hypovolemia: DM, Diabetes insipidus, thyroid storm
- 2. Hypervolemia: SIADH
- 3. Altered carb, fat and protein metabolism: DM, kushings, osteoporosis, protein wasting
What is the leading cause of ESRD?
DKA occurs in patients with....
Type I diabetes and most often starts from infection
- "Diabetic Keto-acidosis"
- Most serious complication of DM
- Severe hyperglycemia: Blood glucose>400 mg/dL
What is a serious complication of diabetes r/t a deficiency of insulin and an increase in insulin counter regulatory hormones such as catecholamines, cortisol, glucagon, GH?
What are the symptoms of DKA
- Symptoms are sudden. Classic symptoms include:
- Polyuria, polydipsia, polyphagia
- weight loss, vomiting, abdominal pain
- dehydration causes decrease UO
- weakness, alt LOC- can lead to coma
- Kussmaul respirations, fruity breath, hypotension
What labs might you see with DKA?
- Elevated plasma and glucose in the urine> 250
- Metabolic acidosis (ABG: pH<7.35, HCO3<15)
- EKG: Flat T wave
- Na= low, normal or high
- K+= normal; elevated with acidosis, low following dehydration
- =Ketonuria 1:2 dilutions
What are the normal kidney functions in homeostasis?
- 1. Body water regulation
- 2. Electrolyte balance
- 3. Acid-base balance
- 4. Metabolic (endocrine) regulation
- 5. Excretory regulation -- PRIMARY FUNCTION OF KIDNEY
What is the best indicator of renal function?
GFR<60 lasting more than 3 months...
What are the risk factors of CKD?
- 1. Diabetes
- 2. Hypertension
- 3. Proteinuria
- 4. Family history
- 5. Increasing age
What are the clinical manifestations of CKD?