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mortality rate of renal disease
70000
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compare overll deaths from 2005-2009 to deaths from nephritis
overall deaths were down by 11000 while nephrotic deaths were up by 5000
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what is another disease state that is raising in the rankings from 2005 to 2009 that could be associated with renal disease
septicemia
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list and describe 4 congenital abnormalities affecting renal disease
- agenesis -a lack or failure of development: bilateral, fatal
- hypoplasia - condition of arrested development: unilateral more common than bilateral
- ectopic - occuring in abnormal positins: usually at lower levels (pelvis). ureters may be linked, lead to UTI's
- horseshoe - fusion at lower (most common) or upper: common state found in 1/500 to 1/100 autopsies (1/400 in children
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renal insufficiency
renal fx ~25% of nl or GFR 25-30ml/min
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renal failure
significant loss of renal fx
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ESRF
les than 10% of renal fxn
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azotemia
increase serum level of urea and/or creatinine
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uremia
azotemia plus S&S of fatigue, anotexia, N/V, pruritus, neurologic changes due to toxic waste buildup, deficiencies, and electrolyte disorders
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acute kidney injury (AKI)
- AKI term is replacing acure renal failure (ARF)
- sudden decline in kidney fxn ans azotemia (meant to include broader range: injury from minimal to severe)
- RIFLE criteria
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RIFLE criteria
- Risk - increased creatinine x 1.5 or GFR decreased by >25%, UO <0.5ml/kg/hr x 6hr
- Injury - increased Cr x 2 of GFR decreased by >50%, UO <0.5ml/kg/hr x 12hr
- Failure - increased CR x 3 or GFR decreased by >75%, UO <0.3ml/kg/hr x 24 hr or anuria (abscence or defective excretion of urine)
- Loss - Persistnet ARF = complete loss of kidney fxn > 4wks
- ESKD - end stage kidney disease (>3months)
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give and explain 4 main anatomical sites of renal disease
- glomeruli - damage often immunologic or inflammatory
- tubules - ischemia, hypoxia, toxins
- interstitium - toxins, drugs
- blood vessels - vasculitis & atherosclerosis, often affects all renal structures
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pre-renal AKI - main cause and some examples
- significant decrease in renal blood flow
- renal ischemia, hypvolemia, hemorrhage, septic shock, massive pulmonary embolism, heart failure
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prognosis of pre-renal AKI
with immediate, appropriate internention, pre-renal is reversible
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Intra-renal AKI - main cause and some examples
- injury to nephrons
- urine flow can drop below 400ml/day in 24 hres and to near zero soon after
- ATN, GN
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prognosis of intra-renal AKI
not immediately reversible, but with appropriate preventive and treatment measurs, may eventually be reversible
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Post-renal AKI - main cause and some examples
- urinary excretion obstruction
- stones, prostrate, post-catheterization-induced edema, tumors, neurogenic
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prognosis of post-renal AKI
reversible if obstruction removed
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In what case was pre-renal injury happening and what was the tx
- smoke inhalation and DIC
- aggressive rehydration
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in what case was intra-renal injury happening and what was the risk
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in what cas was post-renal injury happening
renal calculi/nephrolitiasis
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the kidney undergoes ischemic or nephrotoxic injury because of severe hypotension, aminoglycosides, or radiocontrast agents an producs granular and epithelial cell casts in urine
acute tubular necrosis
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when does ATN most often occur
post surgery (40-50% of cases)
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besides surgery what else is ATN associated with
- severe sepsis
- obstetric complications
- severe trauma including burns
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are ATN and ARF interchangeable
No, ARF failure can occur w/o ATN
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two general descriptions of ATN
- post ischemic - hypotension, hypoperfusion, hypoxemia, reduced ATP, generation of ROS
- nephrotoxic - can be produced by numerous anti-biotics, but the aminoglycosides (neomyocin, gentamicin, tobramycin) ar the major culprits
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three main etiologies of intrarenal acute renal injury/failure
- acute glomerulonephritis
- acute tunular necrosis
- bilateral acute pyelonephritis
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inflammation of the glomerullus caused by numerous factors; infection, immunologic abnormalties, schemia, ree radical, drugs, toxins, vascular disorders, etc.
glomerulonephritis
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The classification of glomerulonephritis can be described according to what five criteria
- cause
- pathologic lesions
- disease progression (acute, rapidly progressive, chronic)
- clinical presentation (nephrotic or nephritic syndrome, acute or chronic kidney syndrome)
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