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Acute renal failure
- azotemia
- accumulation of urea, nitrogen, uric acid and creatinine
- decreased GFR
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postrenal failure
- ureteral obstruction
- bladder obstruction
- prostatic hyperplasia
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Stage 1 acute renal failure
- oliguria lasting 1-2 weeks
- may be followed by a diuretic stage for 2-10 days
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Stage 2 acute renal failure
- diuretic phse
- urine volume increases
- tubular function remains impared
- azotemia continues
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stage 3 acute renal failure
- recovery phase
- lasting up to 12 months
- gradual normalized scr and BUN
- a degree of renal insuficiency persists
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Causes of pre-renal acute renal failure
- decreases in renal blood flow
- drugs/toxins
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Symptoms of pre-renal acute renal failure
- less urine output
- elevated BUN and Scr
- low FeNa <1
- high urine specific gravity
- low urinary sodium <20
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Treatment for pre-renal acute renal failure
- improve renal blood flow
- remove offender
- dialysis
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FeNa >2%
intrinsic acute renal failure
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Intrinsic acute renal failure causes
- ischemia
- sepsis
- drugs
- obstruction
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Chronic kidney disease
- kidney damage for > 3 months + markers of damage or abnormalities
- or GFR <60 mL/min for >3 months with our without kidney damage
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common causes of chronic kidney disease
- diabetes mellitus
- nephritis
- polycystic kidney disease
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complications of chronic kidney disease
- HTN
- cardiovascular risks
- e- imbalance
- osteodystrophy
- malnutrition/anemia
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Stages of chronic kidney disease
- 1: GFR >90 ml/min
- 2: GFR 60-89
- 3: GFR 30-59
- 4: GFR 15-29
- 5: GFR <15
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Nephron loss of stage 1 and 2 CKD
75%
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Stage 3 and 4 nephron loss
- 75-90%
- mild azotemial
- polyuria
- nocturia
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stage 5 - end stage renal disease
- 90% nephrons lost
- BUN and Cr are increased
- e- abnormalities
- uremia, bone problems
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signs and symptoms of CKD
- decreased urine output
- hyperkalemia
- aneima
- weak....
- urine changes
- edema/heart failure symptoms
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Clinical Manifestations
- accumulation of nitrogenous wastes
- fluid, e-, acid base imbalance
- calcium and phosphorus
- hematologic
- pharmacokinetics
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azotemia
accumulation of nitrogenous wastes in blood
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Clinical manifestation of CKD fluids and e-
- impaired sodium excretion
- salt wasting
- increased potassium excretion
- metabolic acidosis
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clinical manifestations -calcium and phosphorus
- impaired phosphate excretion = increased phos & decresed calcium
- increased PTH affects bones
- impaired vitamin D synthesis
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Hyperphophatemia
- not seen until stage 5
- restrict phosphorus in diet
- use phosphate binders
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Pharmacokinetic changes with renal failure
- alterations in gastric emptying
- antacids and phosphate binders may decrease absorption of other meds
- uremic pt may suffer from n/v
- low albumin protein in blood
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Indication acronym for dialysis
- A-acidosis
- E-electrolyte (hyperkalemia)
- I-intoxication
- O-refractory fluid overload
- U-uremia
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