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 Renal diseases

استعرض الموضوع السابق استعرض الموضوع التالي اذهب الى الأسفل 
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dr saad
Admin


عدد المساهمات : 176
تاريخ التسجيل : 12/12/2010
العمر : 35
الموقع : http://medsurgery.ba7r.org

مُساهمةموضوع: Renal diseases   الجمعة 01 أبريل 2011, 20:42

Renal failure
Classification:
a) according to duration
• acute (6 w-6 m)
• chronic (>6 m)
b) according to etiology
Pre renal Renal (most important) Post renal
Hypo volemic cause:
a) decrease amount
of fluid in vessels
( decrease
intravascular fluid)
• loss of
blood(hrg)
• burn
• vomiting and
diarrhea
• diuretic drug
b) decrease amount
of fluid by
extra vastion:
(causes of
edema)
• nephrotic
syndrome
• hepatic
failure
• congestive
heart
failure
c) renal artery
Stenosis
d) sepsis
a) DM  diabetic nephropathy
b) HTN  hypertensive
nephrosclerpsis
c) Glomerulonephritis
d) Infection:
• E. Coli  HUS
(hemolytic uremic syndrome)
• HIV
• HBV & HCV
• TB
• Schistosomiasis
• Malaria
a) Malaria (Ag-Ab)
b) Malaria falciparum
(black water fever)
Urine will be dark
• Syphilis
• Chronic recurrent
pyelonephritis.
e) drugs
• amino glycosides
• NSAIDs
• Diuretics
• Contrast agents
• Gold (heavy metal that treat
RA.)  nephrotoxins
• Penicillamine
Mainly obstruction
due:
Stone
Radiation
Tumor
Lymph. Node
Infection:
• TB
• Bilhariziasis
f) Vasculitis
SLE, RA, connective tissue dis.,
systemic sclerosis, polyarteritis
nodosa
g) Tumor
• Renal cell carcinoma
• Multiple myloma:
1. Hypercalcemia
2. Hyperuracemia
3. Recurrent infection
4. Deposition of paraprotein
h) Metabolic causes:
1. Hypercalcemia
2. Wilson‘s ds.
3. Hemochromatosis
4. Hyperurecemia
I) Polycystic kidney
Complication:
1) Uremia:
o Uremic gastropathy  loss of appetite, loss of wt, nausea, vomiting,
constipation
o Leg swelling
o Respiratory symptoms  SOB, cough, yellowish sputum
o Uremic pericarditis
o Symptoms of cardiac overload (HF)  dyspnea, orthopnea, PND…
o Generalized skin itching
o fatigability
o Uremic encephalopathy  disturbance of sleep, impaired memory,
problems in concentration, confusion in advaced RF
2) HTN
3) Edema (fluid overload)
4) In the endocrine:
3 (increase) 3 (decrease) 2 abnormal
Increase:
LH, prolactine, insulin  lead to gynecomastia in male & dysfunction in
female & improve DM (or hypoglycemia)
Decrease:
Erythropoietin factor& 1.25-DHCC (active vititamin D) & testosterone
Abnormal:
GH secretion & action (impaired growth in child)
Thyroid H. level (myxedema)
5) In skin
5p+ 1E
Pallor
Pigmentation
Pruritis
Purpura
Popular skin rash
Edema
6) Musculoskeletal
Bone:
Renal osteodystophy
Joint:
Gout (uric acid deposition) \ Pseudogout (Ca pyrophosphate deposition)
RF of transplanted Kidney presenting with uremic symptoms  the
cause is Renal Artery Stenosis
7) Electrolyte disturbance:
(Hyperkalemia)
Brain: confusion & mental dullness
CVS: arrest
GIT: atony (nausea, vomiting, constipation)
Muscle: weakness, flaccid paralysis, paraesthesia
Investigation:
 Blood Work
1) CBC: HB  anemia
MCV, MCH  or (nomocytic normochromic)
Pancytopenia…
WBC  infection
2) ESR: increase with infection
3) ABG: metabolic acidosis
4) U & E (renal function): increase creatinine, urea , Pi, Kyperkalemia
(should be treated to protect the heart)
5) Blood sugar: increase with DM
6) HBV & HCV screen
 Urine analysis:
1) Oligouria
2) Proteinuria
3) Hematouria
4) casts: RBC
 Radiology:
1- US:
1) Kidney size
Enlarged:
DM, polycystic kidney, HIV, Amylodosis
Shrunken:
• Chronic GN
• (evidence of obstruction)
LN, stone, tumor
• Hepatosplenomegaly
2) Collection over kidney
2- Urgent US + Doppler  for transplanted kidney  to reveal renal
artery stenosis
3- CXR:
Heart, Pulmonary edema
pleural effusion  uremia
TB
Metastatic kidney
 ECG, Echo, Cardiac Enzymes  if patient has cardiac symptoms
 Band screen  if pt is on line dialysis & febrile
- urine
- sputum culture
- blood
Important Points in RF:
1- Underlying cause:
• DM  how long? does pt has retinopathy (because nephropathy
occur at same time)
 Swelling – renal biopsy – controlled?
• HTN  How long?
 Control
HF
• Unknown etiology
• SLE (pt knows about it)  medications, ……. etc
 Type II diabetic patient for a long time on oral
hypoglycemic, without changing his diet or medications.
How did his DM became controlled? Even sometimes he
has hypoglycemia
Due to development of renal failure
As the insulin is metabolized in kidney, it will be preserved  
insulin
This will lead to control of sugar
So, Oral hypoglycemic should be stopped
 Do you expect this pt to have retinopathy?
No, because his diabetes is controlled
2- Duration of RF
3- Dialysis  through fistula or line
 How many times per week?
4- Symptoms of uremia
If a patient doesn't have symptoms of uremia,
In HPI write: no symptoms of uremia
5- Line sepsis / we have to exclude other causes
6- UTI
Itching:
- Uremia  uremic toxin (we don't know what it is)
- Uremic dryness
- Hyperphosphatemia  major cause especially in Nephrotic syndrome
Renal failure management:
Replacement therapy:
1- Erythropoietin for anemia
2- Calcium & vitamin D for low vitamin D
3- Dialysis
4- Renal transplant
* Low salt diet
* Low protein diet
Dialysis:
Peritoneal dialysis if the patient can do aseptic technique
hemodialysis
Dialysis indication:
- Hyperkalemia not responding to medical therapy
- Fluid over load not responding to medical therapy
- Uremic encephalopathy
- Uremic pericarditis
- Uremic gastropathy
- Rapid increasing in creatinine e.g 100-200
- Metabolic acidosis
- Uremic bone dystrophy (earlier better)
* In ARF pt treated by dialysis recover in 6 weeks
10-25 weeks  CRF  OBSERVE
If creatinine is maintained e.g.: 300 during his life & not increasing  no
need for dialysis, only replacement therapy
Acute on Chronic Renal Failure:
e.g.: creatinine=300 after 2 weeks creatinine=800
Search for the cause, why developed?
1- Infection
2- Drugs: NSAID e.g.: for osteoarthritis,
3- Contrast angiogram
4- Obstruction BPH (benign prostatic hyperplasia)
5- Any fluid loss, dehydration vomiting, sun (sweating) , diuretic , heart
failure
الرجوع الى أعلى الصفحة اذهب الى الأسفل
http://medsurgery.ba7r.org
dr saad
Admin


عدد المساهمات : 176
تاريخ التسجيل : 12/12/2010
العمر : 35
الموقع : http://medsurgery.ba7r.org

مُساهمةموضوع: رد: Renal diseases   الجمعة 01 أبريل 2011, 20:42

Nephrotic syndrome
Definition:
1. Proteinuria > 3.5 g\day.
2. Hypoalbuminemia < 30g\L (< 3g\dl)
3. Hyperlipidemia ( cholesterol, LDL).
4. Evidence of fluid retention and edema.
Causes:
1- 1ry renal:
- Minimal change disease.
- Membranous GN.
- Focal segmental Glomerulosclerosis.
- membranoproliferative GN.
- crescentic GN.
2- 2ry causes:
- Systemic: DM – HTN – SLE – amyloidosis.
- Drugs: NSAIDs – heroin – captopril – gold – penicillamine - probenecide
.
- Infection: HBV – HIV- malaria
- Malignancy: carcinoma – lymphoma – MM.
- Allergy.
Complication:
1- Edema.
2- Hypercoagulability.
3- Hypercholesterolemia.
4- Infection.
الرجوع الى أعلى الصفحة اذهب الى الأسفل
http://medsurgery.ba7r.org
 
Renal diseases
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