Kidney Function and Renal Diseases

Kidney Function Evaluation

• Function of Kidney:
  • Acute or chronic
  • Excretion
  • Secretion
  • Reabsorption
  • Balance electrolyte & blood pressure
    • K^+ imbalances can lead to cardiac arrest.
  • Creatinine levels indicate kidney function.
• Acute vs. Chronic:
  • Acute: Reversible
  • Chronic: Irreversible
  • Symptoms of kidney issues: weakness, lethargy, paresthesia, dysrhythmia
• Diuretics (ta)

Acute Renal Failure

• Hypovolemia can lead to acute renal failure, reversible if the underlying cause is treated successfully.
• Definition: Rapid loss of renal function due to kidney damage.
• Causes:
  • Prerenal (55%):
    • Hypovolemia
    • Decreased active blood volume
    • Cardiac failure
    • Liver dysfunction
    • Septic shock
  • Renal (40%):
    • Interstitial nephritis
    • Acute glomerulonephritis
    • Tubular necrosis
    • Ischemia
  • Post Renal (5-15%):
    • Prostatic hypertrophy
    • Cancer of prostate or cervix
    • Neurogenic bladder
    • Bilateral renal calculi
    • Bilateral or unilateral uretic obstruction
• Symptoms:
  • Decreased urine output
  • Edema
  • Mental change
  • Heart failure
  • Nausea/vomiting
  • Pruritus
  • Anemia
  • Cool, pale, moist skin
• Diagnosis:
  • Blood test or urine specimen
  • Ultrasound to rule out obstruction of the urinary tract
  • Risk indicators:
    • Injury > 25, Serum creatinine levels
    • Failure >3 on
    • Loss: Complete loss of Kidney function
• Management:
  • Consider the stage: Pre-renal, renal, post-renal
  • Address life-threatening conditions: Hyperkalemia, vascular disease, volume overload, electrolyte imbalance
  • Identify the cause: Hypovolemia, toxic agent, obstruction
  • Treat reversible elements: Hydrate, remove drugs, relieve obstruction

Hyperkalemia

• Symptoms:
  • Weakness
  • Lethargy
  • Muscle cramp
  • Paresthesias
  • Dysrhythmia
• Treatment:
  • Calcium gluconate
  • Sodium bicarbonate
  • Insulin/glucose
  • Lasix
  • Albuterol
• Diuretics are used in the treatment of acute renal failure.

Chronic Renal Failure

• Definition: Progressive, irreversible damage to nephrons and glomeruli over more than 3 months, leading to end-stage renal disease (ESRD).
• GFR (Glomerular Filtration Rate) < 60mL/min + duration > 3 months = CRD (Chronic Kidney Disease)
• ESRD: Irreversible stage with loss of endogenous renal function, requiring dialysis or transplantation.
• Azotemia: Nitrogen in the blood due to renal insufficiency.
• Uremia: Clinical and laboratory syndrome resulting from untreated acute or chronic renal failure.
• Ccr (Creatinine clearance): The rate of filtration of creatinine by the kidneys.
• GFR: The total rate of filtration of blood by the kidneys.
• Identify Kidney damage:
  • Proteinuria
  • Urine sedimentation
  • Volume overload: pulmonary edema, pericardial effusion
  • Metabolic acidosis
    • Electrolyte imbalances, including hyperkalemia
  • Biopsy
• ESRD: High risk of death
• Causes:
  • Recurrent Kidney infection
  • Vascular change
  • DM (Diabetes Mellitus) common (50%)
  • Cr below 10mL/min, GFR < 5 mL/min
  • Other causes: Nocturia, oliguria, increased K^+, Mg^{2+}…
  • HTN (Hypertension) most common
  • Glomerulonephritis
  • Interstitial nephritis

Symptoms of Chronic Renal Failure

• Malaise, weakness, fatigue
• Anorexia, N/V (Nausea/Vomiting)
• Seizure / Pruritus, jaundice, constipation, peptic ulcer

Risk Factors for Chronic Renal Failure

• Family history
• Older age
• Past episode of acute Renal failure
• Current Kidney damage

Acute problems in Chronic Renal Failure

• Related to ERSD
• Dialysis (2 week)
• Volume overload (NSS)
• Anemia, HTN, GI bleed
• Abnormal immune function = infection

Treatment Modality

• Decrease fluid (1000mL/day), protein (0.5-1g/kg body weight)
• Decrease Na, K, ISOn
• Dialysis (peritoneal, hemodialysis)

Treatment

• Dialysis
• Renal transplant

Nephritis

• Definition: Inflammation of nephrons of one or both kidneys
• Cause:
  • Infection
  • Auto-immune disorder -> lead to death if delayed
• Nephritis -> 9th highest death
• Excrete protein or urine -> No blood clot -> risk of stroke
• Water retention, edema
• Primary to use with antibiotic steroid (prevent infection
• Subtypes:
  • Glomerulonephritis -> inflamation of glomeruli or small blood vessel in Kidney
  • Interstitial nephritis: space blu renal tubule
  • Pyelonephritis -> uII has reach to pyelon of Kidney
  • Lupus nephritis (inflammation of Kidney cause by SLE

Glomerulonephritis

• Symptoms:
  • Hematuria
  • Oliguria
  • Edema
  • Hypertension
  • Reduce GFR
  • Proteinuria
• Management:
  • Primary: intrinsic Kidney
  • Secondary: infection (bacteria, virus, parasite), drug
  • Fluid diet management
  • Treat hypertension and fluid overload
  • Treat infection
• Complication
  • Hypertensive encephalopathy (seizure, coma)
  • Heart failure
  • Uremia require dialysis
  • Proteinuria (> 3.5g/dL)

Interstitial Nephritis

• Cause:
  • Drug (penicillin, sulphonamide, thiazide, omeprazole…)
  • Infection (bacteria, virus -> infect renal parenchyma -interstitial nephritis)
  • Autoimmune (SLE, transplant rejection)
  • Metabolic (calcium salts, uric acid)
  • Neoplastic infiltration (lymphoma, myeloma)
• Pathological change:
  • Hypertension
  • Proteinuria
  • Reduce urinary concentrating ability
  • Salts wasting
• Diagnosis & Treatment:
  • Renal impairment
  • Renal biopsy
  • Eosinophil in urine
  • Use of corticosteroid (prednisolone)
  • Water and electrolyte
    • SE: coughing
  • Treat HTN (ACE & ARB -> use for proteinuria, albuminemia & Hypertension catopril losatan inalopuil Valsatam

Diabetic Nephropathy

• Enns renal she as DM
• Of intense treatment
• Dialysis if needed
• Treatment by microalbuminemia (< 100mg/24h)

Pyelonephritis

• Inflam renal pelvis, renal tubule, interstitial tissue
• Cause:
  • E- Coli
  • Pregnancy
  • DM
  • Polycystic
  • Urinary tract catheterization
• Symptom:
  • Edematous, inflam
  • Urine: cloudy, pus, mucus, blood
  • Chill, fever, flank pain
  • Azotemia
  • Costovertebral angle (CVA) pain
  • In chronic: autospy roy multiple calculi, calyceal system
• Diagnosis:
  • Culture: See bacteria & pus in urine
• Management:
  • Antibiotic: 14-21d according to results urine culture
  • Adequate fluid
  • Upinary analgesic Feuer !
• To know the right antibiotic using: S culture: 3-5d concent

Lupus Nephritis

• Inflam Kidney cause by SLE
• Symptoms:
  • Weigh gain, high blood pressure
  • Darker foamy wine
  • Swelling eye, leg, ankle, finger
  • Fever, athritis, headache,…
  • me cause
• Diagnosis +
  • Blood test, urinalysis, X-ray, ultrasound + clinical
• Based on biopsy: 5 class
  • class I: mesangial deposite (minimal change)
  • class II: mesangial proliferative -> complete treatment
  • class III: focal proliferative -> complete treatment with high dose of corticosteriod
  • Class IV: diffuse proliferative -> corticosteroid + immunosuppressive drug
  • class V: membrane nephritis
  • Edema & protein loss
  • Nephritis -> proteinuria < 3.5g
  • Nephrotic snd+ > proteinuria >3.5g systemic lupus erynomatus

Nephrotic Syndrome

• Is increase permeability of glomerulus lead to loss of protein into tubule
• Nephrotic syndrome = mass proteinuria = hematuria/red cell cast
• Characterized by:
  • Proteinuria >3.5g/24h (1 glomerular disease)
  • Hypoalbuminemia (<30g/dL) (urinary protein loss in proximal tubule)
  • Edema (an Natio - bad /Hyperlipidemia) total cholesterol, LDL , TG, d doesn albumin transport
• Cause: (Primary: idiopathic no renal biopsy: 5 stage secondary
  • :Bcause ope : (PM, infection , medication , Heriditary… ->steroid or cyclosporine -> / combine steroid with cyclosporine
• Diagnosis:
  • An characterized 4
• Complication:
  • Infection ( albumint)
  • Malnutrition (immunet)
  • Thrombosis (blood clot intravascular ->Hypercoagulation
  • Acute Renal failure
  • Dyslipidemia blood clot, stroke, pulmonary embolism
• Treatment:
  • Support care
  • Diuretic
  • Diminish proteinuria: ACE, ARB
  • Inhibit inflammation & immune response: corticosteroid (slow dose 10% every 1-2week befor stop using
  • Fail corticosteroid
    • cyclosporine (SE: venal, liver toxic injury, expensive Infection-> antibiotis => treat for complication S Thrombosis -I thrombolysis ARF
  • corticosteroid
  • dyslipidemia+ use statin , fibrate