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FISIO II > Fisiopato FINAL > Flashcards

Fisiopato FINAL Flashcards

1
Q

Que es fallo renal?

A

kidneys cant remove metabolic end products from blood and regulate fluid, electrolyte, and pH balance of liquid EC

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2
Q

different causes of fallo renal

A

renal, systemic urologic

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3
Q

acute renal failure onset

A

abrupt onset and reversible

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4
Q

chronic renal failure

A

slow onset, irreversible, 80% of neprhons dont work

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5
Q

characteristics of acute renal failure

A

Rapido decline in kidney function

Aumenta niveles de nitrogenous wastes and impair fluid and electrolyte balance

Reversible

40-90% mortality rate; mas en older people

AZOTEMIA indica AKI

disminucion en TFG

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6
Q

AKI

A

= accumulacion de urea nitrogen, uric acid, creatinine)

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7
Q

Tipos de AKI

A

a. Puede ser por disminución en flujo sanguíneo without ischemic incjurt, ischemic, toxico, obstructive tubular injury, and obstruction of urinary tract outflow
b. Se categorizan como prerenal, intrarenal, y postrenal
c. 80-95% = prerenal y intrarenal

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8
Q

Fallo prerenal

A

a. El mas común
b. Caracterizado por una disminución marcada en flujo sanguíneo renal
c. Reersible si causa se puede identificar y corregir

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9
Q

Causas de Fallo prerenal

A

Hipovolema por (hemorragia, deshidratacion, excessive loss of GI, excess loss from burn)

Decreased vascuolar filling from anaphylactic shock or septic shock

heart failure and cardiogenic shock

decreased renal perfusion from sepsis, vasoactive mediators, drugs, diagnostic agents

  1. Endotoxinas
  2. Radioconstran agents used for cardiac catheterization
  3. Cyclosporine (immunosuppresent to prevent transplant rejection)
  4. AINES –> disminuyen flujo sanguineo renal porque inhiben síntesis de PG

iii. Estas drogas tambien causan acute tubular necrosis (ATN

iv. Drogas can also impair renal adaptive mechanisms and can convert compensated renal hypoperfusion  prerenal failure
v. ACE inhibitor + ARBs disminuyen efectos de renina on flujo sanguineo renal
1. Cuando se combinan con diuréticos  prerenal failure in ppl with decaresed blood flow due to large-vessel or small-vessel kidney disease
vi. PGs  vasodilatacion

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10
Q

causas of intrarenal kindey injury

A

Acute tubular necrosis/acute renal injury

  • Prolonged renal ischemia
  • Exposure to nephrotoxic drugs, heavy metals, and organic solvents - Intratubular obstruction resulting from hemoglobinuria, myoglobinuria, myeloma light chains, or uricacid casts
  • Acute renal disease (acute glomerulonephritis, pyelonephritis)
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11
Q

Causes of Postrenal acute injury of kidney

A

Bilateral ureteral obstruction Bladder outlet obstruction

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12
Q

Normally kidneys receive how much cardiac output

A

20-25%

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13
Q

relation between blood flow and TGF

A

i. As blood flow decreases, TFG descreases, less substances filtered, and the need for energy-dependent mechanisms to reabsorbe these substance is reduced

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14
Q

Manifestaciones of fallo prerenal

A

Dismincion en urine output ( 15:1, 20:1

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15
Q

Fallo postrenal characteristicas

A

Por obstruccion de urine outflow @ urter (calculos) , vejiga (tumors), uretra (BPH) –> presion retrograde –> dano

PH = most commun underlying problema

Debe ser bilateral para producir fallo renal

Tx: causa de obstrucion

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16
Q

Fallo Intrarenal/AKI

A

a. Por daño de parénquima glomerular, vasos, tubulos, or intersticio
b. Ischemia por fallo prerenal
c. Glomerulonefritis aguda o pielonefritis aguda
d. Disminución de TFG y daño epitelial por vasoconstricion intrarenal , decrease in Phydrostatica de glomérulo, changes in arterial tone by tubulogomerular feedback, decreased capillary permeability in glomeruli, increase in tubular hydrostatic pressure secondary to obstruction, and backflow of glomerular filtrate into intersitiam
e. Mos commun cause = injury to tubulos

17
Q

Acute tubular injury or necrosis

A

a. Destruccion de epitelio tubular with acute suppression of renal function
b. Damage por ischemia, sepsis, nefrotoxic drugs, obstruction tubular, toxins from infection
c. Reversible
d. Occure en px con hypovolemia, sepsis, trauma, operado

sepsis causa isquemia porque provoca vasodilatación y hipoperfusión intrarenal; también provoca generación de toxinas

ii. Myoglobinuria hipovolemia, hemolisis, valve prosthesis

18
Q

e. ATN –> AKI

A

i. necrosis of tubular epithelial cells lead to obstruction and increased intraluminal pressure, which decrease filtracion glomerular.
ii. Afferent arteriolar vasoconstriction caused in part by tubuloglomerular feedback mechanisms results in decreased glomerular capillary filtration pressure.
iii. Tubular injury and increased intraluminal pressure cause fluid to move from the tubular lumen into the interstitium

19
Q

TFG effect on blood flow

A

f. TFG doesn’t improve restoring blood flow

20
Q

Drogas pueden causar

A

vascoconsticion, dano tubular, obstrucion intratubular

i. Toxico  necrosis mas común @ PT
ii. Antimicrobials (aminoglycosides: vancomycin, gentamicin), CA QT (cisplation, radiocontrast agents)
iii.  TFG, enf renal, hipovolemia, nefrotoxic drugs contribuyen a nefrotoxicidad de aminoglycosides
iv. Cisplatin  daño mitocondrial, inhibe ATP y transporte soluto
v. RC por direct tubular toxicity y ischemia renal

21
Q

Definicion de insuficiencia renal

A

es un padecimiento en el cual los riñones no eliminan los productos de desecho metabólico de la sangre, ni regulan el balance de líquidos, electrolitos y el pH de los líquidos extracelulares

22
Q

Como puede ser la insuficiencia renal

A

aguda o cronica

23
Q

IRA

A

es de inicio repentino y puede ser reversible si se reconoce en forma temprana y se da tratamiento adecuado

Representa un deterioro rápido en la función renal, suficiente como para aumentar las concentraciones sanguíneas de desechos nitrogenados y deteriorar el balance de líquidos y electrolitos.

La IRA, aunque causa una acumulación de productos que lo normal es que se eliminen a través del riñón, es un proceso potencialmente reversible si se corrigen los factores que causaron el problema

Amenaza frecuente para personas graves en UCI

24
Q

IRC

A

es el resultado final de daño irreparable a los riñones y se desarrolla con lentitud.

25
Q

Tasa de mortalidad de IRA

A

40-90%

26
Q

causa de IRA

A

causada por padecimientos que producen una supresión en la función renal

causada por padecimientos que producen una supresión en la función renal

27
Q

Tipos de IRA

A

prerenal
intrarenal
posrenal

28
Q

IRA prerenal

A

marked decrease in renal blood flow

29
Q

IRA intrarenal

A

damage to structures within the kidney

30
Q

IRA posrenal

A

obstruction of urine outflow from the kidney

31
Q

Forma mas frecuente de IRA

A

insuficiencia prerrenal

32
Q

causas de insuficiencia prerrenal

A

decrease in flujo sanguineo renal

Hipovolemia ( hemorragia, deshidratacion, perdida excesiva de liquidos del tubo digestivo, perdida exesiva de liquido debido a quemaduras)

Disminucion del llenado vascular (shock anafilatico, shock spetico)

IC & Shock cardiogenico

Disminucion de la perfusion renal debida a (septicemia, mediadores vasoactivos, farmacos, agentes diagnosticos)

FISIO II (5 decks)

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