Renal Flashcards
Indication of dialysis
 Acidosis
Electrolyte abnormalities
Intoxication’s
Volume overload
Uremic symptoms
Toxins that causes an intrinsic renal failure
NSAIDs
Cisplatin chemotherapy
Amphotricine
Cyclosporine
Dialyzable substances (slime)
aspirin
Lithium
Isopropyl alcohol
Magnesium laxatives
Ethylene glycol
When to give renal replacement therapy
GFR<5ml/min
GFR 5-15ml/min with aeiou specialty hyperkalemia, and volume overload
Complications of chronic kidney disease
Anemia
Growth failure in children
Dyslipidemia
Bleeding
Infections(abnormal, neutrophil function)
Sexual dysfunction (erectile dysfunction, an ovulation )
Abnormal calcium and phosphate leads to secondary and tertiary hyperparathyroidism
Renal osteodystrophy
Ostitis fibrosa cystica ( from untreated, severe high PTH levels, bone cysts, brown tumors)
So we give phosphate binders
Phosphate binders
They bind phosphates in G.I. tract to decrease serum phosphate
Calcium carbonate
calcium acetate (phoslo)
Sevelamer(renagel)
Lanthanum
Drugs that worsen renal function
Loop thiazide
K sparing diuretics
ACE I
NSAID
Contrast
Calciphylaxis calcific, uremic arteropathy
Seen in chronic hyper phosphatemia in chronic kidney disease
Life-threatening complications of chronic kidney disease
Hyperkalemia
Pulmonary edema
Infections .
Advantages of hemodialysis
More efficient than peritoneal dialysis
High flow rates and efficient dialyzer shorten the period of time required for dialysis
can be initiated more quickly than peritoneal dialysis
Disadvantages of hemodialysis
Less similar to the physiology of natural kidney function
Hypotension
Hypo omolarity
requires vascular access
Advantages and disadvantages of peritoneal dialysis
Advantages :1mimics the physiology of normal kidney. 2.The patient can learn to perform dialysis on his own.
Disadvantages,
high glucose load
peritonitis
the patient must be highly motivated to self, administer it
cosmetics
Complications associated with hemodialysis
Hypotension
hypo osmolality
Hemolysis
Complications associated anticoagulation, hemorrhaged hematoma
Hemodialysis associated amyloidosis
first use syndrome (chest pain ,back pain)
Infection of vascular access 
Complications associated with peritoneal dialysis
Peritonitis,
inguinal, hernia,
hyperglycemia,
protein malnutrition
Nephrotic syndrome remission
No edema urine is proteins for 5 constitutive days
Relapse nephrotic
Syndrome
Edema or first moved in urine sample contains more than 2+ protein for 7constitutive days
Frequent relapsing nephrotic syndrome
More than two relapses within six months
Kidney biopsy considered in
Secondary nephrotic syndrome
child >10
Nephritic and any minimal change with resistance to steroid
Frequent relapsing
Hypertension
Low GFR /RPGN
Went to admit patients to hospital
A new case
Biopsy
Anasarca
Complications
Uremia and blood testing
• Renal dysfunction -> bleeding
• Poor aggregation and adhesion of platelets
• Caused by uremic toxins in plasma
• Uremic platelets work normally in normal serum
• Prolonged bleeding time
* Normal platelet count
• Normal coagulation testing
PT, PT
How to treat pt nephrotic with edema and hyperkalemia
- Lazix diuretics
2.Ventoline nebulizer shifts K inside cell
3.Calcium and insulin as well - Calcium glucanate
5 . Calcium resonium ,na resonium - Dialysis
acute intersitial nephritis
Clinical features:
Answer
1) Symptoms of intrinsic
acute kidney injury ( weight
gain ,edema ‚no urine
output)
2) symptoms of
allergic reactions: rash,
fever, eosinophilia
3) Pyuria & hematuria
acute interstitial nephritis
Inflammation of the interstituim, makes up 10 to 15% of acute kidney injury. - causes:
1)Allergic drug reactionsis the most common cause (sulfa, penicilins)
2) Infections (especially in children ) including strep, and legionella
3)Collagen vascular disease: sarcoidosis
4) autoimmune disease: SLE
causes of nephrotic syndrome
1) Primary: membranes
nephropathy most
common in adults,
FSGS ,Membrinoproliferative
GN, minimal change disease
most common in children
2) Secondary: systemic
disease such as SLE,
collagen vascular disease
HSP, PAN Amyloidosis,
cryoglobulinemia ,drugs and toxins, infection
Causes of Chronic kidney
disease
1) DM is the most common
cause
2) HTN (25%)
Causes of Elevated BUN:
1) Steroids
2) Gl/Soft tissue bleeding
3) High dietery protien intake