Week 12 - Renal PDF

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Week 12 – PARA 240 Renal Pathophysiology

Topical Outline -

Nephralgia Renal Failure Kidney Stones Glomerular Disorders Upper & Lower UT Pathology

Nephralgia -

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“Pain in the kidneys” o Caused by dilation, inflammation, obstruction, or rupture of various structures Associated with voiding Pre-hospital question: o Any pain with/directly after voiding? o What kind of pain? o Down low/up high? Few pain receptors in the kidneys Pain usually felt in surrounding structures o Ureters o Blood vessels o Dermatomes (T10-L1) Common types: o Flank pain, radiates around and down the groin on one or both sides  association with nerve fibers in renal plexus and the spermatic plexus  quite often genital pain associated with urinary problem (Genital urinary = GU)

Renal Failure

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Diseased kidney Granular surface Decreased function Smaller in size as cells start to atrophy High urine protein (proteinuria is a sign of kidneys failing)

Risk Factors -

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Hx of Renal problems o Polycystic kidneys (development of multiple cysts) o Nephrotic syndrome Co-morbidities o Diabetes (diabetic nephropathy) o CAD o HTN o Atherosclerosis o HF – forward effects  diminished CO  diminished renal blood flow  kidney failure o Autoimmune disorders: Lupus Infection o Chronic pylo-nephritis (recurring or chronic UTIs) Urinary obstruction o Stones o BPH – benign prostatic hyperplasia: squeezes the ureters o Malignancy o Mylomas in women Age o Increased risk for hypovolemia o Increased in elderly o Decreased ability to concentrate urine, concentrate sodium, thirst mechanism o By 70, may have 50% fewer nephrons  geriatric nephrons more susceptible to damage Drugs o Alter the autoregulation system that is set up by the kidneys  nephrotoxic o Hypertension drugs:  Angiotensin receptor blockers  ACE-inhibitors  Diuretics o ARBs, ACEI  decrease renal blood flow o Thiazide diuretics (potassium sparing): HCTZ o Loop diuretics

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NSAID use: decrease the cox pathway  decrease prostaglandin activity  decrease autoregulation

Acute Renal Failure (ARF) -

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Aka “acute renal injury (AKI)” ARF is used interchangeably with ATN  but they are NOT the same Sudden & severe decrease in renal function o Drop in renal function where >50% of nephrons have lost their function, this happens across both kidneys (overall) With prompt medication and treatment  they will resolve the issue  if it doesn’t you will develop chronic renal failure In an already critical ill patient goes to 60% mortality rate, if you don’t filter toxins out of your blood it starts to shut down other organs Characterized by: o Oliguria – decrease in urine production o Axotemia – increase in toxic waste in the blood  Increase in urea and creatinine Prerenal, Intrarenal & Postrenal Injury o Prerenal – cause is before the kidneys (heart) o Intrarenal – problem with kidneys themselves o Postrenal – something that happens after and moves backward (bladder)

ARF and Uremia -

Uremia – presence of urea in the blood Uremia causes: o K+ retention & Ca++ losses  affect cardiac system  cardiac arrhythmias o Uremic encephalopathy – build up of waste that travels to the brain  cause neurological symptoms  confusion, seizure, coma o Pruritus – itchiness  increase of waste deposits in the skin, but don’t appear to have an allergic reaction o Pericarditis – waste products lead to inflammation of the pericardium, but does not usually progress to the point of this o Inhibition of blood platelet factor III  Increase bleeding of the mucosal surfaces, pericardial sac or meninges (tongue)  pericarditis & meningitis

Classifications of ARF -

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Urine Output (UO) classification o Oliguric –...