.Acute glomerulonephritis diagnosis - ANSWER-•Patient history
•Clinical manifestations
•Urinalysis
•BUN and Creatinine levels
.Acute glomerulonephritis etiology - ANSWER-•More common in men than women
•A leading cause of chronic ESRD
•Wide variety of triggers
▫Bacterial (usual trigger)
▫Viral
▫Parasitic
▫Systemic disease
.Acute glomerulonephritis pathogenesis - ANSWER-
.Acute glomerulonephritis treatment - ANSWER-•Supportive care
,•Symtomatic
•May include temporary dialysis
.Acute Kidney Injury (AKI) - ANSWER-•Potentially reversible
•Characterized by abrupt deterioration of renal function
▫Fluid and electrolyte imbalances
▫Acid-base imbalances
▫Retention of waste products
▫Increased serum creatinine
▫Decreased GFR
•Oliguria=uop<400 mL/24 hours
•Anuria = uop <100 mL/24 hours
-check urine output every hour
•Increased serum creatinine
•Mortality rates very high in critically ill patients
•Risk increased with co-morbid conditions
▫Diabetes
▫Malignancies
▫Heart failure
▫Liver failure
▫Hypertension
▫Atherosclerosis
▫Exposure to nephrotoxic drugs
▫Advanced age
-GFR at 80 is ½ of what it was at 30
,.Acute pancreatitis pathogenesis - ANSWER-The most prominent factor:
> Obstruction of pancreatic duct by a stone or other cause
> Digestive enzymes get released within the parenchyma of the pancreas
> Autodigestion of pancreas itself
.Acute pancreatitis treatment - ANSWER-Signs and symptoms
Serum lipase (most specific) and amylase
Ultrasound/CT
TREATMENT
NPO
> Nasogastric suctioning
> TPN
IV fluids
Pain management
Nutritional support
.Acute Pyelonephritis Clinical Manifestations - ANSWER-•Sudden onset
•Fever/chills
•Nausea/vomiting/anorexia
•CVA tenderness
-Halmark symptom
-Cause because of inflamed Renal Pelvis
•Dysuria (painful urination), urgency, frequency
•Complications
-Septic shock
-ARDS
-Chronic kidney disease due to scarring
.Acute Pyelonephritis Etiology - ANSWER-•Pregnancy is major risk factor due to
alterations in urinary tract
•Diabetes-vesicoureteral reflux
•Highest incidence in young women, infants, the elderly
•Causative organism: Ecoli in most cases
•Unilateral or bilateral
•Right kidney involved >50% of the time
•Improper cleaning
.Acute Pyelonephritis Pathogenesis - ANSWER-•Usually an "ascending" infection
•Can arrive via bloodstream or lymphatics
•Bacteria binds to epithelial cells
.Acute Pyelonephritis Treatment - ANSWER-•Made via urinalysis
-Bacteria
-RBCs
-WBCs
•Oral antibiotic therapy for 7-10 days usually as outpatient
•May be hospitalized for more severe cases
-Urine culture
-IV antibiotics
-IV fluids
.ADH - ANSWER--causes decrased urine output
-can cause hyponatremia via increased H2O retention
-keeps sodium and water
-Major Stimulus: Increased P osm or decreased extracellular fluid volume
-Nephron Sites of Action: Distal Tubule and Collecting Tubule
-Effects on Transport: Increased H2O reabsorption
.Age Related Changes in the Urinary System - ANSWER-•Kidneys diminish in size and
function by 4th decade
•Decreased glomeruli
•GFR starts to decrease at age 40
•GFR decreases about 10% per decade
•By age 70 30-50% of glomeruli lost
•Renal blood flow decreases
•Number of nephrons decrease
•Less renal reserve
•More susceptible to fluid and electrolyte imbalances
•Susceptible from damage from drugs, medications contrast media
•Get dehydrated more easily
.Aldosterone - ANSWER--Major Stimulus: Increased Angiotensin II or Increased K+
-Nephron Sites of Action: Thick Ascending Tubule, Distal Tubule, and Collecting Tubule
-Effects on Transport: Increased NaCl and H2O reabsorption
.Angiotensin II - ANSWER--Major Stimulus: increased Renin or low BP
-Nephron Sites of Action: Proximal Tubule, Thick Ascending Tubule, Distal Tubule, and
Collecting Tubule
-Effects on Transport: Increased NaCl and H2O reabsorption
.Antibiotics - ANSWER-look at how much is already in the patient, then look at BUN and
Creatinine before administering
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