1 / 11

RENAL DISEASE: OVERVIEW AND ACUTE RENAL FAILURE Pathophysiology of Disease: Chapter 16 (388-394)

RENAL DISEASE: OVERVIEW AND ACUTE RENAL FAILURE Pathophysiology of Disease: Chapter 16 (388-394). Jack DeRuiter, PhD Department of Pharmacal Sciences April, 2000. Kidney Sites Susceptible to Renal Disease (page 388). General: Renal medulla: Low oxygen environment: Ischemia Glomerulus:

rey
Download Presentation

RENAL DISEASE: OVERVIEW AND ACUTE RENAL FAILURE Pathophysiology of Disease: Chapter 16 (388-394)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. RENAL DISEASE:OVERVIEW AND ACUTE RENAL FAILUREPathophysiology of Disease: Chapter 16 (388-394) Jack DeRuiter, PhD Department of Pharmacal Sciences April, 2000

  2. Kidney Sites Susceptible to Renal Disease (page 388) • General: Renal medulla: • Low oxygen environment: Ischemia • Glomerulus: • Structure predisposes it to immune complex deposition and complement fixation • Tubules: • “Post-Renal” Structures (ureters, bladder) • Malformations, Obstruction, Masses (i.e. cancer)

  3. CATEGORIZATION • Generalized Site of Disease: • Prerenal: Inadequate renal blood flow • Intrarenal: Nephron damae • Postrenal: Obstruction, Structural defects • Site of Renal Lesion (Intrarenal) • Glomerulopathy • Nephritic: • Nephrotic: • Tubulointerstitial Disease • Etiologic Factors: Infection, Diabetes, etc.

  4. Glomerular Capillary: Normal versus Pathology

  5. Glomerular Capillary Pathology(see previous slide) 1. Membranous nephropathy: Subepithelial deposits 2. Post-infectious glomerulonephritis: Subepithelial 3. Lupus glomerulonephritis: Subendothelial deposits 4. IgA Nephropathy: Mesangial deposits 5. Goodpasture’s Syndrome: Antibody binding to GBM 6. Glomerular injury with proteinuria: Podocyte effacement

  6. Nephrotic vs Nephritic Disorders • Nephrotic: • profound proteinuria • Immune complex deposits: Epithelial • NO cellular inflammatory reaction • Nephritic: • Variable proteinuria • Immune complex deposits: Subendothelial or GBM • Cellular inflammatory reaction

  7. ACUTE RENAL FAILURE:Clinical Presentation (pages 389-390) • Heterogeneous group of disorders characterized by rapid deterioration in renal function (Decreased GFR) • Rapid elevation of BUN and serum creatinine • Oliguria: Variable • Other: Henaturia, proteinuria, edema, hypertension

  8. ACUTE RENAL FAILURE:Etiology (page 390 and Table 16-3) • Prerenal: • CV and volume depletion • Drug-induced or related (NSAIDs, ACEIs, diuretics) • Intrarenal: • Inflammatory disease: Vasculitis, glomerulo-nephritis, drug-induced • Acute tubular necrosis • Postrenal: Obstruction, Cancer, congenital abnormalities

  9. ACUTE RENAL FAILURE:Pathology (pages 390-392) • Acute tubular necrosis (ATN): • Tubular cell sloughing • Reversibility/Irreversibility: Dependent on time of intervention • ATN Pathogenesis • Tubular occlusion theory and cast formation • Vascular hypoperfusion theory: Afferent vasoconstriction with Efferent vasodilation • Role of renal mediators?

  10. ACUTE RENAL FAILURE:Early Clinical Manifestations (pages 392-394) • Symptoms depend on degree and cause of renal failure (See Table 16-5) • Initial Symptoms: Fatigue and malaise: • Loss of excretory capacity and accumulation of water, electrolytes and nitrogenous wastes • Prerenal azotemia: Elevated BUN/SrCr (20-30:1) with normal SrCr • Urinalysis: No casts detected • Maximal urinary concentration: 1500 mosm/L • Fractional Na Excretion (99%) • May progress to ATN without proper treatment

  11. ACUTE RENAL FAILURE:Later Clinical Manifestations (pages 392-394) • Later Symptoms (frank ATN): dyspnea, orthopnea, heart (sound S3), edema • Normal BUN/SrCr, profressive elevation of SrCr • Casts (protein, RBC, epithelial cells) • Urine osmolality • Fractional excretion of Na (as low as 1%)

More Related