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renal function

T he main symptoms and syndromes in kidney diseases . S ymptomatol gy of acute and chronic glomerulonephritis and pyelonephritis. cleansing - excretion of metabolic products, salts, dyes, chemicals

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renal function

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  1. Themainsymptomsandsyndromesinkidneydiseases. Symptomatolgy ofacuteandchronicglomerulonephritisandpyelonephritis.

  2. cleansing - excretion of metabolic products, salts, dyes, chemicals Homeostatic - maintaining a constant internal environment by regulating the blood, osmotic pressure, KLR erytropoetychna vnutrishnosekretorna regulation of blood pressure renal function

  3. creening methods in nephrology (the first stage of the survey) • blood test • urinalysis • with suspected renal dysfunction - the content of creatinine in the blood

  4. the second phase of the survey • clarifying the main syndrome installation nosology, determining the degree of activity of the process, clarification of kidney function.

  5. laboratory methods • Microscopic methods of quantitative urine, • biochemical methods of blood and urine •   bacteriological, • some (test for amyloid, search LE cells in the blood) • immune methods (CIC, antinuclear antibodies, antibodies to DNA)

  6. Instrumental methods • ultrasound • radiological • radionuclide • kidney biopsy.

  7. Urinalysis • color (from straw yellow to amber-yellow) • transparency (clear, after settling may become turbid) • reaction (pH 5.5-6.5) • proportion (morning urine ranges from 1015 to 1025). Proteinuria 4 g / l increases the proportion of 0.001 and 10 g / l glucose - 0,004.

  8. Bacteriological examination of urine • microbial count (the number of bacteria in 1 ml of urine) (low to 20 thousand, the critical 20-100 thousand, truth more than 100 thousand) • sensitivity to antibiotics and chemotherapy • special bacteriological tests (detection of L-forms of bacteria, mycoplasma, fungi) • for the diagnosis of tuberculosis of the kidneys (urine for 12 h in enriched environment or biological sample)

  9. proportion morning urine (not below 1018-1022) test on Zimnitskiy (urine collected during the day in 3 hours 8 times. determine in each serving size, proportion, ratio of night to day diuresis) sample of deprivation for 12 hours (from 19.00 to 07.00). If the proportion rises to 1024 and more concentration of kidney function considered satisfactory Evaluation ability of the kidneys to urine dilution and concentration

  10. Scoreazotovydilnoyifunction - serumcreatinineandureainserum involvedinrenalelectrolytemetabolismasanindicatorofkidneyfunction (Na, K, Ca, Mg, Cl).

  11. Survey urography - to determine the size and shape of the kidney, the presence of concretions. Urotomohrafiy - gives a three-dimensional image of kidney Excretory urography - helps to determine not only morphological but also functional status of the kidneys and urinary tract. Infusional urography Retrograde (ascending pyelography) - reveals asymmetry Wire cup-pelvic, strain the kidneys. Renal angiography CT X-ray of the kidneys.

  12. isotope renografiy - to determine vascularization, activity of proximal tubules and evacuation capacity of each kidney. Apply hipuran, it is nontoxic, quickly moves from the blood to the kidneys and urinary excretion. Kidneys excrete about 80% due to its secretion in the proximal tubule, and only 20% - by KF. Methods of radionuclide study

  13. Normal renohrama • Phase 1 - vascular (blood) duration of 20-60 seconds. • Phase 2 - secretory (tubular) 2-3 min after injection Contrast agents to 5 min. • Phase 3 - excretory - falling curve (expressing Contrast excretion of substances from the kidney. Duration curve is steep fall in 5 min., A plateau from 5 to 8 minutes.

  14. visual kidney using radionuclides (neohidrynu) indicates localization, shape and size of the kidneys, the degree of local functional activity of the parenchyma, focal and diffuse lesions, abnormalities. Lets differentiate renal tumors, abdominal and extraperitoneal space. Scanning kidney

  15. registration of spontaneous infrared radiation of human skin. thermography

  16. Diffuse glomerulonephritis • inflammatory infectious and allergic disease with predominant and primary involvement in the pathological process of glomerular apparatus of the nephron

  17. Classifications of glomerulonephritis (L.A. Pyrig) • acute diffuse glomerulonephritis • urinary syndrome • nephrotic syndrome (mainly hematurinary, hypertensive, edematous component) • subacute (malignant) glomerulonephritis • quickly progressing glomerulonephritis

  18. chronic glomerulonephritis type • primary chronic • secondary chronic syndrome • urinary • nephrotic stage • anhipertenzive • hypertensive • chronic renal failure phase • aggravation • remission

  19. Acute glomerulonephritis • infectious-allergic disease, mainly affecting vascular renal glomeruli with available also changes in the tubules and interstitial tissue

  20. Clinical course options • rapid onset, severity of symptoms. • mono asymptomatic - gradual onset, uclearness of symptoms.

  21. Syndromes • bladder - the presence of protein in the urine (proteinuria to 3.5 g per day) formal blood elements (red blood cells), cylinders • nephrotic - proteinuria greater than 3.5 g per day, hypoproteinemia, dysproteinemia, hyperlipidemia, edema

  22. Faciesnephritica • pale skin, swelling of the face and eyelids, puffiness under the eyes.

  23. Chronic diffuse glomerulonephritis • inflammation in the glomerulus, tubular epithelial degeneration and progressive proliferation of connective tissue, which leads to the development of secondary wrinkled kidney.

  24. Principles of treatment • considering clinical variant phase, stage of the disease. • diet number 7 (restriction of salt to 4-5 g, nephrotic version - salt-free diet. • medications • pathogenetic therapy: corticosteroids, cytotoxic agents, aminoquinoline drugs • antihypertensive therapy in the presence of hypertension: beta-blockers, clonidine • diuretics edema syndrome: furosemide, urehit, hypothiazide • anticoagulants and antiplatelet: heparin, fraksyparyn, Courant, tyklid, clopidogrel • antibiotics in infectious complications

  25. Nonspecific infectious inflammatory process, which is localized in mostly at cup-pelvic kidney and its tubulo-interstitial area. Pyelonephritis

  26. Running across a sluggish, periodically exacerbated bacterial inflammation of renal parenchyma (cup-pelvic and renal tubules with subsequent damage glomeruli and renal vessels) Chronic pyelonephritis (CPN)

  27. Etiology of CPN • Saprophytes and pathogenic flora (Escherichia coli, Enterococci, Streptococcus, Proteus, Pseudomonas aeruginosa) • mycoplasma • viruses (Coxsackie, adenovirus) • fungi (Candida)

  28. Pathogenesis of CPN • microbial factor • violation of the passage of urine (mechanical and functional abnormalities of the urinary tract) • neurogenic bladder disorder • state of nonspecific immune reactivity • state of cellular and humoral immunity: T-immunity level of Ig A, Ig G

  29. Ways of infection in CPN • ascending urynohennous • hematogenous • lymphogenous

  30. localization one-sided two-sided pyelonephritis single kidney phase of the disease aggravation partial remission complete remission Classification

  31. hypertension CRF (renal failure) paranefryt hydronephrosis uroseptic dystrophy anemia Major syndromes and complications

  32. Examples of formulations diagnosis • Secondary bilateral chronic pyelonephritis, recurrent course, acute phase. Secondary symptomatic hypertension. CRF 1 stage. • Left secondary chronic pyelonephritis, latent, non-remission phase. Nephrolithiasis, stones of left kidney. CRF 0 stage.

  33. Clinic CPN • Pain (aching pain, positive Pasternatskys’ s-m) • syndrome of endogenous intoxication (subfebrile, weakness headache, fatigue) • bladder syndrome (nocturia, dysuria, polakiuriya, pyuria, bacteriuria)

  34. Laboratory studies in CPN • low proteinuria (up to 1 g / l) • leukocyturia • bacteriuria

  35. Instrumental studies in CPN • asymmetry curves with radioisotope study • according to ultrasound and radiography lesions cup-pelvic

  36. Diagnosis of CPN • A history • clinical examination data • typical changes of urinary sediment • availability dizuricheskie phenomenon • combination of dysuria and urinary signs of fever • identify predisposing factors and diseases

  37. Treatment of chronic renal failure (principles of pathogenetic therapy) Stages of treatment • treatment of acute • maintenance therapy (Antirecurrent treatment) Recovery passage of urine (neurogenic, Dysfunctional or urological) anti-inflammatory therapy (antibiotics)

  38. Antibiotics fluoroquinolones • zanotsyn (ofloxacin) - blocks the bacterial enzyme DNA hidratazu, damages the cell membrane of bacteria is well into the fabric of the urinary system macrolides • Wilprafen (josamycin) 0.5 2 times (12-14 days) • flurenisid (ie 0, 05 and 0.15, capsules 0.3, candle 0.1) destroys chlamydia, corrects immunity.

  39. uroseptics group Nitroxoline (5-NOC) to 0.1 to 4 times a day or nalidixic acid (negram, nevihramon) by 0.5-1.0 4 times

  40. correction of microcirculation and blood flow in the kidney (aminophylline, pentoxifylline, stugeron, heparin, fraksyparyn) • effect on free radicals - antioxidants: unitiol, halaskorbin, emoksypin, Essenciale, vitamin E, tiotriazolin. • immunocorrection (prohydiozan, pirogenal. pentoxyl, methyluracil, echinacea) • correction syndrome EI • enzyme: vobenzim (3-9 table. 3 times), flohenzym (2-4 table. 3 times)

  41. Pharmaceutical preparations of plant material Hofitol - artichoke leaves drug (2% solution for injection) • diuretic, zhovchehinnyy, detoxification, solerozchynnyy impact • shows: Diabetic nephropathy and dismetabolic, chronic renal failure

  42. lespenefryl (lespyflan) - a drug with stems and leaves lespedezy capitate (3-6 spatulas of tea a day for 15 minutes before eating, drinking a small amount of water) • accelerates the excretion of nitrogenous substances in the urine • indications: chronic renal failure

  43. Canephron - contains lovage, rosemary, centaury, hips. (due to the able 3-4 times a day) • anti-inflammatory, antiseptic, diuretic, antihypertensive effect • indications: chronic pyelonephritis, urate nephrolithiasis, chronic renal failure

  44. Chronic renal failure (CRF) • This is a consequence of many chronic renal diseases, gradual and steady deterioration of glomerular and tubular kidney function such an extent that the kidneys can not maintain the normal composition of the internal environment. • The main property CRF - exhaustive compensatory abilities kidney impossibility (as opposed to acute renal failure) regeneration of the parenchyma.

  45. Etiology and pathogenesis of chronic renal failure • Chronic glomerulonephritis, subacute, progressive GN • CRF • Collagen (SLE, scleroderma, polyarteritisnodosa) • metabolic diseases (diabetes, gout, amyloidosis) • congenital kidney disease (polycystic, kidney hypoplasia syndrome, Fanconi syndrome, Alporta

  46. primary vascular lesions (renal artery stenosis, malignant hypertension, essential hypertension) • obstructive nephropathy (urolithiasis, hydronephrosis, tumors of the urinary system)

  47. Major disturbances of homeostasis in CRF • excretion of nitrogenous toxins (urea, creatinine, uric acid) • support water and electrolyte balance (urine output less than 600 ml per day)

  48. Classification CRF S.I.Ryabova (1976) • latent (creatinine level in serum below 0.18 mmol / l, Cp above 50% of predicted) • azotemic (cock kraetyninu from 0.19 to 0.71 mmol / l KF 50-10% of predicted) • uremic (content creatinine 0.72 mmol / l and above, cf 10% and below) • Each stage is divided into A and B

  49. Classification of chronic renal failure by Ratner • I - increase in plasma creatinine 0,17-0,44 mmol / l • II - 0,45-0,88 mmol / l • III - 0,89-1,32 mmol / l • IV - 1,32 and above

  50. Clinic CRF (initial period) • fatigue, drowsiness, lethargy, loss of appetite • polyuria, nocturia • myazeva weakness, twitching • osteomalacia, osteoporosis, bone pain • itching, paresthesia, epistaxis, subcutaneous hemorrhage • "Uremic gout", nausea, vomiting, diarrhea

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