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ANATOMY:
2 Kidneys, 2 Ureters , Bladder, Urethra
Physiology:
1. Found along the posterior muscular wall of the abdominal cavity.
2. The left kidney is located slightly more superior than the right kidney
3. Bean shaped
4. EXCRETION OF WASTES
Kidney:
1. Nephron: Working unit of the kidney; Consists of:
1. Glomerulus: works like a sieve
2. Tubules: fluid reabsorbed or sent to bladder
Kidney Functions:
1. Regulates extracellular fluid & osmolarity, electrolyte concentrations, & acid-base balance -
Renin
2. Regulates Blood pressure - Renin
3. Excretes wastes – Urine Formation
4. Produces erythropoietin- RBC production
5. Converts vitamin D to active form
6. Increase calcium absorption - calcitriol
Composition of Urine:
1. A sterile Fluid Composed of:
1. Water (95%)
2. Nitrogen containing waste
1. Urea
2. Uric acid
3. Ammonia
4. creatinine
3. Electrolytes
Glomerular Filtration:
1. Water and Dissolved Substances
1. They move from the vascular system to the glomerulus
2. Then into Bowman’s capsule
2. Glomerular Filtrate is Composed of:
1. Water
2. Electrolytes
3. Waste products
4. Metabolic substrate
3. Glomerular Filtrate Measures Plasma Volume
1. It can be cleared of any given substrate within a certain time frame
1. Depends on:
1. Number of glomeruli functioning at a time
2. Volume of blood passing through the glomeruli per minute
3. Effective of glomerular filtration pressure
2. Under normal conditions
1. About 700 mL of plasma flow through the kidneys per minute and 120 mL of fluid are
filtered into Bowman's capsule
1. Creatinine Clearance
1. Best way to estimate GFR
2. GFR = (creatinine clearance) x (body surface area in m2/1.73)
3. Ways to measure:
1. 24-hour urine creatinine:
1. Creatinine clearance = (Ucr x Uvol)/ plasma Cr
2. Cockcroft-Gault Equation:
1. (140 - age) x lean body weight [kg]
CrCl (mL/min) = ——————————————— x 0.85 if
Cr [mg/dL] x 72 female
2. Limitations: Based on white men with non-diabetes kidney disease
Kidney failure:
Acute Versus Chronic:
1. Acute
1. sudden onset
2. rapid reduction in urine output
3. Usually reversible
4. Tubular cell death and regeneration
2. Chronic
1. Progressive
2. Not reversible
3. Nephron loss
3. 75% of function can be lost before its noticeable
ACUTE RENAL FAILURE:
1. Function rapidly deteriorates
1. Reduced urine output
2. Build up of nitrogenous wastes
2. Mortality rates are high
3. Urine output in ARF:
4. Oliguria = daily urine output < 400 mL
5. Anuria =No urine production, probably time for dialysis
Causes:
1. Pre renal
1. Heart failure
2. Shock
3. Blood loss
2. Intra renal
1. Infections
2. Toxins
3. Drugs
4. Direct trauma
3. Post renal
1. Factors preventing excretion of urine
2. Urinary tract obstructions
4. Pre-renal =
1. vomiting, diarrhea, poor fluid intake, fever, use of diuretics, and heart failure
2. cardiac failure, liver dysfunction, or septic shock
5. Intrinsic
1. Interstitial nephritis, acute glomerulonephritis, tubular necrosis, ischemia, toxins
6. Post-renal =
1. prostatic hypertrophy, cancer of the prostate or cervix, or retroperitoneal disorders
2. neurogenic bladder
3. bilateral renal calculi, papillary necrosis, coagulated blood, bladder carcinoma, and
fungus
Consequences:
1. Oliguria < than 400 mL urine/day
2. Sodium retention
3. Elevated potassium, phosphate, & magnesium
4. Edema
5. Uremia
1. BUN, creatinine & uric acid accumulate in blood
2. Fatigue, lethargy, confusion, headache, anorexia, metallic taste, Nausea & Vomiting,
diarrhea
Treatment of Acute Renal Failure
Goals for treatment:
1. To Treat underlying cause
CRF Symptoms:
1. Weakness 10. Peptic ulceration
2. Fatigue
3. Neuropathy 11. Diverticulosis
4. CHF
12. Anemia
5. Anorexia
6. Nausea 13. Jaundice
7. Vomiting
8. Seizure 14. Abnormal hemostasis
9. Constipation
Consequences of CKD:
4. Evaluation
Renal osteodystrophy
Uremic syndrome
7. Mental dysfunctions
8. Neuromuscular changes
3. Bleeding abnormalities
5. Reduced immunity
2. Prevent symptoms
11.
DIALYSIS:
1. Removes excess fluid & wastes from blood
Principle of dialysis:
1. Employs diffusion, osmosis, & ultrafiltration
3. If substance is higher in the dialysate, substance will diffuse into the blood
2. 3 times/week
3. Complications
1. Infections
2. Blood clotting
3. Hypotension
4. Muscle cramping
5. Headaches, weakness
7. Agitation
PERITONEAL DIALYSIS:
5. Acute failure
TYPES OF ACCESS:
1. Temporary site
2. AV fistula
2. 3 to 6 months to mature
3. AV graft
2. 2 to 6 weeks to mature