Khawla has Complications

Khawla has Complications

1. edema

   • causes
     • increased hydrostatic pressure
     • reduced colloidal or oncotic pressure within blood vessels
     • increased tissue colloidal or oncotic pressure
     • increased blood vessel wall permeability (e.g., inflammation);
     • obstruction of fluid clearance in the lymphatic system
   • Generalized
     • Cardiac Failure
     • Nephrotic Syndrome
   • Organ specific
     • Nephrotic Syndrome
     • Lymph obstruction
     • Contact dermatitis

2. proteinuria

   • Glomerular pathology (for example glomerulonephritis or diabetes)
   • Urinary tract infection
   • congestive heart failure
   • Early in the morning/ dehydration
   • After vigorous exercise
   • High fever
   • Orthostatic proteinuria (in children)

3. Kidney anatomy

   • Retro-peritoneally in the posterior abdominal wall by the side of the vertebral column.
     • T 12 to L3 vertebrae.
       • 1-Fibrous capsule (true capsule) 2-Perinephric fat 3-Renal fascia (gerota) 4-Paranephric fat
       • Renal coverings

4. Renal filtration

   • filtration barrier
     • Capillary endothelium - fenestrated
       • Basement membrane – homogeneous negatively charged glycoproteins /mucopolysaccharide
         • Capsular epithelial cells - podocytes & foot processes
     • Composition of filtrate depends on the filtration barrier
       • easily filtered
         • Major electrolytes: Metabolic waste products: Metabolites;Non-natural substances: inulin, PAH (p-aminohippuric acid) ;Lower-weight proteins and peptides:
       • not freely filtered
         • Albumin and other plasma proteins ; Lipid-soluble substances transported in the plasma attached to proteins, such as lipid-soluble bilirubin, T4 (thyroxine), other lipid-soluble hormones ; Unbound lipid-soluble substances such as free-cortisol are filtered and can appear in the urine

5. Starling forces which determine GFR or glomerular filtration rate

6. classification of renal diseases

   • Acute
   • chronic

7. Diabetic nephropathy

   • signs and symptoms
     • Worsening blood pressure control
     • Nausea and vomiting
     • Swelling of feet, ankles, hands or eyes
     • Increased need to urinate
     • Protein in the urine
     • Confusion or difficulty concentrating
     • loss of appetite
   • NEG of vascular basement membrane leads to hyaline arteriolosclerosis
     • High filtration injury that leads to sclerosis of mesangium

8. Investigations for kidney diseases

   • Hematuria
   • Proteinuria
     • Functional
     • Overflow
     • Glomerular
     • tubular
   • Color, Clarity, Gravity
   • Glucose, ketones
   • Bilirubin, urobilinogen
   • Nitrites, leukocyte esterase

9. Treatment

   • medications
     • ACE inhibitors and ARBs are the mainly the only drugs that actually slow down the progression of the nephropathy
   • diet monitoring
   • Kidney-Pancreas transplant
   • dialysis

10. Prognosis

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