Khawla has Complications

edema
1. causes
  1. increased hydrostatic pressure
  2. reduced colloidal or oncotic pressure within blood vessels
  3. increased tissue colloidal or oncotic pressure
  4. increased blood vessel wall permeability (e.g., inflammation);
  5. obstruction of fluid clearance in the lymphatic system
2. Generalized
  1. Cardiac Failure
  2. Nephrotic Syndrome
3. Organ specific
  1. Nephrotic Syndrome
  2. Lymph obstruction
  3. Contact dermatitis
proteinuria
1. Glomerular pathology (for example glomerulonephritis or diabetes)
2. Urinary tract infection
3. congestive heart failure
4. Early in the morning/ dehydration
5. After vigorous exercise
6. High fever
7. Orthostatic proteinuria (in children)
Kidney anatomy
1. Retro-peritoneally in the posterior abdominal wall by the side of the vertebral column.
  1. T 12 to L3 vertebrae.
    1. 1-Fibrous capsule (true capsule) 2-Perinephric fat 3-Renal fascia (gerota) 4-Paranephric fat
    2. Renal coverings
Renal filtration
1. filtration barrier
  1. Capillary endothelium - fenestrated
    1. Basement membrane – homogeneous negatively charged glycoproteins /mucopolysaccharide
      1. Capsular epithelial cells - podocytes & foot processes
  2. Composition of filtrate depends on the filtration barrier
    1. easily filtered
      1. Major electrolytes: Metabolic waste products: Metabolites;Non-natural substances: inulin, PAH (p-aminohippuric acid) ;Lower-weight proteins and peptides:
    2. not freely filtered
      1. 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
Starling forces which determine GFR or glomerular filtration rate
classification of renal diseases
1. Acute
2. chronic
Diabetic nephropathy
1. signs and symptoms
  1. Worsening blood pressure control
  2. Nausea and vomiting
  3. Swelling of feet, ankles, hands or eyes
  4. Increased need to urinate
  5. Protein in the urine
  6. Confusion or difficulty concentrating
  7. loss of appetite
2. NEG of vascular basement membrane leads to hyaline arteriolosclerosis
  1. High filtration injury that leads to sclerosis of mesangium
Investigations for kidney diseases
1. Hematuria
2. Proteinuria
  1. Functional
  2. Overflow
  3. Glomerular
  4. tubular
3. Color, Clarity, Gravity
4. Glucose, ketones
5. Bilirubin, urobilinogen
6. Nitrites, leukocyte esterase
Treatment
1. medications
  1. ACE inhibitors and ARBs are the mainly the only drugs that actually slow down the progression of the nephropathy
2. diet monitoring
3. Kidney-Pancreas transplant
4. dialysis
Prognosis

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Khawla has Complications

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	Created by Fatma Shwaylia about 6 years ago