A hot summer’s night

A hot summer’s night

1. Physiology of nephron

2. Causes of Renal Failure

   • Prerenal
     • hypovolemia, low cardiac output, systemic dilation, or selective intrarenal vasoconstriction
     • All precipitate as such signs
   • Intrarenal
     • Tubular; Acute Tubular Necrosis; ATN Ischaemic Nephrotoxic
     • Glomerular; Glomerulonephritis;
     • Interstitial; Acute Interstitial Nephritis; AIN
   • Postrenal
     • Obstruction: Stone or tumor

3. Clinical course of renal failure

   • Initiation
     • mild oliguria
     • mild azotemia
   • Maintainance
     • More OLIGURIA
     • More AZOTEMIA
     • Hyperkaleamia
     • dialysis needed
   • Recovery
     • Polyuria
     • Hypokalemia
     • BUN, CREATININE return to normal

4. Complications of ARF

   • General
     • Fluid buildup
     • Muscle weakness
     • Permanent kidney damage
   • Mineral and Uric Acid Homeostasis
     • Hyperphosphatemia
     • Hypocalcemia
     • Hypermagnesemia
     • Hyperuricemia
     • Hyperkalemia
   • Gastrointestinal and Nutritional
     • Anorexia
     • Nausea and vomiting
     • Upper GI bleeding
     • Impaired carbohydrate metabolism
   • Hematologic and Cardiac
     • Anemia
       • due to decreasederythropoesis
     • Metabolic acidosis
     • Hypertension

5. Diagnosis of Renal Failure

   • History
     • Hypotension
       • Recent infection
   • Exam
     • Fever
       • Rash
         • Severe Vomiting, Nausea
   • Physical examination
   • Investigations
     • Urine output measurements
     • Urine analysis
     • Urine electrolyte
     • Serum Creatinine level
     • Blood urea nitrogen (BUN)
     • Serum potassium
     • Renal ultrasonography
     • Renal biopsy

6. Diuretics

   • PCT
     • Osmotic diuretics
     • Acetazolamide
   • Thick ascending limb
     • Osmotic diuretics
     • Loop diuretics
   • DCT
     • Thiazide
   • Collecting tubules
     • Potassium sparing diuretics
   • Diuretics work here

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