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Acute renal failure pathology
Case study 30 acute renal failure
Acute renal failure pathology
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Acute Renal Failure
Problem: A man arrives at a clinic with complaints of asthenia, malaise, headache, weight gain, and a decrease in urination. A tentative diagnosis of acute renal failure is made.
The generic term for an abrupt and sustained decrease in renal function is called acute renal failure. This is the retention of urea, creatinine, and waste products. Prerenal, intrarenal and postrenal are sub classification for acute renal failure.
Prerenal is the most common form of kidney failure. Blood flow to the kidney that is reduce/interrupted may cause damage to the tissues and recue the ability of the kidney to function. This includes burns, loss of blood volume, heart failure, shock, long-term vomiting/diarrhea/bleeding, injury to the kidney, and certain types of surgery. Prerenal failure if identified early and treated correctly may be reversible.
Intrarenal failure is the actual damage to the nephrons and renal parenchyma . This can be categorized as acute tubular necrosis and is a common type of acute renal failure in critically ill patients. This is a reversible type of renal failure but may take weeks or months before adequate renal function return.
The condition that causes obstruction to urine flow is postrenal failure. Any conditions as in tumors, benign prostatic hypertrophy, kidney stones and bladder neck obstruction may cause this type of acute kidney failure. Untreated the result is actual nephron damage and intrarenal failure.
A patient with kidney disease will have laboratory tests done but first a full and complete history will be taken. Physically the patient’s body will show swelling caused by fluid retention and murmur in the heart, crackles in the lungs or any abnormal sounds in the heart or lungs can be found. These tests include BUN (normal range 6-20 mg/dl), creatinine clearance (compares the levels of creatinine in urine and blood), serum creatinine, serum potassium and urinalysis. The preferred test for diagnosing a blockage in the urinary tract would be an ultrasound. X-ray or MRI can also tell if there is a blockage, and the blood test will help reveal the underlying cause of kidney failure.
Insufficient filtering of the blood by the kidney causing high levels of compounds containing nitrogen and other waste products is called azotemia. This waste product is normally excreted in the urine and can lead to uremia. In Uremia the waste products now show in the blood. With oliguria the body gets reed of an abnormally small amount of urine.
Chronic kidney disease also denoted as chronic renal failure is the gradual failure of the kidney to perform its function as required. The condition occurs gradually thus goes undetected until when it is too late. According to Buttaro et al (2013, p.723), there are certain risk factors that lead to the development of chronic kidney disease that individuals should be conversant with. Chronic kidney disease is hereditary meaning it can be passed from a parent to a child via genes. Age is another factor. This implies that people over 60 years are likely to get the disease thus should be cautious. Individuals having atherosclerosis, bladder obstruction, chronic glomerulonephritis or congenital kidney disease are also at the risk of getting the
A 54 year old female was presented with complaints of lethargy, excessive thirst and diminished appetite. Given the fact that these symptoms are very broad and could be the underlying cause of various diseases, the physician decided to order a urinalysis by cystoscope; a comprehensive diagnostic chemistry panel; and a CBC with differential, to acquire a better understanding on his patient health status. The following abnormal results caught the physician’s attention:
The chemistry test shows the levels of electrolytes found in the blood: sodium, potassium, chloride, phosphorus, magnesium and calcium. Imbalances in these electrolytes can cause complications, which especially in the case of potassium, can be deadly. Also shown by the chemistry test, blood urea nitrogen and creatinine levels can show how well the patient’s kidneys are functioning in filtering waste from the blood. Trauma and blood loss can affect how the kidney’s function not only in filtering waste, but also in acid-base balance, and balancing electrolyte levels. Another marker of kidney function is the glomerular filtration rate, which measures the rate filtrate is created by the glomerulus of the kidney (Winkelman, 2016). This is controlled by the kidneys themselves, meaning changes in the function of the kidneys can lead to an altered filtration rate (Winkelman, 2016). Lactic acid is measured by the chemistry test also, and an increase in lactic acid can signify acidosis caused by the lactic acid being formed by cells that do not have adequate oxygen to process glucose for energy (Workman, 2016). This decrease in available oxygen could be caused by damage to or impairment of the lungs. Carbon-dioxide, which is also measured by the chemistry test, can show
Many people never find out that they have had stones in their kidneys. Some stones are small enough to flow through the kidney without ever causing any pain. These are called "silent stones"(Ford-Martin & Odle, 2005) Kidney stones cause problems when they get in the way of the normal flow of urine. They can block the flow through the ureter that carries urine from the kidney to the bladder. “The kidney is not accustomed to experiencing any pressure. When pressure builds from backed-up urine, it causes hydronephrosis” (Ford-Martin & Odle, 2005). If the kidney is subjected to this pressure for a while, there may be damage to the fragile kidney structures. When the kidney stone is lodged further down the ureter, the backed-up urine may also cause the ureter to swell. Because the ureter is a musc...
The editorial explains that diabetes mellitus is the leading cause of irreversible renal failure, known more commonly as End Stage Renal Disease (ESRD). Diabetes mellitus can cause nerve, vascular and other problems that can result in limb amputation and blindness. There are two types of diabetes: long-duration, non-insulin dependent (type 2) and insulin-dependent (type 1). Type 1 seems to attract the most attention from Physicians and the media. Many of those that suffer from type 1 are children and young adults.
Vanholder R, Sever MS, Erek E, Lameire N. Rhabdomyolysis. J Am Soc Nephrol. Aug 2000;11(8):1553-61.
1 in 3 Americans Adults are currently at risk for developing kidney disease. What is acute renal failure, when your kidneys functions all of a sudden stop working and your kidneys are the body’s filter which remove waste products and help balance water, salts and minerals especially electrolytes in your blood when your kidneys stop working you end up building all the products in your body that need to be filtered and eliminated. The pathophysiology of Acute Renal Failure are due to three main causes Pre-renal, Intra-renal, and Post renal. Pre-renal is a sudden drop in blood pressure or interruption of blood flow to the kidneys from illness or sever injury. Intra-renal is direct damage to the kidneys by inflammation of drugs, infection, toxins or reduced blood supply. Post-renal is a sudden obstruction of urine flow because of enlarged prostate bladder tumor, kidney stones, or injury.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
(3)Bellomo,R.,Cass,A.,Cole,L.,Finer,S.,Gallagher,M.,Lo,S.,McAthur,C.,McGuinness,S.,Myburgham J.,Norton,R.,Scheinkestel,C.,& Su,S. for renal study investigators(2009).Intensity of continuous renal-replacement therapy in critically ill patients. The New England Journal of Medicine, 361(17), 1627-1638.
United States Renal Data System (USRDS). (2008). Annual data report: Incidence and prevalence. Retrieved July 8, 2009, from http://www.usrds.org/2008/pdf/V2-02-2008.pdf
This article is for people whose kidneys fail to work. This condition is called end-stage renal disease (ESRD).
blocked has now shut down. This kidney, if left untreated for just a few days,
As mentioned above; Hypoalbuminaemia is a predominantly events that occur due to losses of protein urinary. In response to this, hepatic albumin synthesis increased but they are still insufficient to prevent the fall in the serum albumin concentration. Proteinuria, Nephrotic range proteinuria is almost invariably due to glomerular disease.
Kidney Function Introduction and definition of terms: The kidneys are the main organs in the urinary system. They filter waste products out of blood from the renal artery. These are then excreted. Useful solutes are reabsorbed into the blood. They also have a major homeostatic role in the body, and help to control the water content (osmoregulation) and pH of the blood.
... restore the neutrality by producing more alkaline urine, leading to an increase in their workload (Epstein, 1997). This increased workload can lead to different dysfunctions or renal collapse.