Advanced Med-Surg Review

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PART 1
Exam #1 Review

Renal Overview:

* Renin-angiotensin aldosterone system (RAAS) regulates renal blood flow.

* ACUTE RENAL FAILURE -rapid decline in renal function with progressive azotemia.

* AZOTEMIA An excess of metabolic waste products in the blood Urea Nitrogen and Creatinine

* OLIGURIA Urine Volume less than 400CC/24 hours for a non-trauma, non-surgical adult.

* ACUTE TUBULAR NECROSIS (ATN) Clinical syndrome of ARF secondary to ischemia or toxic injury to the renal tubules

* BUN and Creatinine DO NOT START TO RISE until GREATER than 60 % loss of renal function= Failure.

* BUN and Creatinine DO NOT GET HIGH until 90% loss of renal function = Failure.

* 24 Hour Creatinine clearance = good early indicator of renal Function (GFR).

* Elevated levels BUN/Creatinine are considered to be the “hallmarks” of acute renal failure.

* Creatinine Normal value 0.5 - 1.0 mg/dl

* In general – Creatinine is 1/10 of BUN

Acute Renal Failure * Description: Sudden, reversible cessation of renal function associated with an identifiable toxic or ischemic trauma or obstruction - onset - hours to days.

* Risk Factors: * Advanced Age: GFR decline by 1ml/min/year after age 40 * Renal Blood Flow 10% per decade * Decreased muscle mass – decreased production Cr; Vit D * Diabetes Type I or II * Severe HTN or peripheral vascular disease * Preexisting CKD or proteinuria * CHF * Cirrhosis * NSAIDS, ACEi, vasodilators * Sepsis

Pathophysiology:

* Depressed RBF kidneys vulnerable to further insults - iatrogenic renal injury most common

* Common iatrogenic combinations: * Preexisting renal disease, radio contrast agents, aminoglycosides, atheroembolism, or cardiovascular surgery * ACE inhibitors with diuretics * NSAIDs * Hypovolemia

* Recovery dependent upon restoration of RBF
Once RBF restored - remaining functional nephrons

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