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Acute renal failure

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Shahab Riaz
Shahab Riaz
Salud y medicina
1 de 86
Acute Renal Failure Dr. Asif
Basic Renal Physiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
structural organization ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
renal blood supply: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
glomerular filtration rate (GFR) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
determinants of renal blood flow (RBF) ,[object Object],[object Object],[object Object]
ARF
Acute Renal Failure – Definitions, Facts and Figures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Renal Failure– Definitions, Facts and Figures ,[object Object],[object Object],[object Object],[object Object]
Acute Renal Failure– Definitions, Facts and Figures ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Serum Creatinine (mg/dl) Inulin Clearance (ml/min per 1.73m 2 ) 1.0 0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 40 60 80 100 120 140 160 180 20 0
Acute Renal failure– Definitions, Facts and Figures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Acute vs Chronic (ARF vs progression of chronic kidney disease) ,[object Object],[object Object],[object Object],[object Object]
acute renal failure: common clinical features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Renal Failure Classification ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Acute Renal Failure Pre-renal Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pre-Renal Azotemia Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Renal Blood Flow ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pre-renal ARF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pre-renal ARF ,[object Object],[object Object],[object Object],[object Object]
Pre-renal ARF ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pre-renal ARF ,[object Object],[object Object]
Pre-renal ARF Urine Electrolytes ,[object Object],[object Object]
Urine Electrolytes ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Renal or Intrinsic ARF ,[object Object],[object Object],[object Object],[object Object],[object Object]
Renal or Intrinsic ARF ,[object Object],[object Object]
Renal or Intrinsic ARF – Vascular Type ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Renal or Intrinsic AKI – Vascular Type ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Atheroembolic ARF ,[object Object],[object Object],[object Object]
Renal or Intrinsic ARF – Glomerular ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],RBC Casts
Renal or Intrinsic ARF – Glomerular ,[object Object]
Renal or Intrinsic ARF – Interstitial ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Renal or Intrinsic ATN – Acute Tubular Necrosis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Renal or Intrinsic ATN – Acute Tubular Necrosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Renal or Intrinsic ATN – Acute Tubular Necrosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Granular casts
Acute Tubular Necrosis ,[object Object]
Acute Renal Failure Nephrotoxic ATN ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Tubular Necrosis ,[object Object]
Acute Interstitial Nephritis Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Allergic Interstitial Nephritis Clinical Characteristics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Interstitial Nephritis ,[object Object]
Cholesterol Embolization ,[object Object]
Contrast-Induced ARF Prevalence ,[object Object],[object Object]
Contrast-Induced ARF Risk Factors ,[object Object],[object Object],[object Object],[object Object],[object Object]
Contrast-induced ARF Clinical Characteristics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Contrast-induced ARF Prophylactic Strategies ,[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Renal Failure Post-renal Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Renal Failure Post-renal ,[object Object],[object Object],[object Object]
Post-Renal ARF Obstructive ARF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Post-Renal ARF Obstructive ARF ,[object Object],[object Object],[object Object],[object Object],[object Object]
Normal kidney on ultrasound
Hydronephrosis on ultrasound
Acute Renal Failure Diagnostic Tools ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Distinguishing tubulo-interstitial disease from Pre-Renal ARF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Red Blood Cell Cast ,[object Object]
Red Blood Cells ,[object Object],[object Object],[object Object]
White Blood Cells
White Blood Cell Cast
Renal Tubular Epithelial Cell Cast
Pigmented Granular Casts ,[object Object]
Urine Chemistries Fractional Excretion of Na and Urea ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
renal indices ,[object Object],[object Object],[object Object]
Prerenal azotemia: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Renal azotemia: ,[object Object],[object Object],[object Object],[object Object]
Acute Renal Failure Urine Volume ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
urine and serum laboratory values
Acute Tubular Necrosis Clinical Characteristics 25% 50% Mortality 26% 84% Dialysis required 3.1 + 0.5 6.8 + 1.4 FE Na (%) 50 + 5 68 + 6 U Na (mEq/L) 1,280 + 75 < 400 UV (ml/24h) 30% 8% Toxin-induced 59% 41% Incidence Non-Oliguric ATN Oliguric ATN Characteristic
[object Object]
acute renal failure: prevention ,[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment of ARF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
GENERAL PROTOCOL FOR MANAGEMENT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
acute renal failure: fluid therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
sodium ,[object Object],[object Object]
potassium ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
nutrition ,[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment of ARF – Indications for Dialysis ,[object Object],[object Object],[object Object],[object Object],[object Object]
ARF -- Summary ,[object Object],[object Object]
ARF – Summary (cont…) ,[object Object],[object Object],[object Object]
ARF – Summary (cont…) ,[object Object],[object Object],[object Object],[object Object],[object Object]

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