POM F5 ACUTE RENAL FAILURE CHRONIC RENAL FAILURE Decrease in renal function Decrease in renal function Hours to weeks

Months to years Changes are reversible Changes are irreversible Seen mostly in hospital Seen mostly in chronic setting conditions 3 TYPES OF ACUTE RENAL FAILURE 1. PRERENAL Hypovolemia, hemorrhage, severe dehydration Decrease in blood pressure/ cardiac output Examples: Cardiogenic Shock and Stenosis of Renal Arteries 3. Inflammation Infection problem is in renal parenchyma Nephrosis increase permeability to macromolecules (albumin) Albuminuria edema due to loss of albumin Nephritis inflammation of glomeruli with or without necrosis Interstitial Nephritis acquired when a patient has allergic reaction to drugs seen in hospital settings Acute Tubular Necrosis due to toxicity of drugs in the renal parenchyma Ex. Aminoglycosides Cast of RBC/WBC/platelets in the tubules 4. 2.

Patients are not hospitalized

NEPHROLITHIASIS 1. CALCIUM STONES (OXALATE) 75 85% Not enough water Over production; under secretion Radiopaque

URIC ACID STONES 10% Radiolucent; not seen in x-rays

2.

RENAL

STRUVITE 57% Due to urease producing organisms Secondary to urease producing pathogens i. ii. Proteus Ureaplasma urealitycum

Radiopaque

CYSTEIN STONES 2 3% Error in amino acid metabolism Radiopaque

STAGHORN CALCULI Takes the form of major calyces

DIAGNOSIS HELICAL CT SCAN

3.

POSTRENAL Enlargement of prostate gland Obturation Patients who use catheter for a long time Causes inflamed ureter

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY Very invasive Done only if the stone is 0.5 2 cm in diameter Treatment of

CHRONIC RENAL FAILURE Seen in DM, HPN, Polycystic Kidney Disease o Exists for very long time

UTI (Urinary Tract Infection) Treated with gram negative antibiotics

COMMON CHIEF COMPLAINT FOR UTI: UPPER URINARY TRACT o o o o Pelvic brim Kidneys Systemic Fever, nausea, vomiting, pyonephritis (fever, chills, pus around the kidneys), abdominal pain (systemic) BEST WAY TO DIAGNOSE UTI: Urinalysis Culture sensitivity test Gram staining

ASSESSMENT OF RENAL FAILURE Request for: 1. CBC 2. Know the hemoglobin count Anemia CRE

LOWER URINARY TRACT o o o o o o Bladder Urethra Cystitis Urethritis Localized

Urinalysis Detect presence of macromolecules

3. Dysuria, frequency, urgency

Blood Chemistry Blood urea nitrogen Creatinin Uric acid Electrolytes Sodium Potassium Bicarbonate Chlorine

Give broad spectrum antibiotics, 1st generation cephalosporins, ampicillin, amoxicillin, -lactamase (co-amoxyclav [amoxicillin + clavolanic acid = augmentin/cotrimoxazole])

DRUGS COMMONLY USED FOR UTI: 1. BROAD SPECTRUM (GRAM +/-) Equal coverage for gram and gram + Penicillin (amoxicillin, ampicillin, 1st generation cephalosporin)

2.

DRUG COMBINATION OF BROAD SPECTRUM COTRIMOXAZOLE/BACRIM i. ii. TRIMETHOPRIM SULFAMETHOXAZOLE

AUGMENTIN/COAMOXICLAV i. ii. AMOXICILLIN CLAVOLANIC -Rosette Go 092510

3.

QUINOLONES Strongest CIPROFLOXACIN OFLOXACIN For gram negative