NR507- Advanced Pathophysiology Final Exam 2024 Study Guide

Acute renal failure - Reversible Determining prognosis- kidneys respond to diuretic with good output; this indicates that kidneys are functioning well Acute Pyelonephritis - Diagnosing by clinical symptoms alone can be difficult; can be similar to cystitis Diagnosis established by: -Urine culture -Urinalysis (WBC casts indicates pyelonephritis, but may not always be present) -Signs/Symptoms -Complicated pyelonephritis requires blood cultures and urinary tract imaging Renal Calculi (Renal Stones) - Goals of Treatment: Manage acute pain Promote passage of stone Reduce size of stone Prevent new stone formation Chronic Renal Failure - Chronic Kidney Disease (CKD) is a progressive loss of renal function associated with systemic disease such as hypertension, diabetes mellitus (most significant risk factor), systemic lupus erythematosus or intrinsic kidney disease CKD stage is determined by estimates of GFR and albuminuria Who is a candidate for dialysis? - End-stage renal disease (ESRD) is the final stage of CKD with the number one cause being diabetes mellitus combined with hypertension. At this point, the patient is completely dependent on dialysis to survive. CKD is classified into five stages and is based on the patient's GFR rather than symptoms. Patients will need dialysis when the following symptoms are present: --Metabolic acidosis. --Hyperkalemia: Hyperkalemia in the presence of EKG changes (peaked T-waves) is an indication for dialysis. --Hyperkalemia by itself is not an indication for dialysis. --Drug toxicity: Drug toxicity due to the following drugs is an indication for dialysis and include salicylates, Lithium, Isopropanol, Methanol and Ethylene glycol). --Fluid volume overload that is not responsive to diuretics. --Uremic symptoms due to nitrogenous wastes in the blood stream. Stage I CKD - There is kidney damage with normal or elevated GFR 90-120 Stage II CKD - There is kidney damage with mild decrease in GFR 60-89 Stage III CKD - There is a moderate decrease in GFR 30-59 Stage IV CKD - There is a severe decrease in GFR 15-29 Stage V CKD - Kidney failure- End-stage renal disease <15 (dialysis) Once Stage IV is reached, progression to Stage V is inevitable as well as dialysis or kidney transplant Complications of Decreased GFR - Anemia Hypertension Decreased calcium absorption Hyperlipidemia Heart failure Left ventricular hypertrophy Fluid volume overload Hyperkalemia Hyperparathyroidism Hyperphosphatemia Metabolic acidosis Malnutrition (late complication) GERD - Warning signs include: Symptoms over age of 50: -Dysphagia (difficulty swallowing) -Odynophagia (pain on swallowing) -Nausea and vomiting -Weight loss -Melena -Early satiety (feeling full after eating very little food Hiatal Hernia - Often asymptomatic Generally, a wide variety of symptoms develop later in life and are associated with other GI disorders, primarily GERD --Sliding hiatal hernia: treatment usually conservative. Individuals can diminish reflux by eating small, frequent meals and avoiding the recumbent position after eating. Abdominal supports and tight clothing are avoided and weight control recommended for obese individuals.