CHRONIC RENAL FAILURE.docx - CHRONIC RENAL FAILURE ESRD...

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CHRONIC RENAL FAILURE- ESRD Functions of the Kidney o Urine Formation o Excretion of waste products o Regulation of electrolytes and water o Control of Blood pressure o Regulation of RBC production o Synthesis of Vitamin D to active form o Secretion of prostaglandins Urine Formation- Glomerular Filtration o Blood flows through kidney ~1200 ml /min o 20 % of blood is filtered into the nephron o Filtrate contains water, lytes and small molecules o Large molecules stay in bloodstream- proteins, glucose, RBC o Affected by BP, oncotic pressure, obstruction Excretion of Waste Products o Urea by-product of protein metabolism o Creatinine by-product of muscle metabolism o Phosphates o Sulfates o Uric acid o Drug metabolites Regulation of Na and K o Na - in healthy kidney amount ingested= amount excreted o Sodium volume excreted depends on aldosterone o K- 90% is excreted, affected by acid base balance and aldosterone o Retention of K most life threatening problem in renal failure Regulation of Water and Acid-Base Balance o In distal tubules, ADH allows H2O to be absorbed into the capillaries and returned to blood volume o Aldosterone- reabsorbs water and NA o HCO3 is re-absorbed, H+ is excreted o Atrial- Naturetic Factor with atrial stretch, inhibits the effect of ADH diuresis Other functions o Produces renin in response to low renal artery blood flow o In response to decrease in O2 in renal blood flow erythropoetin is released, stimulates the bone marrow to produce RBCs o Vitamin D- kidneys convert inactive vit D to its active form- vitD necessary for maintaining normal calcium balance o Prostaglandins- cause vasodilation Definitions o CRF is a condition in which the kidney ceases to remove metabolic wastes and excessive water from the blood o Acute renal failure is a reversible syndrome that results in decreased GFR and oliguria
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o End stage renal failure (ESRD) is a progressive, irreversible deterioration of renal function that results in azotemia Definitions to Know o Glomerular filtration rate (GRF): the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Normal 120mL/min o Nephron o Creatinine: waste product of muscle wasting o Azotemia: > accumulation of nitro waste in blood. Classic in renal failure o Urea nitrogen: nitrogenous end product of protein metabolism Risk Factors that Cause ESRD o Diabetes mellitus (leading Cause) 38% o HTN (24%) o Glomerulonephritis (12%) o Polycystic kidney disease o Vascular disorders o Medications or toxic agents o Sickle cell disease o Acute renal failure o Risk Factors: other Nephrotoxic medications Gentamycin NSAIDS Chemicals Health Promotion o Encourage patients to drink at least 3 liters daily.
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  • Spring '14
  • Brinkley
  • Chronic Renal Failure, Renal artery, renal insufficiency,  ESRD

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