Management-of-Patients-With-Renal-Disorders课件.ppt
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1、Copyright 2008 Lippincott Williams&Wilkins.Management of Patients With Renal Disorders 1Copyright 2008 Lippincott Williams&Wilkins.Functions of the KidneyUrine formationExcretion of wastesRegulation of electrolytesRegulation of acid-base balanceControl of water balanceControl of blood pressureRenal
2、clearanceRegulation of red blood cell formationSynthesis of vitamin D to active formSecretion of prostaglandinsRegulates calcium and phosphorus balanceActivates growth hormone2Copyright 2008 Lippincott Williams&Wilkins.Common Fluid and Electrolyte Disturbances in Renal Disorders Fluid volume loss or
3、 excessProtein deficitElectrolyte abnormalities including Na+,K+,Ca+,Mg+,bicarbonate,and phosphorusSee table 47-33Copyright 2008 Lippincott Williams&Wilkins.Glomerular DiseasesAn inflammation of the glomerular capillariesThe glomerulus is a tuft of capillaries forming part of the nephron through whi
4、ch filtration occursThe nephron is the functional unit of the kidney responsible for urine formation and removal of unnecessary substances Antigen-antibody complexes form in the blood and become trapped in the glomerulus and induce inflammatory responseAcute glomerulonephritisChronic glomerulonephri
5、tisNephrotic syndrome4Copyright 2008 Lippincott Williams&Wilkins.Copyright 2008 Lippincott Williams&Wilkins.Acute GlomerulonephritisComplications includeHypertensive encephalopathyHeart failurePulmonary edemaRenal failurePrognosis-Most recover fully6Copyright 2008 Lippincott Williams&Wilkins.Acute G
6、lomerulonephritisMedical management includes supportive care-treat hypertension,edema,rest,sodium and fluid restriction Dietary modifications(high carb,low protein;Treat cause,if appropriate,using antibiotics,possibly corticosteroids 7Copyright 2008 Lippincott Williams&Wilkins.Sequence of Events in
7、Acute Glomerulonephritis 8Copyright 2008 Lippincott Williams&Wilkins.Copyright 2008 Lippincott Williams&Wilkins.Chronic GlomerulonephritisCauses include repeated episodes of acute glomerular nephritis,hypertensive nephrosclerosis,hyperlipidemia,and other causes of glomerular damageSecondary causes m
8、ay include diseases with systemic effects(eg,SLE,Goodpatures,diabetes)Some patients are asymptomatic for years;as glomerular damage increases,signs and symptoms of renal insufficiency and renal failure develop Abnormal laboratory test results include urine with fixed specific gravity,casts,and prote
9、inuria;electrolyte imbalances;and hypoalbuminemia 10Copyright 2008 Lippincott Williams&Wilkins.Chronic GlomerulonephritisMedical managementHTN managementSodium/water restriction,diureticsAdequate nutrition intake,high value proteinEarly initiation of dialysis11Copyright 2008 Lippincott Williams&Wilk
10、ins.Copyright 2008 Lippincott Williams&Wilkins.Nephrotic Syndrome Any condition that seriously damages the glomerular membrane and results in increased permeability to plasma proteins Results in hypoalbuminemia and anasarcaHallmark proteinuria(3.5 g/day)Causes include chronic glomerulonephritis,diab
11、etes mellitus with glomerulosclerosis,amyloidosis,lupus,multiple myeloma,and renal vein thrombosis(table 46-10)Medical management includes drug and dietary therapy13Copyright 2008 Lippincott Williams&Wilkins.Copyright 2008 Lippincott Williams&Wilkins.15Copyright 2008 Lippincott Williams&Wilkins.Sequ
12、ence of Events in Nephrotic Syndrome16Copyright 2008 Lippincott Williams&Wilkins.Copyright 2008 Lippincott Williams&Wilkins.Causes of Acute Renal Failure(ARF)table 47-1PrerenalThe result of impaired blood flow,leading to hypoperfusion of kidneyVolume depletion,impaired cardiac function,vasodilation(
13、eg,shock)IntrarenalResult of actual parenchymal damage to glomeruli or tubules-impaired nephron functionNephrotoxic agents,infectious process,renal ischemia18Copyright 2008 Lippincott Williams&Wilkins.Causes of Acute Renal FailurePostrenalDue to mechanical obstruction somewhere distal to the kidney(
14、eg,calculi,tumors,strictures)19Copyright 2008 Lippincott Williams&Wilkins.Phases of ARFInitiationOliguriaDiuresisRecovery20Copyright 2008 Lippincott Williams&Wilkins.ARF Assessment and FindingsUrine output scant to normal,low specific gravityUltrasound may show anatomic changesElevated BUN and creat
15、inineCreatinine increases as in conjunction with decrease in GFRIf oliguric,risk of hyperkalemiaProgressive metabolic acidosisChanges in calcium and phosphate21Copyright 2008 Lippincott Williams&Wilkins.ARF preventionCareful history to assess for risk factorsBUN/Creatinine monitoring for patients on
16、 nephrotoxic agentsAdequate hydrationPrompt treatment of shockPrompt treatment of hypotensionPrompt treatment of infectionsTo prevent toxic drug effects,monitor renal function,drug dose and durationRecognize potential for radiocontrast-induced nephropathy22Copyright 2008 Lippincott Williams&Wilkins.
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