Polyuria

Nocturia

Urinary frequency

Normal urine output ? 800 – 2500 ML/Day

Physiological - primary polydipsia

Pathological – diabetes insipidus

Burning micturition

Increased frequency

increased Urgency

A/W disorders of urinary tract

Inability to retain urine in bladder

Neurogenic incontinence

Stress incontinence

Mechanical incontinence

Overflow incontinence

Psychogenic incontinence

Functional incontinence

Enuresis

Oliguria

Anuria

Diuresis

Natriuresis

Deterioration of renal functions resulting in

reduced GFR leading to accumulation of

urea ,creatinine , electrolytes ,and non

nitrogenous substances

ARF

CRF

Oliguria

Anuria

Volume overload

Hyperkalemia

Metabolic acidosis

Hypoalcemia

Anorexia , nausea , vomiting , muscle

twitching , fits , coma

Sudden reduction in function of kidney A/w

rapid rise in urea and creatinine

Pre renal

Renal

Post renal

Pre renal – severe hemorrhage , shock ,

hypovolemia , burns , septicaemia

Renal – glomerulonephritis , acute tubular

necrosis

Post renal – urinary tract obstruction

Slow insidious onset

Irreversible loss of renal functions

Leading to uremia

Manifesting as excretory , metabolic ,

hematological , endocrinal functional

abnormalities

Maintenance of adequate water and

electrolyte balance

Control of infection

Control of BP

Acid base balance

Diet

Dialysis

Congenital disorders

Vascular disorders

Glomerular disorders

Tubulointestitial disorders

Obstructive disorders

Massive proteinuria and associated

complications

Hypoalbuminemia

Edema

Hyperlipidemia

Lipiduria

Hypercoagulability

Haemodialysis

Peritoneal dialysis

Functions as artificial kidney in patients with

non functional kidneys

To treat patients in uremic coma

Uses the principle of diffusion of solutes

through a semi-permeable membrane

Can never replace a normal kidney

Does not provide endocrinal , hematological

function of kidney

Dialyzing fluid

Uses heparin as an anti-coagulent

Drains blood from the patient through AV

fistula or large veins

Semi-permeable membrane allows passage

of all solutes except proteins

At any given time artificial kidney contains

500ml of blood

Used in both ARF and CRF

Needs hospitalization and monitoring

Needs AV fistula in CRF for repeated uses

One cycle runs for 4- 6 hours

Clears urea at the rate of 100 – 225 ml/min

Peritoneal membrane is used as dialyzing

membrane

No need for hospitalization

Used in young children and older individuals

Also known as CAPD

Two liters of dialyzing fluid is injected into the

peritoneum

Placement of permanent peritoneal catheter

Exchange happens for 15 min

Dialyzing fluid drained out and measured

One cycle for every 6 hours

Strict i/o chart is maintained

Irreversible or terminally damaged kidneys

ESRD

Donor – cadaveric

sibling

isogenic or allogenic

Left kidney is preferred

Rt iliac fossa is preferred

Immunosupression needed- prednisolone , cyclosporine

Substances increasing urine output

By increasing water excretion

Diuresis occurs along with natriuresis

Loss of both water and solutes

Used to reduce ECF volume

Depending upon their ability (effectiveness) they are classified under

High efficacy diuretics - Loop diuretics

Medium efficacy – Thiazides

Weak diuretic -

Osmotic diuretic

Carbonic anhydrase inhibitors

Aldosterone antagonist

Sodium channel blockers

Diuretics acting on PCT

Diuretics acting on loop of henle

Diuretics acting on DCT and CD

Potassium sparing diuretics

Acting on loop of TAL

Inhibiting Na- k- 2cl symporter

High efficacy diuretiics

Furosemide , bumetanide

Acts on early DCT

Inhibits Na –Cl symport

Medium efficacy drugs

Hydrochlorthiazide

Site of action is PCT

Inhibits H+ secretion thro Na H antiport

Causes loss of Na and bicarbonate

Acetazolamide ..

Mannitol , glycerol , isosorbide

Major site of action PCT

Causes increased osmolarity in the tubules

Loss of water through diffusion

Aldosterone antagonist

EnaC inhibitors

Acts on DT ,CD

Spironolactone , amiloride ,