Upload
khairulamran828
View
277
Download
0
Embed Size (px)
Citation preview
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 1
Azotemia
Azotemia is a type of Nephrotoxicity.
Azotemia is an excess of nitrogen compounds in the blood. Uremia, or uremic syndrome, occurs when the excess of nitrogen compounds
becomes toxic to your system. Azotemia, if untreated, can lead to acute (sudden) renal failure. Renal failure is when each kidney shuts down.
Signs and symptoms of Azotemia • High serum urea level • Reduced urination • Pallor • Confusion • Fatigue • Dry mouth • Thirst • Swelling • Orthostatic blood pressure • Rapid pulse • Reduced alertness
Prevention: • Drink a lot of plain water to keep kidney function properly • Avoid taking substances or medications that can poison or damage kidney tissue • Do physical exams include blood test and urinalysis to monitor kidney and urinary tract health • Regular monitoring of blood pressure, urea, creatinine and glomerular flow rate • Eat a low-fat, low-salt diet • Exercise most days of the week
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 2
Treatment: • Renal dialysis (hemodialysis or peritoneal dialysis) • Transplantation kidney • Dietary restrictions of potassium and phosphate containing foods • Fluid restrictions • Treatment of underlying cause (hypertension,diabetes,autoimmune diseases)
Main causes BUN Creatinine BUN/Creatinine ratio
urinalysis
Prerenal azotemia
true volume depletion
advanced liver disease
congestive heart failure.
Increase significantly
Increase
More than 20
• Oliguria ( urine vol < 500 ml/d) • Anuria ( <100 ml/d) • Specific gravity > 1.015 • Normal urine sediment • Elevation of hematocrit, total
protein/albumin, calcium, bicarbonate from their baseline
Intrarenal azotemia
Drugs Chemotherapy drugs Intravenous (IV) radiocontrast dye - Non-steroidal Anti-inflammatory
Drugs Chronic (long-term) renal failure Diseases that may cause chronic
renal failure
Increase
Increase
Less than 20
• Specific gravity < 1.015 • Active urinary sediment • High urinary sodium ( > 40
mEq/L) • Low urine osmolality
Postrenal azotemia
• Intra-renal Obstruction – Acute uric acid nephropathy
• Drugs • Extra-renal Obstruction
– Renal pelvis or ureter – Bladder Urethra
Increase
Increase
More than 15
Anuria but urine output still may be present
Low than normal protein/abbumin, hematocrit, calcium, bicarbonate and uric acid.
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 3
Acute renal failure, ARF
Description
Acute renal failure is a rapid decrease in renal function over days to weeks, causing an accumulation of nitrogenous
products in the blood (azotemia).
Signs and symptoms
Bloody stools
Breath odor
Bruising easily
Changes in mental status or mood
Decreased appetite
Fatigue
Flank pain (between the ribs and hips)
Hand tremor
High blood pressure
Metallic taste in mouth
Nausea or vomiting, may last for days
Prerenal azotemia Intrarenal azotemia Postrenal azotemia
Causes
1. Low cardiac output Cardiomyopathy,cardiac tamponade, pulmonary embolism, pulmonary hypertension, positive-pressure mechanical ventilation 2. Increased renal vascular
resistance cyclosporine, hypercalcemia, anaphylaxis, anesthetics, renal artery obstruction, renal vein thrombosis, sepsis, hepatorenal syndrome
1. Acute tubular injury Ischemia Surgery, hemorrhage, arterial or venous obstruction Toxins: Aminoglycosides, amphotericin B 2. Acute glomerulonephritis Anti-GBM glomerulonephritis: Goodpasture's syndrome Immune-complex: Lupus glomerulonephritis, postinfectious glomerulonephritis, cryoglobulinemic glomerulonephritis
1. Tubular precipitation Uric acid (tumor lysis), sulfonamides, myeloma protein, myoglobin 2. Ureteral obstruction Intrinsic: Calculi, clots, sloughed renal tissue, fungus ball, edema, malignancy, congenital defects Extrinsic: Malignancy, retroperitoneal fibrosis, ureteral trauma during surgery or high impact injury
Nosebleeds Persistent hiccups Prolonged bleeding Seizures Slow, sluggish movements Swelling - generalized (fluid retention) Swelling of the ankle, foot, and leg Urination changes:
o Decrease in amount of urine o Excessive urination at night
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 4
3. Decreased efferent arteriolar
tone ACE inhibitors or angiotensin II receptor blockers 4. Low systemic vascular resistance Septic shock, liver failure, antihypertensive drugs 5. ECF volume depletion Excessive diuresis, hemorrhage, GI losses, loss of skin and mucus membranes, renal salt- and water-wasting states
3. Acute tubulointerstitial nephritis Drug reaction 4. Acute vascular nephropathy Vasculitis, malignant hypertension, thrombotic microangiopathies, scleroderma, atheroembolism 5. Infiltrative diseases Lymphoma, sarcoidosis, leukemia
3. Bladder obstruction
Mechanical: Benign prostatic
hyperplasia, prostate cancer, bladder
cancer, urethral strictures, urethral
valves, obstructed indwelling urinary
catheter
Lab diagnosis
Prerenal azotemia Intrarenal azotemia Postrenal azotemia
Hx P/E Urine sediment (usually normal,
without cellular elements or abnormal casts, unless chronic kidney disease is present)
UNa< 15 meq/L (>20 in ATN) U/Pcreat> 20 (<15 in ATN) FeNa <1% (>1% in ATN) UNa/K <1/4 BUN/creatinine >20:1 BUN/Creatinine of >20 is typical,
BUT is not specific to prerenal ARF and may also be seen:
Obstructive uropathy
BUN/Creatinine ratio: 10 – 20
Urine specific gravity: ~ 1.010
Urine Na: ~30
FeNa (%): >2-3
Urine Cr/Plasma Cr: </=20
Abnormal urine microscopy
Schistocytes in peripheral smear
Rouleaux formation suggest multiple myeloma
Myoglobin / free hemoglobin and increased serum uric acid level
Hyperkalemia
Hypercalcemia
Hyperphosphatemia
Hypernatremia
BUN/Creatinine ratio: 10 - 20
Urine specific gravity: > 1.010
Urine Na: >400 (early), ~300 (late)
FeNa (%): <1 (early), 3 (late)
Urine Cr/Plasma Cr: >40 (early), >/= 20 (late)
normal urine microscopy
Hyperkalemia
Hypercalcemia
Hyperphosphatemia
Hypernatremia
Hyperuricemia
Acidosis
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 5
Gastrointestinal bleeding
Lab diagnosis
Urinalysis:
Granular, muddy-brown casts, tubular cell cast suggest tubular necrosis
Reddish brown urine indicate presence myoglobin or hemoglobin
RBC casts indicate glomerulonephritis
WBC casts suggest pyelonephritis or acute interstitial nephritis
Uric acid crystals associated with uric acid nephropathy
Calcium oxalate crystals present in cases glycol poisoning Dipstick assay may reveal significant proteinuria as result tubular injury
Prevention
• Drink a lot of plain water to keep kidney function properly • Avoid taking substances or medications that can poison or damage kidney tissue • Do physical exams include blood test and urinalysis to monitor kidney and urinary tract health
Treatments
• Immediate treatment of pulmonary edema and hyperkalemia • Dialysis as needed to control hyperkalemia, pulmonary edema, metabolic acidosis, and uremic symptoms • Adjustment of drug regimen • Usually restriction of water, Na, and K intake, but provision of adequate protein • Possibly phosphate binders and Na polystyrene sulfonate
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 6
ARF Associated with ACE Inhibitors and Angiotensin Receptor Blockers
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 7
Example of Urinary sediment found in acute renal failure
Type of sediment Pictures
Red blood cells
Monomophic dysmorphic
Renal Tubular Epithelial Cell Cast
White blood cell cast
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 8
Uric acid crystal
Calcium Oxalate Crystals
White blood cells
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 9
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 10
Chronic renal failure, CRF
Description
Chronic kidney disease is long-standing, progressive deterioration of renal function.
Signs and symptoms
Effects and symptoms of chronic kidney disease include;
need to urinate frequently, especially at night (nocturia)
swelling of the legs and puffiness around the eyes (fluid retention)
high blood pressure
fatigue and weakness (from anemia or accumulation of waste products in the body)
loss of appetite, nausea and vomiting
itching, easy bruising, and pale skin (from anemia)
shortness of breath from fluid accumulation in the lungs
headaches, numbness in the feet or hands (peripheral neuropathy)
chest pain due to pericarditis (inflammation around the heart);
bleeding (due to poor blood clotting)
bone pain and fractures
decreased sexual interest and erectile dysfunction.
Causes
The most common causes of chronic renal failure are related to:
poorly controlled diabetes
poorly controlled high blood pressure
chronic glomerulonephritis.
Less common causes of chronic renal failure include:
polycystic kidney disease,
reflux nephropathy,
kidney stones, and
prostate disease.
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 11
Lab diagnosis
BUN: elevated
Serum creatinine: elevated
BUN/Creatinine ratio: elevated
Urine specific gravity: > 1.010
RBC count and hemoglobin low
Hypercalcemia
Hyperphosphatemia
Hypernatremia
Hyperuricemia
Acidosis
Prevention
Drink a lot of plain water to keep kidney function properly Do not smoke.
Eat meals that are low in fat and cholesterol
Get regular exercise (talk to your doctor or nurse before starting).
Take drugs to lower your cholesterol, if necessary.
Keep your blood sugar under control.
Regular monitoring of blood pressure, urea, creatinine and glomerular flow rate
Treatments
Dietary restrictions of potassium and phosphate containing foods Fluid restrictions Treatment of underlying cause (hypertension,diabetes,autoimmune diseases) Renal dialysis (hemodialysis or peritoneal dialysis)
Urinalysis:
Proteinuria
Glycosuria
Hematuria
Erythrocytes
Leukocytes
RBC, WBC casts
Uric acid crystals
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 12
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 13
End – stage kidney disease
Description
Renal failure is any acute or chronic loss of kidney function and is the term used when some kidney function remains
Signs and symptoms
Signs and symptoms mentioned in various sources for End-stage renal disease includes the 10 symptoms listed below:
Reduced urine
Total lack of urine
Nausea
Vomiting
Uremia - causing various symptoms of uremia:
Drowsiness
Confusion
Seizures
Coma
Causes
Causes of End-stage renal disease includes:
Kidney disease - obviously ESRD starts as early kidney disease.
Diabetic nephropathy -
Chronic kidney failure - ESRD is by definition the last state of chronic kidney failure
Hypertension
Glomerulonephritis
Polycystic kidney disease
Lab diagnosis
BUN: highly elevated Serum creatinine: highly elevated Hyperkalemia Hypercalcemia Hyperphosphatemia
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 14
Hyernatremia Hyperuricemia Acidosis
RBC count low
Hemoglobin count low Urinalysis:
High microalbumins
Proteinuria, glycosuria
Hematuria
Erythrocytes, leukocytes
RBC, WBC casts
Uric acid crystals
Prevention
Regular check-ups with doctor
Eat a low-fat, low-salt diet
Exercise most days of the week
Treatments
Dialysis or kidney transplantation
ACE inhibitor, angiotensin receptor blocker, or other medications for high blood pressure. is the only treatment for ESRD.
xtra calcium and vitamin D (always talk to your doctor before taking)
Special medicines called phosphate binders, to help prevent phosphorous levels from becoming too high
Treatment for anemia, such as extra iron in the diet, iron pills, special shots of a medicine called erythropoietin, and blood transfusions.
MOHD KHAIRUL AMRAN
HS221/5 MEDICAL LAB TECH UiTM 15
References: 1. Burtis CA, Ashwood ER. (1996) Tietz Fundamentals of Clinical Chemistry 4th Edition.
2. Wrong diagnosis: end – stage renal disease. Retrieved from:
3. http://www.wrongdiagnosis.com/e/end_stage_renal_disease/causes.htmOn 2 jan 2011.
4. Medline plus: end-stade kidney disease. Retrieved from :
5. http://www.nlm.nih.gov/medlineplus/ency/article/000500.htm on 02 jan 2011.
6. Health Encyclopedia - Diseases and Conditions: end – stage kidney disease. Retrieved from:
http://www.healthscout.com/ency/68/680/main.html on 02 jan 2011.
7. The merck manual online medical dictionary: chronic renal failure. Retrived from:
http://www.merckmanuals.com/home/sec11/ch143/ch143c.html on 02 jan 2011.
8. Medicine net: kidney failure. Retrieved from:
9. http://www.medicinenet.com/kidney_failure/article.htm#toccOn 03 jan 2011.
10. Global oneness: azotemia - signs and symptoms. Retrieved from:
11. http://www.experiencefestival.com/azotemia_-_signs_and_symptoms on 03 jan 2011.
12. Syed Rizwan, MD. Acute renal failure ( power point presentation )
13. Peter Fumo, MD, FACP Acute renal failure ( power point presentation )