This chapter includes contents: Label a diagram of the urinary system, distinguish between acute and chronic renal failure, outline the pathophysiology of renal failure, identify the signs and symptoms of renal failure, describe the process of hemodialysis and peritoneal dialysis, describe the signs and symptoms and care of emergent conditions associated with dialysis
(BQ) Part 2 book "Wallach's interpretation of diagnostic tests" presents the following contents: Renal disorders, respiratory, metabolic and acid–base disorders, toxicology and therapeutic drug monitoring, transfusion medicine, laboratory tests, infectious disease assays.
(BQ) Part 2 book "Springhouse review for critical care nursing certification" presents the following contents: Gastrointestinal disorders, renal disorders, multisystem disorders, professional caring and ethical practice.
After a diabetes-related LEA has been reported to be as low as 28% to 31% (169, 170). Persons with renal failure or more proximal levels of amputation have a poor prognosis and higher mortality rate. Those who undergo a diabetesrelated amputation have a 40% to 50 % chance of undergoing a contralateral amputation within 2 years (36, 171, 172). ASSESSMENT OF THE DIABETIC FOOT (Pathway 1) The pedal manifestations of diabetes are well documented and potentially limb-threatening when left untreated.
Miscellaneous Metabolic disorders—ketoacidosis, acute renal failure, eclampsia, acute poisoning
Other—metastatic carcinoma, acute hemorrhage or hemolysis
Abnormal Neutrophil Function
Inherited and acquired abnormalities of phagocyte function are listed in Table 61-3. The resulting diseases are best considered in terms of the functional defects of adherence, chemotaxis, and microbicidal activity. The distinguishing
features of the important inherited disorders of phagocyte function are shown in Table 61-4.
Posterior Ischemic Optic Neuropathy This is an infrequent cause of acute visual loss, induced by the combination of severe anemia and hypotension. Cases have been reported after major blood loss during surgery, exsanguinating trauma, gastrointestinal bleeding, and renal dialysis. The fundus usually appears normal, although optic disc swelling develops if the process extends far enough anteriorly. Vision can be salvaged in some patients by prompt blood transfusion and reversal of hypotension.
Optic Neuritis This is a common inflammatory disease of the optic nerve.
Preeclampsia: Treatment Preeclampsia resolves within a few weeks after delivery. For pregnant women with preeclampsia prior to 37 weeks' gestation, delivery reduces the mother's morbidity but exposes the fetus to the risk of premature delivery. The management of preeclampsia is challenging because it requires the clinician to balance the health of both mother and fetus simultaneously and to make management decisions that afford both the best opportunities for infant survival.
Diabetes Mellitus in Pregnancy: Treatment Pregnancy complicated by diabetes mellitus is associated with higher maternal and perinatal morbidity and mortality rates. Preconception counseling and treatment are important for the diabetic patient contemplating pregnancy and can reduce the risk of congenital malformations and improve pregnancy outcome. Folate supplementation reduces the incidence of fetal neural tube defects, which occur with greater frequency in fetuses of diabetic mothers.
Physiology of Circadian Rhythmicity
The sleep-wake cycle is the most evident of the many 24-h rhythms in humans. Prominent daily variations also occur in endocrine, thermoregulatory, cardiac, pulmonary, renal, gastrointestinal, and neurobehavioral functions. At the molecular level, endogenous circadian rhythmicity is driven by self-sustaining transcriptional/translational feedback loops (Fig. 28-2). In evaluating a daily variation in humans, it is important to distinguish between those rhythmic components passively evoked by periodic environmental or behavioral changes (e.g.
Gestational Hypertension This is the development of elevated blood pressure during pregnancy or in the first 24 h post partum in the absence of preexisting chronic hypertension and other signs of preeclampsia. Uncomplicated gestational hypertension that does not progress to preeclampsia has not been associated with adverse pregnancy outcome or adverse long-term prognosis.
(See also Chaps. 272 and 280)
Normal pregnancy is characterized by an increase in glomerular filtration rate and creatinine clearance.
Thrombotic Thrombocytopenic Purpura TTP and HUS were previously considered overlap syndromes. However, in the past few years the pathophysiology of inherited and idiopathic TTP has become better understood and clearly differs from HUS. TTP was first described in 1924 by Eli Moschcowitz and characterized by a pentad of findings that include microangiopathic hemolytic anemia, thrombocytopenia, renal failure, neurologic findings, and fever. The full-blown syndrome is less commonly seen now, probably due to earlier diagnosis.
Hemolytic Uremic Syndrome HUS is a syndrome characterized by acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia. It is seen predominantly in children and in most cases is preceded by an episode of diarrhea, often hemorrhagic in nature. Escherichia coli O157:H7 is the most frequent, although not only, etiologic serotype. HUS not associated with diarrhea (termed DHUS) is more heterogeneous in presentation and course.
(BQ) Part 1 book "Harrison's nephrology and acid-base disorders" presents the following contents: Introduction to the renal system, alterations of renal function and electrolytes, acute kidney injury and chronic renal failure.
(BQ) Part 2 book "Harrison's nephrology and acid-base disorders" presents the following contents: Glomerular and tubular disorders, renal vascular disease, urinary tract infections and obstruction, urinary tract infections and obstruction.
(BQ) Part 2 book "Pediatric critical care medicine" presents the following contents: Endocrine disorders, disorders of host defense, hematologic and oncologic disorders, cardiac diseases, respiratory disorders, neurologic disorders, gastrointestinal disorders, renal disorders.
Part 2 book "Pediatric critical care medicine" presents the following contents: The hematologic system in critical illness and injury, oncologic disorders in the PICU, the immune system in critical illness and injury, secondary immunodeficiency syndromes.
T HE DECISION to devote this issue to Renal
Nuclear Medicine was largely stimulated by
a planning committee meeting of the Radionuclides
in Nephrourology group in London a little more
than a year ago. At that meeting, a progress report
was delivered on the consensus reports that would
be presented at the Radionuclides in Nephrourology
Meeting to be held in Copenhagen in May of
Therapeutic immunosuppression has very broad applications in clinical medicine,
ranging from prevention and treatment of organ and bone marrow transplant
rejection, management of various autoimmune disorders (e.g., rheumatoid arthritis),
skin diseases, allergies and asthma. Whereas traditionally only a small repertoire of
immunosuppressive agents was available for clinical use, recent discoveries have
significantly increased the number of approved agents, resulting in numerous trials to
further evaluate their potential.
None of the newer evidence altered the priority given to metformin cited in the previous
guideline. Although the specific cardioprotective effects of metformin suggested by the UKPDS
study were open to challenge from some of the very recent studies, this was not on the basis of
strong outcome data. Large observational studies from Canada and Scotland111,112 appeared to
support the widespread advantage of metformin over sulfonylureas, but the A Diabetes Outcome
Progression Trial (ADOPT) study did not.