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Acute Kidney Injury. - Rapid decline in renal filtration function. Acute Kidney Injury. Prerenal AKI. Most common form of AKI 2 major causes: Hypovolemia Renal fluid loss Decreased intake of fluids Altered renal hemodynamics resulting in hypoperfusion

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acute kidney injury

Acute Kidney Injury

- Rapid decline in renal filtration function

prerenal aki
Prerenal AKI
  • Most common form of AKI
  • 2 major causes:
    • Hypovolemia
      • Renal fluid loss
      • Decreased intake of fluids
    • Altered renal hemodynamics resulting in hypoperfusion
      • Low cardiac output state due to pulmonary hpn leading to left heart failure
      • Systemic vasodilation due to antihypertensives
intrinsic aki
Intrinsic AKI
  • Major causes:
    • Renovasculat Obstruction
    • Diseases of the Glomeruli or vasculature
    • Acute Tubular necrosis
      • Ischemia
      • Infection, with or without sepsis
      • Toxins: exogenous, endogenous
    • Interstitial Nephritis
      • Allergic
      • Infection
      • Inflammatory, nonvascular
    • Intratubular obstruction
acute kidney injury3
ACUTE KIDNEY INJURY
  • Tubulointerstitial disease - acute interstitial nephritis
    • Due to baterial, viral and other miscellaneous infection
      • Streptococcus, staphylococcus, legionella, salmonella, Brucella, yersinia
    • Interstitial edema with cortical and medullary infiltration by mononuclear cells and polymorphonuclear leukocytes and patchy areas of tubule cell necrosis
slide7

Chronic form: fibrosis, predominance of mononuclear, widespread atrophy, luminal dilatation and thickening of the tubule basement membranes

  • Defects in renal function
    • Proximal tubule dysfunction
      • Selective reabsorptive defects
      • hypokalemia,
      • Aminoaciduria
      • Glycoasuria
      • Phosphaturia
      • Uricosuria
      • Bicarbonaturia
slide8

Defects in urinary acidification and concentrating ability

    • Hyperchloremic metabolic acidosis
      • Maximal Urine pH <5.3
      • Caused by reduced capacity to generate and excrete ammonia due to reduction in renal mass
modifiers influencing the progression of renal diseases
Modifiers influencing the progression of renal diseases
  • Risk factors for progressive loss of renal function
    • Systemic HPN
    • Diabetes
    • Activation of RAAS system
slide11

Poor cho control will aggrevate renal progression in both diabetic and non diabetics

  • Angiotensin II produces intraglomerular HPN and stimulate fibrogenesis
  • Aldosterone
  • Serves as an indeoendent fibrogenic mediator of progression loss apart from its role in modulating Na and K homeostasis
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