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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


  • 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



Functional consequences of tubulointerstitial disease
Functional consequences of widespread atrophy, luminal dilatation and thickening of the tubule basement membranestubulointerstitial disease


Modifiers influencing the progression of renal diseases
Modifiers influencing the progression of renal diseases widespread atrophy, luminal dilatation and thickening of the tubule basement membranes

  • Risk factors for progressive loss of renal function

    • Systemic HPN

    • Diabetes

    • Activation of RAAS system


  • 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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