A Hot Summer’s Night

Sleep stages
1. Non-REM
  1. Stage 1
    1. Stage 2
      1. Stage 3
        This is the deep sleep stage. It's harder to rouse you during this stage, and if someone woke you up, you would feel disoriented for a few minutes. During the deep stages of NREM sleep, the body repairs and regrows tissues, builds bone and muscle, and strengthens the immune system.
      2. light sleep. Your heart rate slows and your body temperaturedrops.
    2. Your eyes are closed, but it's easy to wake you up. This phase may last for 5 to 10 minutes.
2. REM
  1. REM sleep happens 90 minutes after you fall asleep. The first period of REM typically lasts 10 minutes
    1. heart rate and breathing quickens.
      1. intense dreams during REM sleep, since your brain is more active.
Shock
1. is a life-threatening condition that occurs when the body is not getting enough blood flow
  1. types
    1. cardiogenic
    2. hypovolumeic
    3. anaphylactic
    4. neurogenic
    5. sepsis
  2. Symptoms
    1. Cool, clammy skin.
    2. Pale or ashen skin.
    3. Rapid pulse.
    4. Rapid breathing.
    5. Nausea or vomiting.
    6. Enlarged pupils
    7. Weakness or fatigue.
    8. dizziness or fatigue
  3. Causes
    1. Heart problems
    2. changes in blood vessels
    3. low blood volume
Renal Physiology
1. Kidneys function
2. kidney structure
  1. Externally, the kidney is surrounded by the renal fascia, the perirenal fat capsule, and the renal capsule. Internally, the kidney is most importantly filled with nephrons that filter blood and generate urine.
  2. Nephron: The Functional Unit of the Kidney
    1. a renal corpuscle, a renal tubule, and the associated capillary network, which originates from the cortical radiate arteries.
      1. The renal corpuscle, located in the renal cortex, is composed of a network of capillaries known as the glomerulus, as well as a cup-shaped chamber that surrounds it: the glomerular or Bowman’s capsule.
3. Urine formation
  1. Filtration
    1. blood enters the afferent arteriole and flows into the glomerulus where filterable blood components, such as water and nitrogenous waste, will move towards the inside of the glomerulus, and nonfilterable components, such as cells and serum albumins, will exit via the efferent arteriole. These filterable components accumulate in the glomerulus to form the glomerular filtrate.
  2. Reabsorption
    1. the nephron may be either a passive or active process, and the specific permeability of the each part of the nephron varies considerably in terms of the amount and type of substance reabsorbed
      1. Passive diffusion—passing through plasma membranes of the kidney epithelial cells by concentration gradients.
      2. Active transport—membrane-bound ATPase pumps (such as NA+/K+ ATPase pumps) with carrier proteins that carry substances across the plasma membranes of the kidney epithelial cells by consuming ATP.
      3. Cotransport—this process is particularly important for the reabsorption of water. Water can follow other molecules that are actively transported, particularly glucose and sodium ions in the nephron.
  3. Secretion
    1. secretion occurs are similar to those of reabsorption, however these processes occur in the opposite direction.
      1. The substances that are secreted into the tubular fluid for removal from the body include:
        Potassium ions (K+)
        Potassium balance
        Intercalated cells help in reabsorption during low potassium diet
        Principal cells secrete during high potassium diet
        Increased secretion
        High potassium diet
        Increase aldosterone
        Alkalosis
        Diuretic
        Decreased secretion
        Low potassium diet
        Decreased aldosterone
        Acidosis
        Potassium sparing diuretics
        Hydrogen ions (H+)
        Ammonium ions (NH4+)
        Creatinine
        Urea
        Urea cycle
  4. oligouria
    1. <400 ml/day
  5. anuria
    1. <100ml/day
  6. polyuria
    1. <2L/day
Acute Kidney Failure
1. Chronic Kidney Failure
  1. caused by acute kidney failure
  2. causes
    1. Hypertension
    2. Diabetes
    3. polycystitis
  3. Manifestations
    1. Sodium and water balance
    2. Potassium balance
    3. Metabolic acidosis
    4. Osteodystrophy
    5. Anemia
    6. Chest pain
    7. Shortness of breath
Investigations
1. CBC
2. Urine analysis with microscopy
3. Urine electrolytes
4. Serum biochemistries
5. renal imaging is useful, especially if renal failure is secondary to obstruction
  1. Ultrasound: This test uses sound waves to get a picture of the kidney. It may be used to look for abnormalities in size or position of the kidneys or for obstructions such as stones or tumors.
  2. CT Scan: This imaging technique uses contrast dye to picture the kidneys. It may also be used to look for structural abnormalities and the presence of obstructions.
Management of AKI
1. Treating the underlying cause of your kidney failure
2. Treatments to balance the amount of fluids in your blood.
  1. diuretics
3. Medications to control blood potassium
4. Medications to restore blood calcium levels.
5. Renal Replacement Therapy
  1. dialysis (hemodialysis or peritoneal dialysis), hemofiltration and hemodiafiltration
  2. kidney transplant (ultimate form)
  3. Hemodialysis, hemofiltration and hemodiafiltration can be: Continuous or intermittent Arteriovenous route or venovenous route
  4. continuous arteriovenous hemodialysis, intermittent venovenous hemofiltration
A splenectomy may be indicated in the following cases:
1. Trauma
2. Hematologic Diseases
3. Splenomegaly
4. Cancer
5. When the spleen bleeds
Follow up
1. Arrange follow-up visits as needed for the underlying cause of the kidney failure and the severity of the disease
2. During recovery, doctors may refer patients to a dietitian who would recommend a diet :
  1. low potassium
  2. Avoid food with added salt
  3. Limit phosphorous
prognosis
1. Depends on the cause of the disease
2. Partial recovery of renal function may occur in situations in which the injury does not completely resolve.
  1. On long-term follow-up (1 to 10 years), approximately 12.5% of survivors of acute renal failure require dialysis and 19% to 31% of them have chronic kidney disease
    1. The mortality rate in patients in intensive care (ICU) settings with acute kidney failure that requires dialysis is 70% to 80%.

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A Hot Summer’s Night

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	Created by Fatma Shwaylia over 6 years ago