Kidney Failure

Kidney Failure Checkpoint

Scenario A:

- The kidney regulates its own blood flow and GFR. When the kidneys become hypo perfuse vessels in the kidney dilate with the half of prostaglandins to facilitate a flow. If this auto regulation of blood flow fails, the GFR can be maintained by selective constriction of post-glomerular arteriole by the release of rennin and generation of angiotensin II. Continued hypo perfusion of the kidneys may lead to failure of these compensatory mechanisms and an acute decline in GFR. Renal tubules become hyper functional and re-absorption of sodium and water is increased, through the influence of angiotensins, aldosterone and vasopressin. This leads to the formation of a low volume of urine which is concentrated.

- The most common symptom in acute renal failure is decreased urination. This occurs in 70% of patients. Other signs and symptoms include fever and dizziness.

- Tubular cells in the tubule of the kidney are dying. Ms. Jones is experiencing acute tubular necrosis (ATN). It is a renal cause of ARF.

- Treatment is aimed towards restoring urine output. Supportive treatment, which includes fluid resuscitation, treating metabolic consequences such as hyperkalemia and metabolic acidosis. In extreme cases dialysis may be required.

Scenario B:

- In chronic renal failure, kidney function is chronically impaired. This would lead to volume retention. If Mr. Hodges already has CHF, the added volume load would be hazardous to the rest of his body.

- Mr. Hodges may develop other symptoms that are due to his fluid overloaded. He may also develop pulmonary edema as his condition worsens along with the possibility of gastrointestinal bleeds or liver disease from portal hypertension, seizures and delirium, and poor urine production.

- Mr. Hodge’s kidney disease is probably due to hypo perfusion of the kidney.

- The prognosis overall is poor as mortality increases as kidney function decreases. Treatments are typically focused on decreasing...