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Introduction
Our kidneys are incredible organs that get rid of toxins, retain
substances needed by our bodies, and maintain the right
balance of electrolytes, minerals, and water. Find out what
happens to this 27-year-old when toxins accumulate in her
kidneys leading to acute renal failure.
Case Questions
1. What is the glomerulus?
This patient's symptoms may well indicate the serious and lifethreatening condition know as acute renal failure. The broad
definition certainly means the loss of kidney function to some
degree and is usually of sudden onset. At the kidney level, this
means a loss in the glomerular filtration rate. The link above
presents a good overview of the key points of renal failure and
links to basic kidney function. In this case study, we will focus
on acute tubular necrosis(ATN) as a toxic side-effect of the
antibiotics administered previously.
Case Questions
10. Acute tubular necrosis can be defined as.....?
11. What are the risk factors for ATN?
Lab Results
Initial Significant Laboratory Blood Chemistry Results
Case Questions
12. What 2 blood chemistry values are reflective of the kidneys
ability to excrete waste?
13. Why are these values elevated in this patient?
Lab Results
Initial Significant Laboratory Blood Chemistry Results
Key Urinalysis Values
Case Questions
17. Does the presence of glucose and protein in
Case Questions
21. What are the effects of diuresis in treating a patient with
kidney disease?
22. Why is protein restricted in the diet?
Case Questions
23. What is renal dialysis?
24. What are the 2 different options for a patient facing renal
dialysis? How do these 2 methods differ? List advantages and
disadvantages of each.
ATN is the death of tubular cells, which may result when tubular cells do not get enough
oxygen (ischemic ATN) or when they have been exposed to a toxic drug or molecule
(nephrotoxic ATN). Fortunately, new tubular cells usually replace those that have died.
Indeed, the tubular cells of the kidneys undergo a continuous cycle of cell death and
renewal, much like the cells of the skin.
In the hospital setting, ATN is the most common cause of acute renal failure (ARF).
Hospital patients often have acute medical problems that limit the oxygen supplied to the
tubules or that cause tubular hypoperfusion (decreased blood flow).
Certain medical and surgical situations are associated with a high risk for
developing ischemic ATN:
Hypotension (low blood pressure)
Obstetric (birth-related) complications
Obstructive jaundice (yellow-tinged skin caused by blocked flow of bile
Prolonged prerenal state
Sepsis (infection in the blood or tissues)
Surgery (e.g., open heart surgery, repair of abdominal aortic aneurysm)
Some medications and clinical materials can cause nephrotoxic ATN:
Aminoglycosides (antibacterial antibiotics such as streptomycin and gentamicin)
Amphotericin B (antibiotic used to treat some forms of meningitis and systemic fungal
infections)
Cisplatin (anticancer agent used to treat late-stage ovarian and testicular cancers)
Radioisotopic contrast media (agent used in certain imaging studies)
Treatment
Treat the underlying cause
Renal Dialysis
In medicine, dialysis (from Greek dialusis meaning dissolution, dia,
meaning through, and lysis, meaning loosening or splitting) is a
process for removing waste and excess water from the blood, and is
used primarily as an artificial replacement for lost kidney function in
people with kidney failure.
Dialysis may be used for those with an acute disturbance in kidney
function (acute kidney injury, previously acute renal failure) or
chronic kidney failure
Hemodialysis: Blood is pumped from body to a filter where it is
purified and returned to the body.
Advantages: No patient training is required.
Disadvantages: Dialysis graft failure, cannot be performed at homelack of freedom
Peritoneal dialysis: Bodies peritoneal membrane is used as a
filter. Fluid is drained in and out of abdomen.
Advantages: It can be done at home--more freedom.
Disadvantages: Patient training, possible peritonitis and
membrane failure.