Respiratory Disorders; Kidneys and Renal Disease

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Respiratory Disorders Kidneys and Renal
Disease

• Gilead -Topics in Human Pathophysiology Fall
  2010 Drug Safety and Public Health

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Respiratory Functions

• Gas exchange
• Protection
• Speech
• Compression of abdomen and spine stiffening
• Acid-Base balance

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Respiratory Disorders

• Flu (example H1N1)
• Asthma
• Cystic fibrosis (and accompanying infections)
• Pulmonary aspergillosis
• Pneumonia

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Flu (or H1N1)

• Cause
• Influenza virus
• Symptoms
• Fever
• Sore throat
• Cough
• Body aches
• Headache
• Chills
• Fatigue
• Vomiting and diarrhea

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H1N1
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Flu

• Susceptible populations
• Antivirals for influenza Tamiflu (oseltamivir),
  Relenza (zanamivir), peramivir
• Complications
• Pneumonia and respiratory failure
• Bronchitis
• Ear infections
• Sinus infections

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Asthma
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Cystic fibrosis

• Inherited disorder causing a defect in a cell
  membrane Cl- channel
• Causes thick sticky mucus buildup in airways and
  ducts of pancreas, etc.
• Shortens lifespan because of pneumonia,
  malnutrition, etc.

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Pulmonary aspergillosis

• Fungal lung infection
• Common with AIDs patients and cystic fibrosis
  patients
• Treated with Ambisome (amphoterocin B), one of
  several antifungals, alters fungal cell
  permeability

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Pulmonary Aspergillosisfrom an AIDS patient
during autopsy
http//www.ispub.com/ostia/index.php?xmlFilePathj
ournals/ijid/vol6n1/aspergillosis.xml
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Pneumonia

• Fluid buildup in lung alveoli
• Thickens respiratory interface, interrupting
  diffusion of gases
• Caused by a wide variety of microorganisms
  including bacteria, aspergillus and pneumocystis
  fungi, influenza virus (Tamiflu), cytomegalovirus
  (Vistide)

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Pneumonia
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Gilead treatments for lung infections

• Cayston (aztreonam) for Pseudomonas aeruginosa
• Tamiflu for influenza viruses
• Ambisome for aspergillus fungus
• Vistide for cytomegalovirus

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Tests for Lung Function

• Chest X-ray
• Pulmonary function tests
• Sputum cultures
• Pulse oximetry
• Arterial Blood Gases (ABGs)

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Pneumonia X-ray
http//www.med-ed.virginia.edu/courses/rad/cxr/pat
hology3chest.html
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Sputum Culture

• Patient donates a sputum sample
• It is cultured with various media to determine
  causative agent of lung infection

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Pulse Oximetry

• Measures arterial hemoglobin oxygen saturation
• Normal is gt 95
• Indicator of effectiveness of respiratory
  interface and gas diffusion

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Arterial Blood Gases

• pH
• PCO2
• PO2
• O2 Saturation
• HCO3-

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Renal Pathophysiology
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Kidneys maintain homeostasis

• Maintain water balance
• Regulate salt balance
• Maintain acid-base balance and blood pH
• Control production of red blood cells
• Activate an inactive form of vitamin D

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Figure 15.2
Normal Kidney Anatomy
The nephron is the functional unit of the kidney
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Figure 15.6
Overview of Nephron Actions
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Nephron Actions

• Filtration
• Reabsorption
• Secretion

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Figure 15.4
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Glomerular Apparatus
The glomerular capillaries filter the
blood. Glomerular filtration rate is an indicator
of kidney health.
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Tubules reabsorb nonwastes, and secrete wastes,
allow urine to be concentrated, control
electrolyte balance.
Figure 25.16
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Kidney DisordersAcute Renal Failure

• Causes
• Decreased blood flow to kidneys
• Large kidney stones
• Infections
• Burns
• Severe injuries
• Toxic drugs and or chemicals (antivirals,
  especially anti-HIV drugs)
• Tubule damage is typical and signs include
  problems with reabsorption and secretion and thus
  changes in serum electrolytes
• Can be reversed by eliminating the cause

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From radiology.rsna.org/ content/242/1/175/F5.exp
ansion
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Acute Renal Failure

• Signs symptoms
• Oliguria or anuria
• Swelling / edema
• Mental status changes
• Tests
• Urinalysis
• Serum creatinine
• blood urea nitrogen (BUN)
• serum potassium
• Kidney ultrasound or X-ray to rule out
  obstructions to urine

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Kidney DisordersChronic Renal Failure - End
Stage Renal Disease (ESRD)

• Generally caused by long term damage to nephrons
  reducing GFR and urine output
• Risks include hypertension, diabetes mellitus,
  untreated acute renal failure
• Increased leakage through glomerulus leads to
• Proteinuria- proteins in urine
• Hematuria blood in urine
• Azotemia excess nitrogen containing compounds
  in blood
• Edema
• Hypertension

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Kidneys maintain homeostasis

• Maintain water balance
• Regulate salt balance
• Maintain acid-base balance and blood pH
• Control production of red blood cells
• Activate an inactive form of vitamin D

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Stages of Chronic Kidney Disease (ESRF)
Stage 1 Normal or increased GFR 90mL/min or above Some evidence of kidney damage (microalbuminuria/proteinuria, hematuria, or histologic changes) Asymptomatic
Stage 2 GFR 60-90 mL/min Kidney damage with mild decrease in GFR Asymptomatic
Stage 3 GFR 30-59 mL/min Kidney damage with moderate decrease in GFR Asymptomatic, may have anemia
Stage 4 GFR 15-29 mL/min Kidney damage with severe decrease in GFR Hyperkalemia Anemia
Stage 5 GFR lt15 mL/min Kidney failure renal replacement therapy needed to sustain life Uremia, platelet dysfunction, encephalopathy, peripheral neuropathy, anorexia, nausea and vomiting, pericarditis, pruritus, lethargy and increased somnolence) Metabolic acidosis Protein catabolism Renal bone disease Sodium water retention?edema, pulmonary hypertension, systolic hypertension
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Treatment for Renal Failure

• Control the underlying cause, i.e. diabetes, HTN,
  drug therapy
• Controlled fluid intake
• Diet
• rhEPO
• Kidney Transplant
• Dialysis

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Dialysis Treatment
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Review of Clinical Tests for Renal Injury

• Complete medical and medication history
• Complete physical examination
• Microscopic exam---clues in the urine sediment
  (eg. hematuria)
• Urinalysis---any protein, WBCs, blood?
• BUN/creatinine, electrolytes, GFR, quantitative
  protein, urine serum/potassium
• Renal ultrasound
• Renal biopsy