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L13 Renal and Hepatic impairment - Coggle Diagram
L13 Renal and Hepatic impairment
Functions of kidney
Endocrine-secrete renin, produce and secrete prostaglandins and erythropoietin
Metabolic- Activation of vitamin D, gluconeogenesis, metabolism of insulin and steroids
Excretory- Excretion of fluids, solutes, metabolic waste and maintaining homeostasis
Maintaining fluid balance
Maintaining normal blood pressure
Regulating bone mineralization
Producing Red blood cells
How to assess function of kidney?
Clinical evaluation
Low urine output may be acute renal failure
Uraemia-caused by excess nitrogenous waste retention
Causes nausea, vomiting, diarrhoea, confusion, fatigue, oedema (fluids retention)
Serum creatinine
Approximated GFR
Serum creatinine is used to approximate GFR.
Cockcroft-gault formula, also known as creatinine clearance (CrCl), not adjusted for body surface area.
CrCl=(140-age) x total body weight (Kg) x 88.4 x0.85(if female)/ SCr(μmol/L) x 72. *If SCr is given in mg/dL, omit 88.4 from equation.
Elevated serum creatinine is reduction of kidney function, but high muscle mass can also cause high serum creatinine
Normal range for women is 45-90 μmol/L, Men is 60-110 μmol/L
Estimated Glomerular filtration rate (eGFR), adjusted for body surface area, more accurate but not readily available. Units: ml/min/1.73m^2. eGFR= 175 x (standardized SCr (mg/dL)) ^-1.154 x (age)^ -0.203 x 0.742 (if female) x 1.210(if African American)
Blood urea nitrogen
Hemoglobin
Parathyroid hormone
Electrolyte levels
Urinary tract imaging & renal ultrasound
Urine analysis
Albumin/Creatinine ratio
Renal impairment
Risk factors
Age>60
Female gender
Smoking
Overweight
African American, Hispanic or Asian
Existing med condition like diabetes
Nephrotoxic drugs like ACEi, long half-lives drugs
Acute renal failure
Prerenal