It Is Imperative For Guide Angela Into Talking By Angela...

It Is Imperative For Guide Angela Into Talking By Angela...
It is imperative to guide Angela into talking. This involves listening to the whole story and retelling
the story to Angela of what was heard by her telling the story. Time guiding the conversation to aid
Angela in understanding that the grief process is also a healing process. Guiding also "include
instruction and information, but it is aimed much less at acquiring than restoring – restoring the
parishioner's soul, thus becoming more of her true self again."
One of the other issue Pastor Bob needs to address is the congregation and their concerns and
emotions dealing with the situation. There is evidence that they are creating triangles by talking
among themselves. They seem to be justifying the death being cause by Angela's possible drinking
and lack of being present when the water swept her son into the current. "Triangles are created more
frequently and cause great damage when anxiety increases in a system." There is certainly anxiety in
this case study in reference to the death of a child.
The second case study addressed in this paper is Die or Dialysis found on pages 83 – 85 of the
Wood and Blue book. In this case study, Pastor Bob of St. Miscellaneous church deals with a shut–
in from his congregation named Olive who had only been able to attend worship service a few times
during Pastor Bob's five year assignment at that church. Olive suffered from a number of illnesses.
She is a breast cancer survivor and was currently on kidney dialysis for her kidney
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Acute Kidney Injury
Acute Kidney Injury (AKI) is often characterized by a rapid decline in renal excretory function,
and/or a significant decrease in urine output (SOURCE). The exact level of function loss required to
be defined as AKI has been debated; however, the Acute Kidney Injury Network (AKIN) has
released a widely accepted system used to define AKI and its varying levels of severity (1). The
stages of AKI severity are classified as: risk, injury, failure, loss of function, and end–stage kidney
disease, collectively referred to as RIFLE, as illustrated in Figure 1. Severity is defined based on
glomerular filtration rate (GFR) and urine output criteria. GFR criteria includes serum creatinine
concentration (Screat) and GFR, with an increase in Screat or a ... Show more content on
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This physical damage can result from _____________. Mechanical ventilation can also cause the
development of AKI by alteration of systemic and renal hemodynamics through changes to cardiac
output. Studies have shown that PPV, by increase intrathoracic pressure, can decrease cardiac output
(CO), which has been correlated with a decrease in renal plasma flow (RPF), GFR and UO (25).
This correlation is supported in a canine study done by Qvist et al., in which they found that when
CO was not altered during PPV, there was no decrease in GFR or UO (26). In addition to the
hemodynamic effects seen in PPV, there are also marked neurohormonal effects of mechanical
ventilation resulting in AKI. These include the increase of antidiuretic hormone (ADH) secretion,
suppression of atrial naturitic peptide release, as well as alteration of the renin–angiotensin–
aldosterone–axis (RANA) through the increase in sympathetic flow, and the accompanying increase
in renin activity. These changes result in decreased renal blood flow, GFR, and UO. There is also an
increase in fluid retention, however, there is some evidence that this occurs as a result of the release
of vasoactive substances, which shift intrarenal blood flow from the cortex to the medulla, resulting
in greater fluid retention, regardless of the level of renal

The Causes and Treatments of Acute Renal Failure
According to Sushrut Waikar, "Every year more than 1 million hospitalizations in the United States
are complicated by acute kidney injury, accounting for an estimated $10 billion in excess costs to
the healthcare system." Acute Renal failure is the inability of your kidneys to work properly. Your
kidneys lose the ability to remove waste, filter and balance fluid and electrolytes. This type of renal
failure happens most often when there is an injury or trauma and blood flow to kidneys is severely
compromised. A person can return back to normal after having acute renal failure, that is if you
detect the problem and treat it on time. There are three causes prerenal, intrarenal and postrenal. In
prerenal there is a sudden and drastic drop in blood pressure which can result in no blood flow to
your kidneys also dehydration can be a part of it as well. Intrarenal occurs when the damage being
done is directly to the kidneys. This can happen from the overuse of medications. Medications are
not bad when used correctly but when you overuse or don't use them correctly they can be very
harmful to your kidneys. Postrenal is when there is an obstruction in the urinary tract most often
from renal calculi or an enlarged prostate in men that blocks the flow of urine.
Diagnostic tests can be done to determine kidney function. The most important test to determine
kidney function would be BUN and creatinine. Normal BUN is 6–20 mg/dl, creatinine normal levels
are 0.6–1.2mg/dl. If kidneys begin

Acute Kidney Injury Essay
Acute Kidney Injury (AKI) refers to the rapid decline of renal filtration and urine production.
Damage is often due to an injury, causing functional and/or structural deviations in the kidney. This
can lead to complications such an increased risk of chronic kidney disease, or it can affect other
organ systems. Additionally, AKI can potentially lead to death. Hypoxia (deficiency of the amount
of oxygen reaching tissues) often causes inflammation of the kidney, creating damage.
Purpose of Research:
The objective for this project is to use a hypoxia–induced mouse model to study AKI to gain a
deeper understanding of acute kidney injury.
To find early detection metabolic biomarkers for hypoxia–induced AKI.
Goals:
¥ The goal is to subject 24 mice to 3 hours of 10% Oxygen (normal Oxygen is about 22%) to mimic
the symptoms of hypoxia–induced AKI in humans. ... Show more content on Helpwriting.net ...
¥ This early detection biomarker will then allow for patients who are suffering most from this illness
to be diagnosed with hypoxia–induced AKI much earlier allowing for a greater chance of survival.
Expected outcomes:
¥ To find one or multiple biomarkers (such as: NGAL, Cystatin C, HIF–1, or Aquaporin–1) that will
earlier detect hypoxia–induced AKI.
¥ To find a statistical difference between the upregulation of a specific metabolite in the hypoxia–
induced mice as compared to the control mice.
¥ To use the mouse model as a comparison to human metabolites and determine if the same
metabolites found in the mouse model can also be found in humans.
Educational Benefit:
¥ Learning how to improve technique when performing mice dissections and to be more
comfortable when handling and working with mice as well as and improving proper lab technique
when preparing

Acute Kidney Injury : Acute Liver Injury
Prerenal Acute Kidney Injury Pathophysiology The human body has paired kidneys at the back of
the abdominal wall. The kidneys play an important role in filtering blood, removing wastes and
maintaining the body's electrolyte and fluid balance by means of creating urine. Kidneys also play a
crucial duty in producing red blood cells and regulating blood pressure by the secretion of hormones
(Huether & McCance, 2012). Kidney function is vital for life and the disruption of function could be
detrimental to one's health.
Acute kidney injury (AKI) is rapid renal function decline with a decrease in glomerular filtration
and consequently the build up of nitrogenous waste products in the body. AKI is reversible, but is it
also more likely to progress into chronic kidney disease. Acute kidney injury incidence is common
in the United States and it's growing. According to research, acute kidney injury accounts for ten to
twenty percent of hospitalized adults (Levey, 2015). Since it is fairly common there is a need to
diagnose earlier with increased meticulousness in order to prevent total kidney failure. Acute kidney
injury can be categorized as prerenal, intrinsic, and postrenal (Yaklin, 2011) Prerenal injury
prevalence is the most common and will be discussed further.
Pathophysiology
The main development in prerenal acute kidney injury occurs from the blockage of the renal artery.
This blockage is what ultimately leads to an insufficient supply of oxygen and nutrients.

Acute Treatment Of Acute Kidney Injury
Acute kidney injury (AKI, previously referred to as acute renal failure) is a common and serious
condition particularly among hospitalized patients with acute illness and those undergoing major
surgery.It can be life–threatening but it can also be reversible. Clinically AKI is characterized by
abrupt loss of kidney function resulting in a rapid decline in the glomerular filtration rate
(GFR),water and electrolytes imbalance, and accumulation of nitrogenous wastes such as blood–
urea nitrogen and creatinine.
Epidemiology of AKI
The mortality rate of AKI is very high (up to 80% mortality in critically ill children and adults).The
incidence rate of AKI has increased in hospitalized patients gradually from 4.9% in 1983 [1] to 20%
in 2012 [2].There are more than 35 definitions of AKI [3] which makes the incidence rate varies
greatly due to the lack of a standard and Definition. The Acute Dialysis Quality Initiative (ADQI)
published (RIFLE) criteria (Risk, Injury, Failure, Loss, End–Stag) in 2004 (table1).
Pathophysiology:
In order to study a biomarker of AKI, It is very important to understand the early response
mechanism of the kidney to acute injury. AKI results from multiple causative factors which are
classified as pre renal (ischemia, hypovalemia), renal(toxins, drugs, infection and inflammation of
the kidney e.g glomerulonephritis and acute tubular necrosis) and post renal (obstruction e.g Acute
obstructive uropathy, benign prostatic hyperplasia and kidney stone).This

The Issues Associates with Acute Renal Failure
Acute renal failure is the most common kidney disease that exists today. It occurs when blood flow
to the kidneys is in some way compromised which causes a sudden stop in kidney function. Acute
renal failure is a very serious complication for a already hospitalized patient since they are already
in a vulnerable state from staying in the hospital, in fact, it is the most common cause of death
amongst hospitalized patients, and most commonly they occur because of a hospital workers error.
Acute renal failure causes many serious problems for patients, including abnormal electrolyte and
acid–base balance, excess in fluid volume, and an excess in nitrogenous wastes. Acute renal failure
can have either pre–renal, intra–renal, or post–renal causes. According to WebMD (2011), "the
pathophysiology of pre–renal acute renal failure is a sudden reduction in blood flow to the kidney
causes a loss of kidney function. In pre–renal acute renal failure, there is nothing wrong with the
kidney itself." The pathophysiology of intra–renal acute renal failure is when there is damage
directly done to the kidneys from either inflammation, infection, drugs, toxins, or a reduced blood
supply to the kidneys. The pathophysiology of post–renal acute renal failure is when there is
suddenly an obstruction of the flow of urine because of a tumor, kidney stones, an enlarged prostate,
or an injury. At the end of the post–renal acute renal failure stage, the next stage is chronic renal
failure. As the stages

Acute Real Failure
The diagnosis of acute renal failure (ARF), also referred to as acute kidney injury (AKI),
encompasses a wide–ranging continuum of acute renal pathologies that are characterized by sudden
deterioration of kidney function. This results in abrupt aberrations in fluid, electrolyte, and acid–
base balance, nitrogenous waste removal, creatinine clearance, and glomerular filtration rate. ARF
or AKI is subdivided into three general categories based on the etiology. Again, aging alone, without
the presence of any comorbidities, is associated with an increased susceptibility to ARF. This is due
to deterioration of renal blood flow with age and consequent decrease in glomerular filtration rate
(GFR). This is probably because, with these changes, there ... Show more content on
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intracellular potassium ion gradient is fundamental to the establishment of the resting membrane
potential in excitable cells (neurons and muscle cells) is necessary in order to appreciate how
hyperkalemia (excess extracellular K) disrupts this delicate balance. Because of the loss of this
potassium gradient, excitable cells become hypopolarized, and are therefore less responsive to
stimuli (action potentials). This results in muscle weakness and flaccid paralysis that progresses in
an ascending pattern. The main concern with hyperkalemia is its implication on the cardiac system
(Copstead & Banasik, 2013). Hyperkalemia that exceeds 6.0 mEq/L can be fatal because of its
depressant effects on myocardial activity. This is demonstrated on an ECG tracing with the
disappearance of the P wave, extended T wave and QRS segment, and depressed ST segment.
Should this happen, the client is an emergent situation and immediate measures must be taken to
reduce serum potassium to prevent cardiac arrest (Osborn, et al. 2014). This patient's serum
potassium was 6.1 mEq/L on arrival, which placed at an extremely high risk for cardiac dysfunction.
He was immediately given a combination of immediate and longer–acting medications to lower his
serum potassium (calcium, D50, insulin, bicarbonate, and

Chronic Renal Failure Research Paper
Acute renal failure occurs when your kidneys suddenly become unable to filter waste products from
your blood. As a result, dangerous levels of wastes may accumulate and your blood's chemical
makeup may get out of balance. It is usually caused by an event that leads to kidney malfunction
such as dehydration, blood loss from a major surgery or injury, or the use of certain medications.
Symptoms of decreased kidney function, such as fluid buildup or electrolyte imbalance are more
likely to develop with acute renal failure, regardless of how long the kidney itself has been
malfunctioning. The signs and symptoms present may reflect the actual cause of the kidney
problem. For instance, an obstruction in the urinary tract may cause flank pain, blood ... Show more
content on Helpwriting.net ...
Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine.
Initially, there may not be very many signs or symptoms present. As a result, chronic renal failure
may not become apparent until kidney function is significantly impaired. It is not uncommon for
signs and symptoms to develop over time if kidney damage progresses slowly. With that being said,
signs and symptoms of renal failure are often nonspecific and can be caused by other illnesses.
Chronic renal failure usually occurs when a disease or condition impairs kidney function such as
diabetes or hypertension, which causes kidney damage to worsen over several months or years.
Unfortunately, this can potentially lead to other problems including anemia and increased levels of
phosphate in the blood. There are several different forms of treatment for chronic renal failure,
consisting mostly of medications. These medications are used to treat the following: high blood
pressure, lower cholesterol levels, anemia, relieve swelling and protection of bones. In addition, a
lower protein diet may be recommended to minimize waste products in your blood. If your kidneys
are unable to maintain waste and fluid clearance on their own, however, dialysis and or a kidney
transplant may be

Acute Renal Failure
Acute Renal Failure
Acute Renal Failure (also called acute kidney failure) means that your kidneys have
Suddenly stopped working. Your kidneys remove waste products and help balance
water and salt and other minerals (electrolytes) in your blood. Acute Renal Failure is
dangerous because the kidney stop filtering toxin, waste and excess fluids from the
the body. Acute Renal Failure is often the result of an infection, an injury, major
surgery, or a condition called nephrotoxicity. It can also happen from an overdose of
drugs, or when the blood flow to a kidney is obstructed or blocked and this can cause
a damage to the kidney even death. There were three main causes of acute renal
failure (Prerenal, Intrarenal and Postrenal).
Prerenal– The kidneys do not receive enough blood to filter that can cause multiple
complications such as disruption of the blood flow in the kidneys from a variety of
causes such as blockage or narrowing of a blood to the kidneys, liver failure causing
changes in hormones that affect blood flow and pressure to the kidneys, drastic drop in
blood pressure after surgery with blood loss, sever injury or burns, or infection in the
bloodstream (sepsis) causing blood vessel to inappropriately relax. Blockage or
narrowing of a blood vessel caring blood to the kidneys. Heart failure or heart attacks
causing low blood flow and dehydration from diarrhea, vomiting, water pills and blood

Health And Social Care Reflection Essay
For the purpose of confidentiality and anonymity, I have changed the patients name and throughout
of the reflection I will refer to them as Mrs Smith. Mrs Smith is a pleasant lady in her late 70's who
suffered from breast cancer, renal failure and several other health issues. Mrs Smith was diagnosed
with diabetes quite early on in her life and has recovered from hip replacement and several fractures
leading to restricted mobility. Mrs Smith requires a vast amount of assistance whilst socialising and
being at home, she is incapable of applying weight on her legs therefore requires hoisting to and
from her bed/chair. The majority of Mrs Smith's care whilst at home is covered by district nurses
who pay a visit on a daily basis, Mr Smith also ... Show more content on Helpwriting.net ...
Criticising upon the experience Mr and Mrs Smith had with their GP shouldn't have been the way it
was, due to the fact Mrs Smith also had several other health related issues her matter should have
been considered serious however unfortunately she wasn't supported as well. The NMC code,
(2016) states that people are to be prioritised, to achieve this practitioner's must 'make sure they
deliver the fundamentals of care effectively' and 'make sure that any treatment, assistance or care for
which they are responsible is delivered without undue delay.' The aim of the NHS is to nurture,
provide, and protect the general public, after the rejection on several occasions from her GP she felt
that she wasn't supported as she should have been. 'Commitment to the quality of care' is one of the
core values which can be used to reflect and evaluate upon the situation Mrs Smith was in, 'the NHS
aspires to the highest standards of excellence and professionalism in the provision of high quality
care that is safe, effective and focused on patient experience.' However, commitment wasn't shown
effectively to the patient whilst continual visits made to the GP were meaningless, as a reflection
upon this for future experiences I would always aim to implement the most suitable and appropriate
care to help my patients and encourage patients to seek emergency help when unsure about their

Acute Renal Failures
Acute Renal Failure The kidneys are vitals organs that are responsible for various function in the
human body such as reabsorption, secretion and excretion. They are the filters that enable us to get
waste materials that are produced by metabolism or ingested. The most important element that they
filter is blood plasma. The kidneys simultaneously eliminate unwanted substances by excreting them
into the urine and return substances that are needed back in to the blood. While filtration is the
primary function the kidneys are responsible for regulation of arterial pressure, acid–base balance
and excretion of hormones. Any injury to the kidney may result in an interruption of these functions.
The kidneys are highly vascular organs that receive on average about 1100ml of blood per min.
which is 20–25% of total cardiac output. This large volume is necessary to provide enough plasma
for the high glomerular filtration rate needed to effectively regulate fluid volumes and solute
concentrations. Therefore when the blood supply to the kidneys is compromised the kidneys start to
show signs of failure. The causes of renal failure can divided into three categories prerenal,
intrarenal, and postrenal. Prerenal cute renal failure is a result of decreased blood flow to the
kidneys. It can be a result cardiac failure and of intravascular volume depletion such as hemorrhage
and burns. Without adequate blood flow the glomerular filtration rate is reduced as well as the
amount of

A Brief Note On Acute Renal Failure Condition Essay
1. Describe the pathophysiological changes that occur in acute renal failure. Acute renal failure
condition is diagnosed and retitled as acute kidney injury. The purpose of the change of terminology
was to encompass the full spectrum of the clinical manifestations associated with the syndrome.
This includes a range from a small decline in kidney function to a severe impairment. Furthermore,
the acute condition is characterized by a rapid loss of kidney function. In addition, associated
manifestation(s) may be displayed as a rise in serum creatinine or a reduction in urine output. As a
result of increase of serum creatinine or decline in urine output may developed and aggress to the
clinical manifestation azotemia. However, acute kidney injury is complications are reversible.
Patients with life threatening conditions are more susceptible to developing this disorder. Acute
kidney injury is commonly developed after either chronic hypotension or hypovolemia or exposure
to a nephrotoxic agent. With increased levels of blood urea nitrogen (BUN), creatinine, and
potassium with or without a reduction in urine output develops acute kidney injury over hours or
days (Lewis, 2014, p. 1101–1102). High incidents of hospitalized patients develop AKI, one out of
five, and a high mortality rate. (Lewis, 2014, pp. 1101–1102)
2. Differentiate between the causes, signs and symptoms, and diagnostic findings in pre– renal,
intra–renal, and post–renal failure.
Prerenal
In the

Acute Renal Failure Of The Urinary System
Diana Galeana
MED 2049
Acute Renal Failure
Instructor Michelle Earxsion– Lamothe
7/25/2014
Acute Renal Failure
Although the function of the urinary system is used to filter and eliminate waste from the body, it
also contributes with maintenance of homeostasis of water and blood pressure, regulates
electrolytes, pH balance, and activates vitamin D. The urinary system consists of 2 kidneys which
extract wastes from the blood, balance body fluid, and converts it into urine. It also includes 2
ureters which conduct urine from the kidneys to the urinary bladder via peristalsis, a urinary bladder
which serves as a reservoir for urine and finally a urethra which conducts urine from the bladder to
the outside of the body for elimination. The ureters, urinary bladder, and urethra together form the
urinary tract, which acts as a plumbing system to drain urine from the kidneys, store it, and then
release it during urination (Taylor, 1999).
As simple as this urinary system may sound there are also complication such as acute renal failure
or acute kidney failure, this occurs when the kidneys suddenly are unable to filter waste products
from the blood. When kidneys lose their filtering ability, dangerous levels of wastes may accumulate
and the blood 's chemical makeup may get out of balance (mayo clinic, 1998). Acute renal failure is
categories into three different stages prerenal, intrarenal, and postrenal.
Prerenal is the most common type of acute renal

The Epidemiology Of Chronic Kidney Disease
In the past decade, the epidemiology of acute kidney injury and chronic kidney disease has pointed
to the fact that these are not distinct disease entities, but are in fact interconnected. Acute kidney
injury may lead to chronic kidney disease, both share common risk factors: (1) race/ethnicity; (2)
genetic factors; (3) hypertension; (4) diabetes mellitus; and (5) metabolic syndrome (Chawla,
Eggers, Star & Kimmel, 2014)
Mr. Fisher has chronic hypertension, diabetes, and may have metabolic syndrome, as evidenced by
obesity and hypertension. Metabolic syndrome is characterized by an increased waist size,
triglycerides that are >150mg/dl, HDL 130/85, fasting glucose >100mg/dl. (McCance & Huether,
2014). I do not how well Mr. Fisher's blood glucose

Acute Renal Failure Essay
Acute renal failure is the sudden loss of the kidneys ability to function; affecting more than 100,000
people in the United States alone each year (NIDDK, 2008). This paper will discuss the basic
pathophysiology of acute renal failure, including its cause, disease mechanisms, symptoms, some of
the treatments and pharmacological therapies.
Pathophysiology
Acute renal failure (ARF) is the rapid loss of kidney function occurring when high levels of uremic
toxins accumulate in the blood. ARF occurs when the kidneys are unable to excrete the daily load of
toxins in the urine. The most common causes of ARF are dehydration, blood loss from major
surgery or injury, or medications such as NSAIDs, antibiotics, or the dyes used in ... Show more
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However, the kidneys usually start working again within several weeks to months after the
underlying cause has been treated. "Many people, however, die because of the primary disease that
has caused the kidney failure. Studies have estimated overall death rates for AKF at 42–88%,"
(Krapp, 2002). Up to 10% of patients who experience ARF will suffer irreversible kidney damage.
They will eventually go on to develop chronic kidney failure or end–stage renal disease. These
patients will require long–term dialysis or kidney transplantation to replace their lost renal
functioning (Krapp, 2002).
Clinical manifestations
In the beginning stages of ARF, there may not be any symptoms; usually symptoms become
noticeable the longer ARF goes undetected or is left untreated. Fatigue is a common symptom due to
anemia. Healthy kidneys produce a hormone called erythropoietin that tells the body to make red
blood cells. As the kidneys fail, they make less erythropoietin (NIDDK, 2008). With fewer red blood
cells to carry oxygen, the body becomes tired very quickly. Some patients experience lower back
pain resulting from kidney stones or other obstructions. A big indicator of kidney problems is
changes in the urination, including decreased urine output. In addition, the urine might be foamy
signifying buildup of protein, or contain blood due to an obstruction. Edema could be present due to
the build of fluids within the body (Cadwallader, 2002).
Diagnosing ARF

Cardiorenal Syndrome Research Paper
Type 1 (Acute Cardiorenal Syndrome)
Type 1 cardiorenal syndrome is defined as "Acute worsening of heart function leading to kidney
injury and/or dysfunction" (7). Examples include acute heart failure, acute coronary syndrome or
cardiac surgery resulting in worsening of renal function, or contrast induced nephropathy after
coronary angiogram (8). 27 to 40% of patients admitted to the hospital with acute decompensated
heart failure (ADHF) appear to develop acute kidney injury and fall into this clinical entity (9, 10).
These patients experience higher morbidity and mortality, and longer hospital stay (2).
Type 2 (Chronic Cardiorenal Syndrome)
Type 2 cardiorenal syndrome is defined as "Chronic abnormalities in heart function leading to
kidney injury and/or dysfunction" (7). Examples include ischemic heart disease, hypertension,
congenital heart disease, chronic heart failure, left ventricular remodeling and dysfunction, diastolic
dysfunction and cardiomyopathy resulting in kidney disease. (7, 8). This type is reported in 63% of
patients admitted to the hospital with congestive heart failure. (11, 12). ... Show more content on
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This subtype refers to abnormalities in cardiac function (acute heart failure, acute coronary
syndrome, arrhythmia, cardiogenic shock or acute pulmonary edema) secondary to acute kidney
dysfunction such as acute kidney injury, ischemia or glomerulonephritis, or contrast induced
nephropathy with adverse cardiac outcomes (7, 8, 13).
Type 4 (Chronic Renocardiac

Catheterization Term Paper
The decision either to perform or not to perform a cardiac catheterization in a patient who also has
acute renal failure can be a difficult decision to reach. Diagnostic blood and urine tests can prove to
be beneficial in helping the provider make such a tough decision. The contrast used in the cardiac
catheterization can harm the function of the kidneys, and it can push the patient from acute to
chronic renal failure, which can influence quality of life as well as morbidity and mortality. When a
patient has chest pain, the nurse practitioner should perform a thorough assessment to ensure the
angina is cardiac–related and not from another source, such as pleuritic chest pain or muscular chest
pain (Grossman & Porth, 2014). Once it is confirmed by one's assessment that the chest pain is
cardiac–related, then one should look at serum diagnostic results, such as the cardiac enzymes. ...
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(2012) is the urinary live–type fatty acid–binding protein (L–FABP). Manabe et al. (2012) found L–
FABP is a valuable predictor of contrast–induced nephropathy for individuals with chronic kidney
disease who required contrast for diagnostics prior to actual exposure to the dye. The predictive
level of L–FABP is greater than or equal to 24.5 µg/g for individuals with chronic kidney failure
prior to contrast exposure (Manabe et al., 2012); this means that if an individual has an L–FABP
level of 24.5 or higher, then the likelihood of developing contrast–induced nephropathy is high.
However, there is a need for more studies for the utility of L–FABP for individuals with acute
kidney failure, instead of chronic kidney failure. If this test proves to be beneficial for individuals
with acute renal failure, then perhaps this could assist providers in their evaluation of the risks and
benefits associated with contrast–involved diagnostic studies and interventions in patients with acute
renal

Acute Renal Failure: A Case Study
Acute renal failure is defined as a substantial deficiency in renal function (Huether, 2017, p. 760).
Dirkes (2016) article explains:
Acute renal failure (ARF) was used in the past to describe any kind of kidney failure. The new term
acute kidney injury (AKI) indicates that this problem is a clinical manifestation of several disorders
that affect the kidney acutely. AKI indicates injury is occurring and it can be graded into mild,
moderate, and severe injury. The key is to identify kidney injury before it becomes kidney failure.
(p. 75)
AKI syndrome occurs when there is a sudden loss of excretory function by the kidney along with
buildup of nitrogenous metabolics such as creatinine and urea (Bellomo, Kellum, & Ronco, 2012, p.
756). The purpose of this essay is to describe and explain the pathophysiology, clinical
manifestations, and treatment of acute kidney injury.
Specific criteria for defining AKI, identified by the Acute Dialysis Quality Initiative, include the
following (RIFLE): Risk, Injury, Failure, Loss, and End–stage kidney disease (Bellomo et al., 2012,
p. 756). There are three classifications for AKI: prerenal AKI (renal hypoperfusion); intrarenal AKI
(intrinsic renal injury); or postrenal AKI ... Show more content on Helpwriting.net ...
If there are indications of prerenal AKI, hemodynamic resuscitation must begin immediately and
intravascular volume should be upheld or returned (Bellomo et al., 2012, p. 760). Management of
AKI includes: maintaining appropriate fluid and electrolyte levels, controlling extreme blood
pressures, treating and preventing infections, observing nutritious habits, and acknowledging that
specific drugs or their metabolic products may not be excreted and could be toxic. If AKI is not
diagnosed within a reasonable time, or if an individual has been in uncontrolled acidosis,
hyperkalemia, or severe fluid overload, then dialysis may be indicated (Huether, 2017, p.

Acute Renal Failure Essay example
Acute renal failure, also known as acute kidney injury is described to be a rapid loss of
kidney function, or a rapid decline in renal filtration function. The first signs of acute renal
failure can be found by a rise in serum creatinine concentration or azotemia, which is a rise
in blood urea nitrogen (BUN) concentration. Symptoms of acute renal failure may include,
little or no urine when urinating, swelling in the legs and feet, not feeling like eating,
nausea and vomiting, feeling confused, restless, sleepy or anxious, or pain in the back
below the rib cage.
The pathophysiology of acute renal failure is still uncertain though it is thought to be
caused by tubular necrosis and vasoconstriction. ... Show more content on Helpwriting.net ...
The third cause is the
postrenal, which is when there are obstructions in the urinary tract. This one affects the
normal flow of urine out of both kidneys from a blockage caused by kidney stones, a tumor,
an injury or from an enlarged prostate gland.
The diagnostic exams used to diagnose acute renal failure are the blood urea nitrogen
(BUN), the creatinine clearance, the serum creatinine, the serum potassium and the
urinalysis. Other tests to diagnose renal failure can include, an ultrasound to reveal any
obstruction to the kidneys, an imaging test which include CT scans or MRI to reveal a more
detailed image of the kidneys and other organs, a kidney biopsy where a small piece of

tissue can be removed and examined, or an x–ray to examine for pulmonary edema, fluid
retention in the lungs.
The first stage of renal failure is the acute renal failure stage, which is the crucial stage.
The patient must pay close attention to signs and symptoms in this stage. Signs may
include drowsiness, headache, and back pain, typically on the side also referred to as flank
pain. The second stage is the chronic renal failure, which is accompanied by feelings of
physical weakness, loss of appetite, generalized swelling and shortness of breath. The third
stage is end stage renal

Case Study: 70-Year-Old Patient
The patient is a 70–year–old gentleman that presented to the ED complaining of inability to walk
because of right hip pain. The patient was seen in the emergency room on 11/20/16, was given
Tylenol 3 discharged with pain meds after hip x–rays reported as being negative. The patient
continued to be in great pain and could not bear the pain any longer and in fact had an appointment
with his pain management physician and could not get there it was increased with any movement
and not relieved by Percocet. His comorbid conditions are asthma, congestive heart failure,
hypertension, morbid obesity, dyslipidemias and obstructive sleep apnea. He has also a right
inguinal hernia repair, back surgery a number of years ago. Upon admission it is noted that he has
intractable right hip ... Show more content on Helpwriting.net ...
He has chronic kidney disease compounded by acute renal failure, acute kidney injury at this point.
He also has diabetes. He is being treated with Metformin which is being held at this point because of
the acute kidney injury. Orthopedic consult reveals that he has limited range of motion of both lower
extremities in the left hip and the right hip pain consult that reveals that he has a CT bilateral L4–L5
and L5–S1 foraminal stenosis. He is seen in consult by the pain consultants who feel that he will
profit from bilateral SI joint

Essay On Renal Failure
Mr. Armstrong has a history of renal insufficiency and uncontrolled hypertension, along with
symptoms of fatigue, pedal edema, and occasional shortness of breath. He does not have a history of
trauma or obstruction to his kidneys, but his creatinine and BUN levels are currently at 3.5 mg/dl
and 40 mg/dl. Normal creatinine concentration values are 0.7 to 1.2 mg/dl and normal BUN values
are 10 to 20 mg/dl; this reveals that Mr. Armstrong's kidneys are not removing wastes properly
(McCance, Huether, Brashers, & Rote, 2014). Mr. Armstrong's history of renal insufficiency and
uncontrolled hypertension is commonly found in patients diagnosed with intrarenal (intrinsic) acute
renal failure. Intrarenal acute renal failure can be categorized as ... Show more content on
Helpwriting.net ...
Nephrotoxins, acute interstitial nephritis, glomerular damage, and vascular damage also correlate
with intrarenal acute renal failure (Singh, Levy, & Pusey, 2013). Postrenal acute renal failure is
usually a result of a urinary tract obstruction that affects the kidneys bilaterally, which causes the
intraluminal pressure upstream from the site of the obstruction to increase with a progressive
decrease in the glomerular filtration rate (McCance, Huether, Brashers, & Rote, 2014). A pattern
consisting of several hours of anuria with flank pain followed by polyuria is typically found in
individuals with postrenal acute renal failure (McCance, Huether, Brashers, & Rote, 2014).
What health issues has Mr. Armstrong had that can factor into the development of renal failure? Mr.
Armstrong being 76–years–old likely plays a factor in his diagnosis, considering that acute renal
failure is most common amongst the elderly (Singh, Levy, & Pusey 2013). Mr. Armstrong's history
of uncontrolled hypertension is likely due to primary hypertension, which is sustained increases in
blood pressure due to genetics combined with environmental factors that increase vascular tone and
blood volume (McCance, Huether, Brashers, & Rote, 2014). "Increased vascular volume is related
to a decrease in renal excretion of salt, often referred to as a shift in the pressure–natriuresis

Heart Failure And Acute Kidney Injury
Our current study demonstrates that among hospitalized HF patients, 2179 (32%) had traditional
AKI (rise in serum creatinine by >=0.3 mg/dl) and 789 (12%) of hospitalized HF patients developed
reverse AKI (drop in serum creatinine by >=0.3 mg/dl). The change in serum creatinine of greater
than or equal to 0.3mg/dl was associated with higher 30–day all–cause readmission and mortality.
Interestingly, reverse AKI group was also associated with higher 30–day all–cause readmission and
mortality. To our knowledge this is the first study that reports 30–day all cause readmission and
mortality by serial changes in serum creatinine in hospitalized HF patients. There is a need for
increased awareness regarding this particular subset of patients. ... Show more content on
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The explanation for presentation of this group is multifactorial including advanced stage of heart
failure, old age, hypertension, diabetes mellitus, acute coronary syndrome, secondary to aggressive
diuresis as supported by increased use of loop and potassium sparing diuretics and an intrinsic
imbalance between the vasoconstrictive (epinephrine, angiotensin, endothelin) and vasodilatory
hormones (natriuretic peptides, nitric oxide). 7
The risk of readmission and mortality in reverse AKI group is similar to traditional AKI as shown in
our study. Hence the increase in creatinine is not only a marker of severity of heart failure but also
represents a pathway for accelerated cardiovascular injury.
In a study of chronic heart failure patients in ambulatory setting the authors found that worsening
renal function within 6 months of referral was prognostically associated with all–cause mortality
and heart failure readmission. 8 Major studies to date predicting heart failure morbidity and
mortality do not include AKI as one of the prognostic indicators.9, 10 A recently published meta–
analysis suggests that the benefit of renin–angiotensin aldosterone inhibitor is not diminished by
worsening renal function and is in fact greater in the group with the worsening renal function.11
Hence contrary to the practice of stopping ACE/ARB in patients with AKI they are more essential in
this high risk group with increased readmission and mortality. Also

The Effects Of Diabetic Retinopathy On Mice
For as long as I can remember, I was always fascinated with how things worked. I'd take apart
electronics simply to learn about them and reassemble them afterwards. If I would receive a piece of
technology, the first thing I'd do is dismantle its hardware and software to learn how it worked and
how I could improvement. However, I noticed that something was missing– electronics never had
the close–knit relationship with people; you were essentially working with machines; you'd input a
command and you'd know what the output was each and every time. By the time I had started high
school, I had become increasingly interested in medicine when I took my first anatomy and
physiology course. This ultimately led me to pursue various clinical and research opportunities
when I started college. From my first year at Xavier University, my adviser gave me the opportunity
to begin researching the effects of diabetic retinopathy in mice. Being from Illinois and now going
to school in New Orleans, I never knew just how big of an issue diabetes was in the South. My
research in my adviser's lab helped relate what I had learned from my BCPM courses with what I
had observed in my clinical experiences and what I was exposed to socially. I was able to see that
medicine was about finding new avenues to deliver treatment and improve quality of life. This
allowed me to solidify what I had learned in lecture and see its immediate effects by integrating it
into my lab practices. By presenting at

Essay about Understanding Acute Renal Failure
The pathophysiology of acute renal failure is divided in 3 different causes. Out of the 3 causes of
acute renal failure pre renal is the most common. It may result in hypoperfusion and ischemia. Pre
renal is caused by a sudden drop in blood pressure or renal interruption of blood flow from the
kidneys from sudden severe injury or illness. Intrarenal is caused by direct damage to the kidneys
either by inflammation, toxins, drugs, infection or reduced blood supply. Postrenal is a sudden
obstruction of urine flow due to an enlarged prostate, kidney stones or bladder tumor or injury. The
least common out of all of these is the post renal acute renal failure. There will be several diagnostic
and lab tests preformed to help doctors ... Show more content on Helpwriting.net ...
Some subjective data includes.
I feel sick to my stomach
My appetite is not what it used to be
It hurts when I pee
I feel like I have to use the restroom all the time. There are many definitions associated with acute
renal failure. This includes Asthenia which is an abnormal physical weakness or lack of energy.
Azotemia means a medical condition characterized by abnormally high levels of urea and creatinne
in the blood. Uremia is a raised level in the blood of urea and other nitro waste compounds that are
usually eliminated by the kidneys. Oliguria is know by less urine coming out of the body. There are
many dietary restrictions to follow when you are diagnosed with acute renal failure. The nurse needs
to teach the client to eat foods that are healthy carbs, herbs and spices. The nurse needs to teach to
eat fruits like apples, grapes, cranberries, blueberries and strawberries because they are low in
potassium. The nurse also needs to tell the patient to avoid foods that are high in potassium like
bananas, oranges, and veggies like potatoes. The nurse should also recommend avoiding foods high
in phosphorus like milk, yogurt, cheese and colas. High protein foods should be avoided like
chicken and eggs and to stay away from salty foods like chips and pretzels. Limit fluid in– take and
take all medications prescribed by your doctor. Medical management is first and foremost in finding
the cause. The nurse can be expected to do many

Acute Kidney Injury (AKI)
Acute kidney injury (AKI) is a common clinical issue but the understanding of the syndrome has
been re–evaluated, standardised and aprimorated in the past years. The change from acute renal
failure to AKI happened due the fact the even mild change in function or structure of the kidney can
cause abrupt clinical manifestations such as change in extracellular volume and electrolytes balance
and inability to properly excrete nitrogenous waste products like urea. The old terminology is used
now saved for cases were renal replacement therapy is been considered due to severity. The AKI
diagnostic criteria is based in a 48 hour creatinin serum level rise by 0.3mg/dL or 1.5 times the
patient baseline level or urine decrease to a volume less than ... Show more content on
Helpwriting.net ...
The incidence and risk factors analysis of AKI postoperative has been mostly studied in cardiac
surgery. A study shows that the AKI requiring dialysis was 3.5% as a primary outcome and for
KDIGO–AKI 23% as a secondary outcome.(1)
A study appointed that patients submitted to urological surgery had a higher AKI incidence
accordingly with the type of procedure. Individuals enduring partial/radical nephrectomy and
nephroureterectomy had 43.1% incidence of AKI, other examples are transurethral resection of
bladder tumor with 15.3%, cystoprostatectomy at 3.6%, ureteroscopic lithotripsy at 3.6%,
transurethral resection of the prostate at 2.2% and both radical prostatectomy and JJ–stent insertion
with

Essay on Acute Renal Failure
1. Explain the pathoplysiology of acute renal failure. Including perenal,intraernal and posternal
causes. Acute renal failure is when the kidneys have suddenly stopped working this disease disables
the body's mechanism of excreting waste products and maintaining fluid electrolyte balance.
According to WebMD, the causes are characterized as a sudden decrease of blood flow to the
kidneys, damage from some medications, poisons, or infections, a sudden blockage that stops urine
from flowing out of the kidney.
Prerenal failure is caused by the perfusion of the kidney which then results to reduced cardiac output
and constriction of the afferent arteriole. If there is lengethened hypoperfusion which is
characterized as the decrease in the ... Show more content on Helpwriting.net ...
Lastly, for postrenal results from bilateral obstruction, accidental liagtion of ureters, bladder
obstruction, or urethral obstruction.
3. What are the subjective and objective signs and symptoms of acute renal failure. In this answer,
discuss the following terms: asthenia, azotemia, uremia, oliguria, anuria. Acute renal failure is the
sudden loss of the ability of kidneys to remove waste and concentrate urine without losing
electrolytes. It is classified into three categories prerenal, intrarenal and postrenal. According to
Health Communities.com, the signs and symptoms of acute renal failure are: dizziness, dry mouth,
low blood pressure, rapid heart rate, slack skin, thirst, weight loss, and a decrease in urine output.
Asthenia, azotemia, uremia, oliguria, anuria are all symptoms of acute renal failure. According to
medicine.net, asthenia is defined as weakness or lack of energy, strength. Azotemia is a medical
condition characterized by having abnormal high levels of nitrogen containing compounds. Oliguria
is characterized as a decreased production of urine. While uremia also called as prerenal azotemia is
described as the illness accompanying kidney failure. Lastly, anuria is defined as inability to
produce urine.
4. What dietary modification should the nurse teach the client who has renal insufficiency, chronic
renal failure or acute renal failure. Patient with kidney disease, also called renal failure, can use

What is Acute Renal Failure?
Acute renal failure is a disorder of the urinary system. It involves the loss of kidney function and
may occur suddenly. Acute renal failure occurs when blood flow to the kidneys is decreased. There
are numerous reasons why there may be a decrease in renal function. A urinary tract obstruction, low
blood pressure, illness, inflammation of the kidneys, and harmful substances are examples of causes
of acute renal failure. These causes have different origins. The causes are separated into prerenal,
intrarenal, and postrenal. Prerenal causes of acute renal failure are caused by a sudden drop in blood
pressure. It may also be due to an "interruption of blood flow to the kidneys from severe injury or
illness"(Stanbridge College, 2014). Prerenal is the most common cause of acute renal failure.
Intrarenal is caused by harmful substances, infection, and inflammation. These cause direct damage
to the kidneys. Postrenal is due to a decrease in urine flow. Obstruction of urine may be caused by
renal calculi, injury, strictures, an enlarged prostate, or a tumor in the bladder. Acute renal failure is
associated with decreased urine output. Further lab results can confirm acute renal failure.
Diagnostics that can confirm ARF test BUN, creatinine, phosphorous, potassium, hemoglobin,
hematocrit, and bicarbonate levels. There will be in increase in BUN, creatinine, potassium and
phosphorous levels. ARF test results will also show a decrease in hemoglobin, hematocrite, and
bicarbonate

Cardiac Surgery With Cardiopulmonary Bypass Essay
Introduction
Cardiac surgery with cardiopulmonary bypass (CPB) is one of the most widely recognized major
surgical procedures worldwide. Renal failure is a noteworthy cause of morbidity and mortality after
cardiac surgery.1,2 Acute kidney injury (AKI) occurs in about 20–40% of patients3 and is associated
with a mortality rate of 8% compared with 0.9% in patients without AKI. AKI requiring
hemodialysis in the postoperative period is uncommon (~ 1% to 5%), yet associated with a
remarkably high mortality rate of 30% to 60%.4 (11–13). AKI increases the risk for ensuing chronic
kidney disease and kidney failure, with its associated morbidity and mortality.5
Clinical prediction tools have been developed to estimate the possibility of cardiac surgery–
associated AKI (CSA–AKI).8–10 These have recognized female gender, impaired left ventricular
function, insulin–requiring diabetes, emergency surgery, and abnormal baseline renal function as
independent predictors of requirement for dialysis.23 Pathophysiological mechanisms of CSA–AKI
include decreased renal perfusion, lack of pulsatile flow, oxidative stress, hypothermia,
atheroembolism, and inflammation 23. The main mechanism of injury is thought to be intraoperative
ischemia–reperfusion injury (IRI).20 Prolonged duration of cardiopulmonary bypass (CPB) and its
inflammatory response, and prolonged aortic cross–clamping are the leading factors associated with
an increased likelihood of cardiac ischemia–reperfusion injury.22 Although

Ethical Issues Regarding Acute Kidney Injury
Acute kidney injury (AKI) is a fatal kidney disorder typically caused by renal ischemia, a condition
in which the kidneys do not receive enough blood. This syndrome is fatal and new therapeutic
strategies are needed to treat patients who have this syndrome. When the kidney goes through acute
injury, some regeneration occurs. replacing the damaged kidney cells and renal progenitor cells
(RPC) are a key player in kidney repair, however, they are very rare. Another method which can be
used for regeneration are stem cells. Stem cells are cells with no specific function until they
differentiate and they can become any other cell in the body. Both embryonic and adult ones can
help with self–repair. Adult stem cells(tissue specific stem cells) are ... Show more content on
Helpwriting.net ...
In this case they would use the embryonic stem cells to make more renal progenitor cells, which
would thus heal the kidney, however there are many ethical issues regarding embryonic stem cells.
The best option is a special type of stem cell known as an induced pluripotent stem cell(iPST). This
type of stem cell has been made from normal cells but have been changed in the laboratory to act
like embryonic stem cells. A major concern they had about induced pluripotent stem cells was that
they may cause a rapid increase of kidney cells, resulting in cancer. After putting induced
pluripotent stem cells in the kidneys of rats which had Acute kidney injury, the kidneys of the rats
started healing within 7 days and, over the course of 3 months, there was no cancer development in
the mice. The induced pluripotent stem cells were making more renal progenitor cells which, in turn,
helped heal the kidneys of the rats. This research is important because it shows how induced
pluripotent stem cells can help repair kidney injury. Perhaps stem cells can cure other disorders in
humans, relieving the suffering that the people with the disorders and giving them a better quality of

Severe Acute Kidney Injury
Introduction Acute kidney injury (AKI) following cardiac surgery is a well–known complication
that occurs in up to 30% of patients(1,2). Severe acute renal failure, which requires renal
replacement therapy, is associated with a very high mortality(60–100%) when treated with the usual
intermittent hemodialysis(3–5) . However, the introduction of continuous renal replacement therapy
has resulted in significant improvement in outcome as well reduction in mortality(1,5). One such
form of continuous renal replacement is continuous venovenous hemofiltration(CVVH). CVVH
treats uraemia and ultrafiltrate toxic proteins such as the myocardial depressant factor, thus it
improves heart and lung functions in patients with ARF and cardiac shock after heart surgery(6,7). It
offers better control of the patient's volume status and also avoids the hemodynamic instability
associated with intermittent hemodialysis(4,7). Such modality of treatment was reported to be
approximately 6% after CABG(8,9). It is essential to predict which group of patients would benefits
from such intensive use of CVVH so as to use it more rationally(3). Based on many published
studies, early use of CVVH is advocated to have better outcomes(3,7). However, its use has been
criticized for being costly, resource intensive and virtually may not improve ... Show more content
on Helpwriting.net ...
It is reported that even small increase (0.3–0.5 mg/dl) in serum creatinine after cardiac surgery is
associated with nearly three–fold increase in 30 day mortality, while a larger increase > 0.5 mg/dl is
associated with more that 18–fold increase in 30 – day mortality(13). Patients in need for renal
replacement therapy(RRT) have significantly longer in–hospital stay as well as increased

The Pathophysiology of Acute Renal Failure, Questions and...
Problem: A man arrives at a clinic with complaints of asthenia, malaise, headache, weight gain, and
a decrease in urination. A tentative diagnosis of acute renal failure is made.
1. Explain the pathophysiology of acute renal failure. Include prerenal, intrarenal, and postrenal
causes.
The Urinary System plays an important role in our everyday life. It's most important functions are
maintenance of homeostasis, manufacture hormones that we need, and to process our wastes for
elimination. Our kidneys are part of this whole system; bad habits and lifestyle affect the whole
cycle. This system has a long list of disorders and diseases that an individual may acquire; one of
these is Acute Renal Failure (ARF). Its fast development impairs the kidneys– unless the problem is
found immediately and treated. In Acute Renal Failure (ARF) the kidneys suddenly stops working.
It loses its functions, which are: eliminate wastes, maintain fluid balance, and preserve our body's
electrolytes. Blood enters the kidneys through the renal arteries and leaves through the renal veins.
The strength of pressure exerted onto the kidneys is what makes the glomerular filtration work. The
glomerulus, or the capillary network inside the Bowman's capsule, is the filtration system. This
pressure depends upon the flow of blood and the resistance between the afferent and efferent
arterioles. The afferent aterioles brings blood to the glomeruli; while the efferent arteriole takes the
blood away. When the flow

The Pathophisiology of Acute Renal Failure
Acute renal failure, recently being called Acute Kidney injury (AKI), according to Susan Dirkes
(2011), "the classification criteria for AKI include three grades of severity: risk of acute renal
failure, injury to the kidney and failure of renal function." (p.37). Explain the pathophysiology of
acute renal failure. Include prerenal, intrarenal, and postrenal causes. Pre–renal failure has to do
with inadequate fluid in the body, which leads to inadequate perfusion, or blood circulation in the
body. This disables the kidney from properly filtering out the blood. Patients have low blood
pressure, feel very ill and can go into shock. This may lead to multiple organ failure. Intrarenal
failure, sometimes called intristic failure, is different than pre–renal or post– renal in the sense that
intrarenal is an actual damage to the nephrons, kidney tissue necrosis or renal injury due to
nephrotoxic medications like (aminoglycosides, NSAIDS, chemotherapy medications like
methotrexate, some metals like mercury, lithium, drug abuse such as, heroin, cocaine, and also the
use of radiological contrast agents). Intrarenal failure can be irreversible but it can take several
months of treatment. Post–renal failure has to do with an acute obstruction to urine outflow from
either one or both kidneys, which is usually a cause of ureter obstruction kidney stones, etc. The
patient will feel back pressure or pain. What diagnostic exams would be used to

Acute Kidney Injury Paper
HPHG7004: Acute kidney injury following cardiac surgery
Title: An exploration of the physiological changes during and after cardio–pulmonary bypass
surgery that result in acute kidney injury
Introduction
Percutaneous coronary intervention (PCI) may offer an alternative to open heart surgery for the
treatment of symptomatic ischaemic heart disease, however this less invasive method of
revascularisation is not indicated for each individual. For patients with complex lesions or multi–
vessel coronary artery disease coronary artery bypass grafting remains the standard (Mohr et al,
2013, p.629). Whilst there are numerous complications associated with cardiac surgery, acute kidney
injury is recognised as one of the most common (Case et al, 2012, p. 1, Mao et al, 2013, p.179 and
Rosner et al, 2006, p. 19). Increased knowledge of cellular physiology, and the multiple pathways
involved in the pathogenesis of acute kidney ... Show more content on Helpwriting.net ...
4210–4211, Case et al, 2013, p.2, Goren & Matot, 2015, p.114, Susantitaphong et al, 2012, p.160),
there are specific risk factors pertinent to patients having undergone cardio pulmonary bypass
(Rosner et al, 2006, p. 20). These risks include impaired ventricular function, pre–operative intra–
aortic balloon pump, emergency surgery, raised pre–operative serum creatinine and valve surgery.
As well, there are particular factors related to the cardio–pulmonary bypass procedure including
type of procedure; on or off pump, cross–clamp time, perfusion pressure during cardio–pulmonary
bypass, haemodilution, haemolysis and blood transfusion which are all implicated in the subsequent
onset of acute kidney injury (Goren et al, 2015, p.ii6, Mao et al, 2013, p.20 and Rosner et al, 2006,

Interstitial Nephritis
A child with abrupt onset of acute kidney injury with a fever, rash, and a urinalysis with abnormal
urinary sediment should be highly suspected of having acute interstitial nephritis (AIN). In 75% of
cases, AIN is a drug–induced hypersensitivity reaction. It is characterized by the classic triad of
fever, rash, and arthralgia, with acute renal dysfunction resulting from the infiltration and activity of
inflammatory cells when the drug/antigen is exposed to the interstitium of the kidney. Medications
commonly associated with AIN include nonsteroidal anti–inflammatory drugs (NSAIDs),
antibiotics, diuretics, and proton pump inhibitors. Nonsteroidal anti–inflammatory drugs are the
most common, the most studied, and possibly the most avoidable drugs that cause AIN–induced
acute kidney injury. The mainstay of treatment of drug–induced AIN is to discontinue treatment with
the offending drug as soon as possible and restore and/or maintain intravascular volume with
isotonic fluids to maintain renal perfusion. Once adequate renal perfusion has been accomplished,
close monitoring of fluid and electrolyte balance is of utmost importance.
Avoidance of other nephrotoxic drugs is equally important; therefore, the other 3 answer choices are
incorrect. ... Show more content on Helpwriting.net ...
Therefore, starting treatment with penicillin at this time is not appropriate. Changes in urine and
frequency of urination could be due to acute poststreptococcal glomerulonephritis, but there is
typically a 1– to 2–week latent period between the onset of the throat infection and these changes.
Therefore, the timeline in the vignette does not fit. Treatment with penicillin should also be avoided
in this patient because penicillins are the second most common cause of drug–induced AIN behind

Acute Syndrome : Acute Nephritic Syndrome
Acute Nephritic Syndrome
Introduction
Acute nephritic syndrome is a group of symptoms that occurs with a few disorders that cause
glomerulonephritis or swelling and inflammation of the glomeruli in the kidney as shown in Figure
1. Inflammation of the kidneys and glomerulus affects the function of the glomerulus – part of the
kidney that filters blood, resulting in blood and protein to appear in urine – excess fluid also builds
up in the body. Swelling of the body occurs when blood loses albumin, which is a vital component
to the blood as it keeps fluid in blood vessels. Blood loss from damaged kidney structures
progresses to allow blood in the urine. Acute nephritis is potentially life threatening as it could lead
to acute kidney failure. (http://www.nlm.nih.gov/medlineplus/ency/article/000495.htm)
It is distinguished from nephrotic syndrome, and some conditions can cause either syndrome and
both have similar appearances upon biopsy, but neither term represents a definitive diagnosis.
(http://www.fastbleep.com/medical–notes/gi–and–renal/12/20/135) Figure 1. Glomerular
inflammation (http://www.fastbleep.com/medical–notes/gi–and–renal/12/20/135)
Pathology
Nephritic syndrome usually damages the glomerulus by immune–mediated injury. The causes for
inflammation is either from an antibody targeting components of the glomerulus, or from immune
complexes generated in the body are trapped by glomerular filtration. These immune complexes
eventually lead to the activation of the

J. S. Kidney Injury: A Case Study
As for J.S. condition, he is developing acute kidney injury (AKI). The risk for having AKI is due to
other preexisting issues such previous kidney impairment, cardiovascular and PVD, hypertension,
DM, heart failure, malignancies, and BPH. This kind of renal failure is also common with
individuals between the ages of 20 and 80 years old. It is characterized by a decreased of renal blood
flow to 50% and GFR by 8ml/min/1.73 m2 every 10 years after the age of 30. Aging kidneys are
unable in concentrating and diluting urine, conserving Na, producing prostaglandin, and maintaining
levels of renin and aldosterone (Copstead & Banasik, 2013 p. 594).
Specifically, J.S. condition falls under prerenal kidney injury and can be reversed before renal
perfusion

Acute Kidney Injury Essay
ABSTRACT
Acute Kidney Injury (AKI) is a critical complication after pediatric cardiac surgery that significantly
diminishes the quality of life. Early detection of AKI after pediatric cardiac surgery can lead to
better preventive and therapeutic interventions. The aim of this study was to assess the usefulness of
plasma neutrophil gelatinase–associated lipocalin (NGAL) as an early marker of acute kidney injury
(AKI) in cardiopulmonary bypass (CPB) in pediatric cardiac patients. We measured serum
creatinine, serum urea, and plasma NGAL levels in 30 Egyptian children undergoing cardiac surgery
with cardiopulmonary bypass. We classified patients according to creatinine criteria of Acute
Kidney Injury Network into AKI (n=9) and non–AKI (n=21) groups. ... Show more content on
Helpwriting.net ...
They were undergoing cardiac surgery with CPB for surgical correction or palliation of congenital
heart disease. Monitoring of the patients was achieved by serial measurements of plasma NGAL,
S.Cr and serum urea levels at 2 h preoperatively, as well as 2 h, and 24 h postoperatively. In
addition, we measured the postoperative S.Cr and serum urea during 48 h after surgery. Venous
blood sample was withdrawn from every patient by suitable syringe according to patients' age and
weight. Estimation of plasma NGAL was carried out using Human Neutrophil Gelatinase–
Associated Lipocalin (NGAL) ELISA kit (Catalog #: 95645) of Glory Science Co., Ltd, USA. It was
measured on MR–96 Microplate Reader (CLINDIAG SYSTEMS B.V.B.A; MR–96; MR2GL002;
Belgium). Estimation of S.Cr was carried out using commercially available reagent kit. The
diagnostic kit of the kinetic Jaffé method used for the estimation of S.Cr was obtained from
Egyptian Company for Biotechnology (S.A.E). Estimation of serum urea was carried out by urease–
colorimetric method (Modified Urease–Berthelot Method). The diagnostic kit employed for the
determination of serum urea was obtained from Egyptian Company

Acute Pyelonephritis: A Case Study
Acute pyelonephritis is potentially life–threatening infection caused by bacteria invasion of the renal
parenchyma and often leads to scarring of the kidney. Bacteria reach the kidney by ascending from
lower urinary tract. Also, the bacteria may reach the kidney through the blood stream (Fulop, 2015).
McCance and Huether (2014) indicate that, in pyelonephritis, the inflammation process mainly
affects pelvis, calyces, and the medulla. The infection causes medullary infiltration of white blood
cells with renal inflammation, renal edema, and purulent urine explaining Ms. Cornwall urinalysis
results (bacteria and white blood cell cast). Other symptoms include fever, chills, and flank or groin
pain. With severe infection, abscess in the medulla may spread to the cortex. Acute pyelonephritis
hardly leads to renal failure. After the acute attack, healing with deposition of scar tissue, fibrosis,
and atrophy occurs in affected areas (McCance & Huether, 2014). ... Show more content on
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This results in elevation in plasma creatinine and blood urea nitrogen levels. ARF affects
approximately 5% of patients and has a mortality rate of 50% to 80%. AKI can be classified as
prerenal AKI, intrarenal or intrinsic AKI, and postrenal AKI all caused by different mechanism.
Prerenal AKI is caused by conditions resulting to renal hypoperfusion, while intrarenal AKI is due to
conditions involving structural damage to the renal parenchymal or interstitial tissue. Postrenal AKI
results from conditions associated with acute urinary tract obstruction. Of the three AKI, prerenal is
the most common. If detected early and treated immediately, most AKI are reversible (McCance &
Huether,

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