Renal pathophysiology

Blueprints Notes Cases—Pathophysiology Renal, Hematology, and Oncology Aaron B. Caughey, Christie del Castillo, Nancy Palmer, Karen Spizer, Dana N. Tuttle... 

Apply knowledge of the pathophysiology of acute renal failure to the development of a treatment plan. 

Cyclosporine and tacrolimus are calcineurin inhibitors that are administered as part of immunosuppressive regimens in kidney, liver, heart, lung, and bone marrow transplant recipients. In addition, they are used in autoimmune disorders such as psoriasis and multiple sclerosis. The pathophysiologic mechanism for ARF is renal vascular vasoconstriction.41 It often occurs within the first 6 to 12 months of treatment, and can be reversible with dose reduction or drug discontinuation. Risk factors include high dose, elevated trough blood concentrations, increased age, and concomitant therapy with other nephrotoxic drugs.41 Cyclosporine and tacrolimus are extensively metabolized by... 

FIGURE 23-1. Proposed mechanisms for progression of renal disease. (From Joy MS, Kshirsagar A, Paparello J. Chronic kidney disease Progression-modifying therapies. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 803, with permission.)... 

Segerer S, Nelson PJ, Schlondorff D. Chemokines, chemokine receptors, and renal disease from basic science to pathophysiologic and therapeutic studies. J Am Soc Nephrol 2000 11 152-176. 

Joosten SA, Sijpkens YW, van Kooten C, Paul LC. Chronic renal allograft rejection pathophysiologic considerations. Kidney Int 2005 68 1-13. 

Z4. Zenichi, M., Masakazu, U., Koichi, A., Masao, E., and Masaki, K Pathophysiologic role of en-dothelin-l in renal function in rats with endotoxin shock. Surgery 115,199-204(1994). 

The potent antidiuretic hormone AVP orchestrates the regulation of free water absorption, body fluid osmolality, cell contraction, blood volume, and blood pressure through stimulation of three G-protein-coupled receptor subtypes Vi-vascular types a and b, V2-renal, and V3-pituitary. Increased AVP secretion is the trademark of several pathophysiological disorders, including heart failure, impaired renal function, liver cirrhosis, and SIADH. As a consequence, these patients experience excess water retention or inadequate free-water excretion, which results in the dilution of sodium concentrations, frequently manifesting as clinical hyponatremia (serum sodium concentration <135mmol/L). This electrolyte imbalance increases mortality rates by 60-fold. Selective antagonism of the AVP V2 receptor promotes water... 

Amphotericin B Azoles Nephrotoxins (e.g, aminoglycosides, cidofovir, cyclosporine, foscarnet, pentamidine) See Chap. 125 in Pharmacotherapy A Pathophysiologic Approach, seventh edition, page 1998. Additive adverse effects Monitor renal function... 

The pathophysiology, clinical manifestations, diagnosis, and treatment of acute renal failure and chronic kidney disease (CKD) or end-stage renal disease are discussed in Chaps. 75 and 76, respectively. 

Quigley s group in Cork, Ireland, have concluded that normal aging is associated with changes in motility but the pattern is varied and no clear clinical consequence can be identified (67). More important in their view are the pathophysiological influences, including depression (and treatment with anti-cholinergics and opiates), hypothyroidism, and chronic renal failure. 

Pathophysiologically normochromic and normo-cytic anaemia, as occurs in many clinical syndromes exemplified by renal failure, a number of cancers, rheumatoid arthritis and systemic lupus erythematosus, is typical. Initially erythrocytes are of normal size and degree of haemoglobinization. However, persistent impairment of iron supply, especially from mitochondria to globin in the cytoplasm, leads to them becoming hypochromic and microcytic. 

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