Porth's Pathophysiology, 9e

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Acute Renal Injury and Chronic Kidney Disease

Sheila Grossman

ACUTE RENAL INJURY Types of Acute Renal Injury

Prerenal Failure Postrenal Failure Intrarenal Renal Failure or Acute Kidney Injury Diagnosis and Treatment CHRONIC KIDNEY DISEASE Definition and Classification Assessment of Glomerular Filtration Rate and Other Indicators of Renal Function Clinical Manifestations Accumulation of Nitrogenous Wastes Fluid, Electrolyte, and Acid–Base Disorders Disorders of Calcium and Phosphorus Metabolism and Bone Disease Hematologic Disorders Cardiovascular Disorders Gastrointestinal Disorders Neuromuscular Disorders Altered Immune Function Disorders of Skin Integrity Sexual Dysfunction Elimination of Drugs Treatment Measures to Slow Progression of the Disorder Dialysis and Transplantation Dietary Management CHRONIC KIDNEY DISEASE IN CHILDREN AND OLDER ADULTS Chronic Kidney Disease in Children Etiology Clinical Manifestations Treatment Chronic Kidney Disease in Older Adults

Renal failure is a condition in which the kidneys fail to remove metabolic end products from the blood and regulate the fluid, electrolyte, and pH balance of the extracellular fluids. The under- lying cause may be renal disease, systemic disease, or urologic defects of nonrenal origin. Renal failure can occur as an acute or a chronic disorder. Acute renal injury is abrupt in onset and often is reversible if recognized early and treated appropriately. In contrast, chronic kidney disease is the end result of irrepa- rable damage to the kidneys. It develops slowly, usually over the course of a number of years. In fact, 80% of the nephrons need to be nonfunctioning before the symptoms of chronic kidney disease are manifested. Approximately 26 million American adults, or 1 in 9 adults, have some form of renal disease. 1 After completing this section of the chapter, you should be able to meet the following objectives: •• Describe acute renal injury in terms of its causes, treatment, and outcome. •• Differentiate the prerenal, intrarenal (acute renal injury), and postrenal forms of acute renal injury in terms of the mechanisms of development and manifestations. Acute renal injury or also termed acute kidney injury (AKI) represents a rapid decline in kidney function sufficient to increase blood levels of nitrogenous wastes and impair fluid and electrolyte balance. 1 Unlike chronic kidney disease (CKD) and failure, acute renal injury is potentially reversible if the precipitating factors can be corrected or removed before permanent kidney damage has occurred. ACUTE RENAL INJURY

Etiology and Diagnosis Clinical Manifestations Treatment

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