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Respiratory and Renal Pathophysiology Topics in Human Pathophysiology Fall 2011 Gilead Drug Safety and Public Health Outline Respiratory Disorders Respiratory Interface Lung function Respiratory Disorders Kidneys and Renal Function Overview of system Nephrons Disorders of Urinary System Figure 10.8 Figure 10.7 Selected Respiratory Disorders Viral and bacterial infections fungal infections (Pulmonary aspergillosis) Cystic fibrosis (and accompanying infections) Pneumonia Asthma Flu • Cause – • Influenza virus Symptoms – – – – – – – – Fever Sore throat Cough Body aches Headache Chills Fatigue Vomiting and diarrhea Flu Susceptible populations Antivirals for influenza – Tamiflu (oseltamivir), Relenza (zanamivir), peramivir Complications Pneumonia and respiratory failure Bronchitis Ear infections Sinus infections 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. Fungal Lung Infections Fungal lung infection - Pulmonary aspergillosis Common with AIDs patients and cystic fibrosis patients Treated with Ambisome (amphoterocin B), one of several antifungals, alters fungal cell permeability Pulmonary Aspergillosis from an AIDS patient during autopsy http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijid/vol 6n1/aspergillosis.xml 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 Pneumonia Asthma Gilead treatments for lung infections • Cayston® (aztreonam) for Pseudomonas aeruginosa • Tamiflu for influenza viruses • Ambisome for aspergillus fungus • Vistide for cytomegalovirus Tests for Lung Function Chest X-ray Pulmonary function tests Sputum cultures Pulse oximetry Arterial Blood Gases (ABGs) Pneumonia X-ray http://www.med-ed.virginia.edu/courses/rad/cxr/pathology3chest.html Spirometry Sputum Culture •Patient donates a sputum sample •It is cultured with various media to determine causative agent of lung infection Pulse Oximetry •Measures arterial hemoglobin oxygen saturation •Normal is > 95% •Indicator of effectiveness of respiratory interface and gas diffusion Arterial Blood Gases pH PCO2 PO2 O2 Saturation HCO3- Renal Pathophysiology Kidneys maintain homeostasis Excrete nitrogenous wastes 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 Figure 15.2 Normal Kidney Anatomy The nephron is the functional unit of the kidney Figure 15.6 Overview of Nephron Actions Figure 15.4 Glomerular Apparatus The glomerular capillaries filter the blood. Glomerular filtration rate is an indicator of kidney health. Tubules reabsorb nonwastes, and secrete wastes, allow urine to be concentrated, control electrolyte balance. Figure 25.16 32 Kidney Disorders Acute 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 From: radiology.rsna.org/ content/242/1/175/F5.expansion 34 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 Xray to rule out obstructions to urine 35 Kidney Disorders Chronic 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 Kidneys maintain homeostasis Excrete nitrogenous wastes 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 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Increased GFR 90mL/min or above Normal or GFR 6090 mL/min GFR 30-59 mL/min GFR 15-29 mL/min GFR <15 mL/min Some evidence of kidney damage (microalbum inuria/protei nuria, hematuria, or histologic changes) Asymptomat ic Kidney damage with mild decrease in GFR Asympto matic Kidney damage with moderate decrease in GFR Asymptomatic, may have anemia Kidney damage with severe decrease in GFR Hyperkalemi a Anemia 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 retentionedema, pulmonary hypertension, systolic hypertension 37 Treatment for Renal Failure Control the underlying cause, i.e. diabetes, HTN, drug therapy Controlled fluid intake Diet rhEPO Kidney Transplant Dialysis Dialysis Treatment 40 Clinical Tests for Renal Function Complete medical and medication history Complete physical examination Microscopic exam---clues in the urine sediment (eg. hematuria) Urinalysis---any protein, WBCs, blood? BUN and creatinine, electrolytes, GFR, quantitative protein, urine and serum potassium Renal ultrasound Renal biopsy Topics in Human Pathophysiology Fall 2011 Gilead Drug Safety and Public Health Thank You!
