respiratory and renal pathophysiology topics in human pathophysiology fall 2011 gilead drug safety...
TRANSCRIPT
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Respiratory and Renal Pathophysiology
Topics in Human Pathophysiology Fall 2011Gilead Drug Safety and Public Health
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Outline
Respiratory Disorders Respiratory Interface Lung function Respiratory Disorders
Kidneys and Renal Function Overview of system Nephrons Disorders of Urinary System
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Figure 10.8
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Figure 10.7
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Viral and bacterial infections
fungal infections (Pulmonary aspergillosis)
Cystic fibrosis (and accompanying infections)
Pneumonia
Asthma
Selected Respiratory Disorders
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• Cause– Influenza virus
• Symptoms– Fever– Sore throat– Cough– Body aches– Headache– Chills– Fatigue– Vomiting and diarrhea
Flu
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Susceptible populations
Antivirals for influenza – Tamiflu (oseltamivir), Relenza (zanamivir), peramivir
Complications Pneumonia and respiratory failure Bronchitis Ear infections Sinus infections
Flu
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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.
Cystic fibrosis
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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
Fungal Lung Infections
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Pulmonary Aspergillosisfrom an AIDS patient during autopsy
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijid/vol6n1/aspergillosis.xml
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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
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Pneumonia
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Asthma
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Gilead treatments for lung infections
• Cayston® (aztreonam) for Pseudomonas aeruginosa
• Tamiflu for influenza viruses• Ambisome for aspergillus fungus• Vistide for cytomegalovirus
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Chest X-ray
Pulmonary function tests
Sputum cultures
Pulse oximetry
Arterial Blood Gases (ABGs)
Tests for Lung Function
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Pneumonia X-ray
http://www.med-ed.virginia.edu/courses/rad/cxr/pathology3chest.html
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Spirometry
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Sputum Culture
• Patient donates a sputum sample
• It is cultured with various media to determine causative agent of lung infection
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Pulse Oximetry
• Measures arterial hemoglobin oxygen saturation
• Normal is > 95%• Indicator of effectiveness
of respiratory interface and gas diffusion
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pH
PCO2
PO2
O2 Saturation
HCO3-
Arterial Blood Gases
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Renal Pathophysiology
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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
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Figure 15.2
Normal Kidney Anatomy
The nephron is the functional unit of the kidney
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Figure 15.6
Overview of Nephron Actions
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Figure 15.4
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Glomerular Apparatus
The glomerular capillaries filter the blood.Glomerular filtration rate is an indicator of kidney health.
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Figure 25.16
Tubules reabsorb nonwastes, and secrete wastes, allow urine to be concentrated, control electrolyte balance.
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Kidney DisordersAcute 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
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From: radiology.rsna.org/ content/242/1/175/F5.expansion
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Signs & symptoms Oliguria or anuria Swelling / edema Mental status changes
Tests Urinalysis Serum creatinine blood urea nitrogen
(BUN) serum potassium Kidney ultrasound or X-
ray to rule out obstructions to urine
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Acute Renal Failure
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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
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Kidney DisordersChronic Renal Failure - End Stage Renal Disease (ESRD
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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
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37Stage 1
Stage 2
Stage 3 Stage 4
Stage 5
Increased GFR90mL/min or above
Normal orGFR 60-90 mL/min
GFR 30-59 mL/min
GFR 15-29 mL/min
GFR <15 mL/min
Some evidence of kidney damage (microalbuminuria/proteinuria, hematuria, or histologic changes) Asymptomatic
Kidney damage with mild decrease in GFRAsymptomatic
Kidney damage with moderate decrease in GFRAsymptomatic, may have anemia
Kidney damage with severe decrease in GFRHyperkalemiaAnemia
Kidney failure; renal replacement therapy needed to sustain lifeUremia, platelet dysfunction, encephalopathy, peripheral neuropathy, anorexia, nausea and vomiting, pericarditis, pruritus, lethargy and increased somnolence)Metabolic acidosis, Protein catabolismRenal bone diseaseSodium & water retentionedema, pulmonary hypertension, systolic hypertension
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Treatment for Renal Failure
Control the underlying cause, i.e. diabetes, HTN, drug therapy
Controlled fluid intake
Diet
rhEPO
Kidney Transplant
Dialysis
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Dialysis Treatment
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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
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Clinical Tests for Renal Function
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Topics in Human Pathophysiology Fall 2011Gilead Drug Safety and Public Health
Thank You!