Transcript Respiratory Interface

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
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Cause
–
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Influenza virus
Symptoms
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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
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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
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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
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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 retentionedema,
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
Dialysis Treatment
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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!