Nephrology Dr.

Shaf3y

Neurology
2015 17

Renal vascular disorders

discuss renal vascular disorders

disorder vascular renal
capillaries arterioles branches Renal artery
renal veins

renal artery
renal artery
renal artery stenosis

injury embolism Thrombosis

arterioles Kidney branches renal artery branches

capillaries
scleroderma crisis
Kidney branches Malignant hypertension scleroderma crisis
atherosclerosis cholesterol emboli
cholesterol embolism atherosclerosis
branches collagen diseases vasculitis

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 Nephrology Dr. Shaf3y

small thrombotic thrombocytopenic purpura hemolytic uremic syndrome

Kidney branches

renal vein disease renal vein

Thrombosis

Renal veins thrombosis

Nephrotic syndrome << hypercoagulability hypercoagulability
renal vein specially << thrombosis anti thrombin three

anti thrombin three Nephrotic syndrome

thrombosis
deficiency << protein C and protein S

thrombosis renal vein Hyper nephroma Renal carcinoma

renal vein thrombosis complication

pulmonary embolism
Pulmonary embolism renal vein thrombosis complication
embolism detachment thrombus renal vein

renal artery stenosis

Renal artery stenosis
renal artery stenosis etiology
stenosis Artery
etiology
Atherosclerosis

renal artery stenosis

gaps

etiology
renal artery Atherosclerosis
congenital

1/3 females congenital

Unfortunately
2/3 Males atherosclerosis
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Nephrology Dr. Shaf3y

renal artery stenosis

Kidney renal artery stenosis

Hypertension renin renin

secondary hypertension

renal artery stenosis

Non steroidal ACEI
acute renal failure
pre renal compensatory mechanisms
efferent vaso constriction
afferent vaso dilatation
Non steroidal ACEI
acute renal failure

renal artery stenosis

chronic renal failure

renal artery stenosis

Hypertension renal artery stenosis

acute and chronic renal failure
Non steroidal ACEI acute
Long standing cases chronic

Kidney Ischemia renal artery stenosis

Kidney hypoxia
Hypoxic Kidney
Erythropoietin
secondary polycythemia

renal artery stenosis

plethoric facies Hypertension

abdomen auscultation

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 Nephrology Dr. Shaf3y

renal angle
renal artery stenosis renal bruit

renal artery stenosis

Renal angle renal bruit

Investigations renal artery stenosis

Ultrasound renal duplex

angiography
kidney Nephrotoxic
renal arteries Aorta
selective cannulation of renal artery renal artery

MRA Nephrotoxic
is not nephrotoxic << MRA
MRA Duplex

angiography
selective renal angiography aortic angiography

IVP

both kidneys Intravenous

Kidney

X ray Kidney Kidney

Kidney
kidney

renal artery stenosis

Duplex MRA
Kidney delay appearance delay uptake IVP
filtration Intra venous radio isotopic scanning
Kidney Kidney
stenosis kidney

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 Nephrology Dr. Shaf3y

hypertension
ACEI
bilateral renal artery stenosis ACEI

calcium channel blocker beta blocker

ACEI

stent renal artery

renal vascular disorders renal artery stenosis

chronic renal failure

Chronic renal failure
chronic renal failure
by definition << chronic renal failure
It is a gradual deterioration in renal function that occurs over months to years, which is irreversible
even the cause has been treated


It is a gradual deterioration in renal function that occurs over months or years, which is irreversible
even the cause has been treated

acute renal failure

acute
days Hours
Years Months << chronic

reversible when the cause is treated acute

even the cause is treated it is irreversible chronic

chronic renal failure etiology

renal impairment renal failure

dialysis renal failure

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 Nephrology Dr. Shaf3y

renal failure
patient cannot sustain his life without dialysis
15 glomerular filtration rate

Normal
127

15 << glomerular filtration rate

He cannot live without dialysis

dialysis 2 creatinine

renal impairment

Kidney disease renal impairment

But the patient can survive without dialysis

cannot survive without dialysis renal failure

chronic renal failure etiology

causes of acute renal failure
post renal renal pre renal

post renal renal Pre renal << chronic renal failure etiology
acute renal failure

Pre renal << Pre renal

vascular

chronic renal failure vascular causes

Renal artery stenosis

collagen diseases vasculitis hypertension

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 Nephrology Dr. Shaf3y

renal causes
renal causes
tubular interstitial vascular Glomerular

chronic renal failure

renal causes causes
interstitial causes tubular causes glomerular causes

vascular Pre renal

Interstitial tubular glomerular renal

Post renal
Obstructive

glomerulonephritis << glomerular causes

idiopathic 40 %

amylodosis Kimmelesteil Wilson syndrome diabetes

tubular causes
chronic tubular lesions
Polycystic kidney
congenital renal tubular defects Detoni-Fanconi syndrome
renal tubules gradual precipitation Uric acid

interstitial
chronic interstitial nephritis
chronic interstitial nephritis

allergy infection Interstitial nephritis

Kidney Infiltration chronic interstitial nephritis
amylodosis haemochromatosis kidney Irradiation

obstructive
chronic renal failure obstructive causes
gradual << prostatic enlargement , stricture ) Uretheral obstruction
cervical fibroid << tumor << ureter Obstruction
cervical fibroid complications

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 Nephrology Dr. Shaf3y

retroperitoneal fibrosis bilaterally ureter

retroperitoneal fibrosis
Methergine
migraine

pathophysiology

kidney chronic renal failure

chronic renal failure

diabetic diabetes
Kidney damage
controlled treatment diabetic
damage
damage

damage controlled diabetic

renin
glomeruli blood direction vaso constriction

glomeruli

glomerular filtration rate glomeruli

polyuria chronic renal failure <<

glomeruli directed

glomeruli <<
<< glomeruli pressure
Hypertension glomeruli
sclerosis
diabetes diabetes Which means

kidney damage diabetes

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 Nephrology Dr. Shaf3y

Normal kidney diabetes

glomeruli Hypertension diabetes diabetes
damage Kidney
damage

diabetes
You don't prevent renal failure
delay

functions Kidney
functions
Water balance 
Electrolyte balance 
Acid base balance 
Excretion of waste products 
Endocrinal function 


Maintain renal failure

 cause

glomerular filtration rate << glomeruli

retain

reabsorption << tubules

Lose

water retainer << glomerular lesion

water loser << tubular lesions

renal failure
are water retainers << renal failure << glomerular

are water retainers << renal failure

glomerular Kidney

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 Nephrology Dr. Shaf3y

water losers << tubular lesion

electrolytes

Maintain renal failure

sodium retainer << glomerular lesion

sodium loser << tubular lesion


damage glomeruli disease
angiotensin renin renin
aldosterone angiotensin
glomeruli aldosterone

damage
angiotensin renin renin damaged
aldosterone angiotensin
glomeruli aldosterone
GIT
Kidney aldosterone
Intestine salivary gland

disease
potassium loser
Hypokalemia

excretion aldosterone glomeruli

Hypokalemia Initially
angiotensin renin renin damaged glomeruli
aldosterone angiotensin
glomeruli aldosterone

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 Nephrology Dr. Shaf3y

glomeruli
Hyperkalemia
is a marker of end stage renal disease << hyperkalemia <<
Kidney

Urine
Urine
GIT secretion

tissues precipitation

diet GIT
absorption

renal failure
Vitamin D is not activated by the kidney

Hypocalcemia

tissues
calcium absorption GIT
vitamin D activation

secondary hyperparathyroid
secondary hyper parathyroid
tertiary hyper para thyroid
hypercalcemia << tertiary hyper parathyroidism

renal failure

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Nephrology Dr. Shaf3y

hypocalcemic
secondary hyper parathyroidism

tertiary hyper parathyroidism

hyper calcemia

sodium retainer << glomeruli

sodium loser << tubular

aldosterone

tertiary hyper parathyroidism

acid base balance

acids excretion kidney
acidosis

 << acidosis

 acidosis


 acidosis
contractility of the heart
kussmaul breathing rapid deep breathing
gastritis acidity

acidosis

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 Nephrology Dr. Shaf3y

ionized << acidosis

hypocalcemia
tetany
total calcium hypocalcemia
acidosis ionized total calcium

renal failure hypocalcemia

tetany

Ionized << calcium acidosis

waste products
renal failure waste products

MW 500 -12000 dalton Middle molecules urochrome pigments Uric acid creatinine Urea

Urea
breakdown of proteins urea
excreted by the kidneys urea
excretion Kidney Urea renal failure

renal failure
Urea excretion
Urea
saliva Urea
uriniferous odor

pleurisy << pleura

pericarditis << Pericardium
uremic asthma << bronchi
nausea, vomiting and uremic dysentery << Intestine
urea frost << sweat

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 Nephrology Dr. Shaf3y

renal failure creatinine

creatinine

Is not toxic << creatinine

sarcosine guanidinosuccinic acid

sarcosine guanidinosuccinic acid creatinine

toxic

not toxic << creatinine

toxic material creatinine

sarcosine guanidinosuccinic acid

toxic to the nerves peripheral neuritis

bleeding tendency Platelets functions inhibition

creatinine Urea

Uric acid
gout Uric acid

uric acid
urochrome pigments

Urochrome pigments

urochrome pigments
Urine
Urine
amber yellow

amber yellow





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Nephrology Dr. Shaf3y

Amber yellow

amber yellow color

Urine urochrome pigments

renal failure
Urine Urochrome pigments
colorless Urine

skin urochrome pigment

brownish
earthy looking appearance
deposition of urochrome pigment

Middle molecules

Middle molecules

dialysis

dialysis
Membrane dialysis
dialysate solution

urea
creatinine
dialysate
dialysate
deficient toxins

dialysis dialysis

dialysis
total partially

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 Nephrology Dr. Shaf3y

normal creatinine Urea totally partially

manifestations
toxins

membrane

Membrane

totally Membrane

creatinine Urea toxins

renal failure toxins
Middle molecules

nature of these toxins

We have no idea
the most important toxins in renal failure

vitamin D erythropoietin renal failure

insulin prolactin renin

pathophysiology

clinical pictures
chronic renal failure clinical pictures
clinical pictures

 mechanisms renal failure

 clinical pictures

chronic renal failure clinical pictures

chronic renal failure clinical pictures

 organ

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 Nephrology Dr. Shaf3y


C.N.S.
brain

Edema

cerebral edema edema

Increase intra cranial tension
even coma convulsions confusion Headache

hypernateremia severe hyponateremia electrolytes

Hyperkalemia Hypokalemia
coma Confusion

waste products
coma confusion Middle molecules creatinine urea

anemia erythropoietin

Headache anemia

Hypertension renin
Headache hypertension

brain
Headache

Mechanism of headache
Hypertension anemia Edema

uremic encephalopathy confusion

mechanism of uremic encephalopathy
Hypertension toxins acidosis electrolyte imbalance Cerebral edema
inverted sleeping rhythm flapping tremors uremic encephalopathy
disoriented for time, place and persons

Hepatic encephalopathy
carbon dioxide narcosis

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 Nephrology Dr. Shaf3y

And finally the patient will go into coma

coma

hypertensive encephalopathy toxins electrolyte imbalance Edema

brain
renal failure
dialysis treatment brain renal failure
aluminum dementia
aluminum dementia

dialysis dialysis
dialysate
dialysate


dialysate

dialysis
dementia dialysis

brain autopsy
aluminum brain

dialysate

Urine Kidney

renal failure
brain ≪

dialysis

dialysis

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Nephrology Dr. Shaf3y

dialysis

dialysis

Egyptians
dialysis
dialysis
dialysis dialysis

aluminum dementia


disequilibrium syndrome
disequilibrium syndrome

disequilibrium syndrome
200 Urea renal failure
blood vessels wall urea urea
brain cells wall

200 ≪ urea brain cells

200 ≪ Urea renal failure

200 ≪ brain cells






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Nephrology Dr. Shaf3y

branch

 

urea
200 ≪ Urea

 40

 dialysis

Urea
osmolarity 40 urea

200 ≪ Urea
Urea

urea Urea

brain cells blood vessel

edema brain cells
convulsions confusion
disequilibrium syndrome

Normal
gradually ≪ urea
disequilibrium syndrome




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Nephrology Dr. Shaf3y

uremic encephalopathy renal failure

Urea
Urea
cerebral edema Disequilibrium syndrome

mannitol
Intra venous mannitol urea
Osmolarity
brain

Urea
intra venous mannitol Urea

disequilibrium syndrome

C.N.S.
disequilibrium syndrome coma encephalopathy headache
aluminum dementia
brain

brain
Peripheral nerves cerebellum spinal cord brain stem

cerebellum
cerebellar ataxia toxins

peripheral neuritis

peripheral neuritis cranial nerve

vertigo

Peripheral neuritis

sarcosine guanidinosuccinic acid creatinine

peripheral neuritis Nerves toxic

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 Nephrology Dr. Shaf3y

Middle molecules

Urine Kidney proteins

Beta two microglobulin

Urine B2 microglobulin renal failure

nerves tissues
amyloidosis

Nerve amyloidosis
carpel tunnel syndrome

Beta two microglobulins proteins

excreted by the kidney in urine
Since we have renal failure
excreted ≪ Beta two microglobulins
And will precipitate in the tissues
carpel tunnel syndrome
And thickening nerve

Peripheral neuritis
sensory neuropathy and autonomic neuropathy sensory autonomic

C.N.S. complications

eye C.N.S.
clinical pictures eye
DD OO NN
 OO NN


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 Nephrology Dr. Shaf3y

eye Water retention

edema in conjunctiva chemosis Eye lid edema

electrolytes
cornea
Band keratopathy
conjunctival congestion

waste products
retinal artery spasm toxins ≪ waster products
transient blindness
amurosis

amurosis fugax protein amurosis uremic amurosis alcoholic amurosis

endocrinal
Hypertensive retinopathy ≪ renin hypertension
eye

Aortic stenosis
Aortic stenosis
chronic
renal failure

eye
 Nose
 Nose

blood

Mouth
Mouth

electrolyte

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Nephrology Dr. Shaf3y

acidosis
kussmaul breathing

waste products
uriniferous odor of breath saliva Urea

tongue Urea
coated tongue

endocrine
pallor red glazed tongue
G.I.T. Oral cavity

basic
clinical pictures

Nephritic Nephrotic

Neck oral cavity

cardiovascular system Neck

cardiovascular
blood vessel vascular

water retainer hypertension

blood vessel wall

Hypertension

waster products

endocrinal
Hypertension vasoconstriction renin

hypertension water retention

hypertension blood vessel wall calcification
hypertension renin

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 Nephrology Dr. Shaf3y

atherosclerosis hypertension

Hypotension

autonomic neuropathy peripheral neuritis

orthostatic hypotension

Heart

pericardial effusion ≪ Pericardium

Pericarditis pericardium Urea

pericardium
Myocardium
Heart failure
Heart failure
electrolyte imbalance arrhythmia Volume overload
suppression of contractility acidosis
contractility suppression ≪ toxins

And finally, they have hypertension

after load ≪ Increase

Heart failure
Volume overload 
Arrhythmia 
Suppression of contractility by acidosis and waste products 
Hyeprtension Increase of afterload 

L-carnitine and selenium Heart failure

L-Carnitine Selenium
L-Carnitine Selenium
glucose consumer is a fat consumer ≪ heart
fat energy Heart
glucose

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Nephrology Dr. Shaf3y

Selenium L-Carnitine
Metabolism of fat trace elements
fat Metabolism heart
energy

dialysis
dialysis selenium L-Carnitine

L-Carnitine Selenium dialysis

L-Carnitine Selenium


Myocardium pericardium
Endocardium
 valves endocardium
valves
valve calcification deposition of calcium
calcific aortic stenosis
cardiovascular
 cardiovascular
cardiovascular C.N.S.

 Lung
chronic renal failure lung


Pleural effusion ≪ Pleura

Pulmonary edema ≪ Lung

electrolytes

acidosis
kussmaul breathing

waste products
pleurisy ≪ Pleura Urea
uremic asthma bronchospasm bronchi trachea

Liable for infection ≪ endocrinal

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 Nephrology Dr. Shaf3y

Organ

G.I.T.
Oral cavity G.I.T.
esophagus

esophagus
low immunity candidiasis

stomach
gastritis peptic ulcer acidosis
acidosis gastritis stomach

small intestine

peristalsis affect Paralytic ileus electrolytes

Malabsorption

waste products
dysentery G.I.T. Urea

Hard stool
constipation

G.I.T.
pancreas
chronic renal failure pancreas
pancreatitis
gall bladder stones alcoholism pancreatitis
Hyper parathyroidism Hypercalcemia

trypsin trypsinogen activation

digestion active trypsin

abdomen
Liver

renal failure
dialysis Hepatitis hepatitis dialysis

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Nephrology Dr. Shaf3y

Hepatitis dialysis
dialysis Hepatitis
Normal bilirubin Liver enzymes
dialysis bilirubin Liver enzymes
with a normal enzymes and bilirubin ≪ Hepatitis

Hepatitis
dialysis chronic renal failure
bilirubin enzymes Hepatitis markers
Normal

abdomen
Kidney  Kidney kidney
Kidney

amylodosis polycystic kidney Hydronephrosis

shrunken ≪ Kidney
glomerulonephritis Pyelonephritis

chronic renal failure

PR examination

Prostate
Prostate is more common in males 

PR renal failure female

fibroid uterus
Prostate PR

Genitalia
endocrinal system genitalia
Hypocalcemia vitamin D Hypertension renin
anemia erythropoietin

prolactin
amenorrhea galactorrhea females
infertility galactorrhea gynecomastia male

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Nephrology Dr. Shaf3y

Hypoglycemia

stunted growth

Lower limbs
skin
skin
edema skin

electrolyte
pruritis skin

acidosis
skin acidosis
Urine acidosis
sweat Hydrogen
acidic
papules skin irritation

acidosis

You can diagnose renal failure by the sour taste of the kiss 




renal failure
sour taste

 Urea and cratinine

uremic

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 Nephrology Dr. Shaf3y

acidosis
sweat Urea waste products
sweat Urea
urea frost
frost

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 Nephrology Dr. Shaf3y

By the way


skin
papules acidic sweat acidosis puritis calcium Edema
Urea forst urea

urochromogen pigments
earthy look skin

pallor erythropoietin
skin manifestations
skin infection candidasis

Muscles
Hyponateremia muscle cramps
irritable leg syndrome

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Nephrology Dr. Shaf3y

restless leg syndrome

hyponateremia psychosis

Tetany is rare in this patient

tetany rare
acidosis

Muscle atrophy
Disuse atrophy Muscle atrophy
bone severe pain
Muscles
bones and muscles disuse atrophy

secondary hyper parathyroidism

bony cysts Osteoclast
Pathological fractures bony weakness

dialysis deposition

tertiary hyper parathyroidism

More mobilization of calcium from bone

pathological fractures bone aches

renal osteodystrophy bony osteodystrophy

joints

Gout

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 Nephrology Dr. Shaf3y

2015 15 46

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