Select one or more of the Lecturio videos that you are asked to review during week five or week six: (Renal system, I have included 2 transcripts for references on the material covered)
After watching your chosen video series, please compose a 300-word reflection on the main points discussed in the various videos. In your reflection, please address the pathophysiology of the condition, signs and symptoms, and management strategies discussed.
- You are also to include one scholarly evidence-based reference to support your reflection post.
- Please copy and paste the links to the videos you use to help compose your reflection on your reference page.Lecturio Reflection – 10 pts
Lecturio Reflection – 10 pts Criteria Ratings Pts This criterion is linked to a Learning OutcomeCritical Analysis 3 ptsMeets or Exceeds ExpectationsPresents an exemplary articulation and insightful analysis. Offers detailed and specific examples for all questions. Makes keen observations, making note of essential information. Ideas are professionally sound and creative; they are supported by scientific evidence that is credible and timely. Draws insightful and comprehensive conclusions and solutions. 2.55 ptsMostly Meets ExpectationsPresents an accurate analysis of significant concepts and/or theories. Offers some detail and some examples for most questions. Makes occasional note of essential information. Ideas are mostly supported by scientific evidence that is credible and timely. Makes some attempt to draw conclusions and solutions. 2.25 ptsBelow ExpectationsProvides insufficient explanations of significant concepts. Offers little or insignificant detail and no examples for most questions. Fails to address essential information. Ideas are generally unsupported by scientific evidence, but some attempt has been made. Fails to draw conclusion. 1.77 ptsDoes Not Meet ExpectationsDoes not, or incorrectly, answers with insufficient explanations. Information is not scientifically sound. 3 pts This criterion is linked to a Learning OutcomeContent 3 ptsMeets or Exceeds ExpectationsMakes insightful, clear and accurate connections to key concepts and relevant theories. Response indicates a comprehensive, high-level understanding of the concepts. 2.55 ptsMostly Meets ExpectationsMakes mostly accurate connections to key concepts and relevant theories. Response indicates a general understanding of the concepts. 2.25 ptsBelow ExpectationsProvides several insufficient or inaccurate explanations, although attempts are made to address some key concepts. Response indicates an introductory understanding of the concepts. 1.77 ptsDoes Not Meet ExpectationsInformation is inaccurate or inadequate. Response indicates little or no understanding of the concepts. 3 pts This criterion is linked to a Learning OutcomeMechanics 2 ptsMeets or Exceeds ExpectationsAnswers are well written throughout. Information is well organized and clearly communicated. Assignment is free of spelling and grammatical errors. 1.7 ptsMostly Meets ExpectationsAnswers are well written throughout and the information is reasonably organized and communicated. Assignment is mostly free of spelling and grammatical errors. 1.5 ptsBelow ExpectationsAnswers are somewhat organized and lack some clarity. Contains some spelling and grammatical errors. 1.18 ptsDoes Not Meet ExpectationsAnswers are not well written and lack clarity. Information is poorly organized. Assignment contains many spelling and grammatical errors. 2 pts This criterion is linked to a Learning OutcomeAPA Format 2 ptsMeets or Exceeds ExpectationsFollows all the requirements related to format, length, source citations, and layout. 1.71 ptsMostly Meets ExpectationsFollows length requirement and most of the requirements related to format, source citations, and layout. 1.51 ptsBelow ExpectationsFollows most of the requirements related to format, length, source citations, and layout. 1.19 ptsDoes Not Meet ExpectationsDoes not follow format, length, source citations, and layout requirements. 2 pts Total Points: 10 - TRANSCRIPT Acute Kidney Injury
00:01
Alright, now, there is a particular topic here and you’ve heard of this before but you’re not maybe quite sure as to when to use it, how to use it, and do you use it every single time? Well, I want to now clarify and elaborate on your usage of azotemia.
00:21
Okay? Azotemia.
00:23
Students tend to get confused with uremia and azotemia.
00:26
Uremia is the clinical manifestations of renal failure and I just gave you metabolic acidosis, hypocalcemia, so on, and so forth.
00:34
Whereas, azotemia is something that you could actually measure.
00:38
Azotemia, you need to think of this as being a disturbance in your BUN/Creatinine.
00:45
Azotemia is a clinically significant increase in the blood urea nitrogen, or BUN Now, what does it mean in terms of disturbance? Let me walk you through the picture so you’re clear about what you’re seeing and the characteristics of two major components.
00:59
The big fat arrow that you see there in red is your blood urea nitrogen.
01:04
That little blue narrow arrow that you see there is referring to creatinine.
01:08
Okay, now, you tell me about the normal properties of your BUN/Creatinine.
01:12
Close your eyes. Both are arriving through the afferent arteriole to the glomerulus.
01:19
Will both of these be filtered? Yes, they both will be filtered.
01:23
Of the two, creatinine and BUN, which is only reabsorbed? Good, blood urea nitrogen, we had a huge discussion, we talked about creatinine why it is never reabsorbed.
01:36
If anything, it is slightly secreted, is that clear? Next, so if you are now reabsorbing BUN, blood urea nitrogen, the ratio is BUN over creatinine.
01:49
Take a look at the right side here.
01:51
You see BUN over creatinine, and this is the ratio that you’re paying attention to.
01:57
It’s an increased ratio, isn’t it? So that increase in ratio, you must then memorize, is greater than 20, maybe perhaps up to 30.
02:05
And what does this indicate to you? This is prerenal azotemia.
02:09
I told you this may lead into kidney damage.
02:13
Would you tell me what one of the most common causes are of acute kidney injury, AKI, or acute renal failure? Ischemia.
02:22
So if there’s decreased cardiac output, doesn’t that mean decreased perfusion? Doesn’t that mean ischemia? Of course, let’s move on.
02:33
So, continuation, let’s say that your patient has decreased cardiac output, maybe hypovolemia, decreased perfusion to the kidney.
02:41
At some point, what’s gonna happen? Oh, there’s going to be a kidney damage.
02:46
So one of the – you’ll see this and you read this, and you might be told this.
02:51
One of the most common causes of renal azotemia which is my topic here is prerenal azotemia.
02:58
So now, say the perfusion as decreased, you have ischemia who’s going to be affected? The tubular epithelial cells.
03:06
You focus on the filtrate please.
03:09
You see that? The filtrate, so acutely, are substances being filtered.
03:15
Sure, they are, but if they are being filtered and the tubular epithelial cells are dead, are you able to properly reabsorb your BUN? No, you’re not.
TRANSCRIPT Chronic Kidney Disease
00:01
Okay, we have now officially completed our discussion of acute renal failure.
00:06
Our discussion now takes us into chronic renal failure.
00:09
One of the most common causes in fact would be diabetic nephropathy.
00:13
It is important that you absolutely know the stages of end stage renal disease, under the stages as we progress into one, two, three, four, and five.
00:23
We have killed our kidney.
00:26
So chronic renal failure as it progresses through one stages, one, two, three, four, and five, the later the stages, the kidney still has no chance of recovering, and your only choice at this point perhaps is a dialysis type of treatment or perhaps, even transplant.
00:43
Now, what we’ll do here is go into stage four and five.
00:47
Stage four and five of chronic renal failure, severe decrease in GFR, you can expect there to be hyperkalemia, hypertension, metabolic acidosis, things that we discussed earlier.
00:59
What is it called when you find these signs and symptoms with the chronic renal failure? Is that azotemia or is that uremia? That is uremia.
01:08
As we go into stage five, we have now officially entered end stage kidney disease, renal failure.
01:17
We have all the signs and symptoms of uremia.
01:19
Really, as far as your GFR, take a look at this, less than 15 and GFR normally is at 100.
01:26
It could get pretty massive in terms of death.
01:29
Okay, now, what are we going to walk through now? We’re going to walk through the patterns that you expect to find with the chronic renal failure.
01:37
The uremia if untreated, what does that mean again? Once again, maybe perhaps, you’re thinking about hypocalcemia, second hyperparathyroidism, renal osteodystrophy, I’ll talk about all this, not to worry.
01:48
You’ll find an increase in creatinine and your azotemia here.
01:52
While you have more of an increase in, well, your ratio is going to decrease but the creatinine will be elevated automatically and that becomes important for you to understand.
02:02
Remember, what’s your normal creatinine? 0.6 to 1.2, 6 and 12.
02:09
As your kidney starts dying and you get older, remember, the filtration of creatinine decreases.
02:15
That’s what you wanna keep in mind.
02:17
Your second order of testing is effective GFR, a disease group will be end-stage kidney disease, stage five.
02:24
Oliguria, what are you thinking about here? A couple of things.
02:28
Remember when we had acute renal failure and we had the initiation phase and the maintenance phase.
02:35
It was during that time where in acute renal failure, you did have oliguria.
02:40
Could you have oliguria with chronic renal failure? Sure you can.
02:43
What is the actual definition? Objectively, less than 400 milliliters per day of urine being produced.
02:49
Your second order of testing here would be BUN/Creatinine ratio.
02:53
It will be depressed here, and then, therefore, you’re thinking about acute kidney injury, most common cause, ATN ischemia.
03:01
Nonoliguria, in-patient.
03:04
Here, you find an increase in creatinine.
03:06
Here, you’re looking for that fractional excretion of sodium.
03:09
So your patient is nonoliguric but you’re suspecting acute renal failure, you are going to look for increased creatinine, in-hospital.
03:18
This is no joke.
03:19
Next, fractional excretion of sodium here is going to be – well, if it behaves like acute renal failure, it is then going to be increased, very important, and this then will put you in a group of acute kidney injury, in-patient.
03:33
Hematuria, with hematuria, well, the pattern here could be either nephritic or nephrotic, it’s usually nephritic.
03:42
You end up finding RBC cast as your objective measure.
03:46
Well a renal biopsy, not poststreptococcal.
03:49
Puts you in a disease group of glomerulonephritis.
03:52
Presentation, well, if it’s edema, nephrotic syndrome, we talked about objective measure, nephrotic.
04:01
Second order testing, renal biopsy, not from minimal change disease or even diabetes.
04:06
Fever, costovertebral angled tenderness or pain.
04:11
CVA, costovertebral angled tenderness, pyelonephritis, we expect to find objective measured, and WBC cast, you’re thinking about neutrophils, you do a culture, culture, culture.
04:24
Pain, colicky type, this is not the costovertebral.
04:28
Here, you’re worried about your renal stones of calculus and we have imaging and hematuria, and this we’ll talk about and in the subsequent topic of nephrolithiasis.
04:40
Increased blood pressure, well here, pattern here, Renovascular hypertension, what does that mean? Maybe there’s a renal artery stenosis resulting in increased blood pressure, secondary type.
04:52
It could be a female less than 30, your diagnosis there.
04:56
Fibromuscular dysplasia greater than 50, what’s causing renal artery stenosis? Atherosclerosis.
05:04
In addition, what are you gonna look for? What are you gonna try to see is to whether or not it’s a primary or secondary? It’s a renal vein renin becomes important for us and for example, if you are thinking about decreased perfusion, you can expect there to be an increase in renin, don’t you? You expect the increase in plasma renin activity, renin vein or renal vein type of renin.
