renal injury

関

nephron loss

WordNet

1. any physical damage to the body caused by violence or accident or fracture etc. (同)hurt, harm, trauma
2. an act that causes someone or something to receive physical damage
3. wrongdoing that violates anothers rights and is unjustly inflicted
4. an accident that results in physical damage or hurt (同)accidental injury

PrepTutorEJDIC

1. 『負傷』,『損害』,損傷 / (名誉などを)傷つけること,侮辱《+『to』+『名』》
2. 腎臓の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/30 11:43:51」(JST)

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Renal failure
A hemodialysis machine, used to replace the function of the kidneys in renal failure
Classification and external resources
Specialty	Nephrology
ICD-10	N17-N19
ICD-9-CM	584-585
DiseasesDB	26060
MeSH	C12.777.419.780.500

Renal failure, also known as kidney failure or renal insufficiency, is a medical condition in which the kidneys fail to adequately filter waste products from the blood. The two main forms are acute kidney injury, which is often reversible with adequate treatment, and chronic kidney disease, which is often not reversible. In both cases, there is usually an underlying cause.

Kidney failure is mainly determined by a decrease in glomerular filtration rate, the rate at which blood is filtered in the glomeruli of the kidney. This is detected by a decrease in or absence of urine production or determination of waste products (creatinine or urea) in the blood. Depending on the cause, hematuria (blood loss in the urine) and proteinuria (protein loss in the urine) may be noted.

In kidney failure, there may be problems with increased fluid in the body (leading to swelling), increased acid levels, raised levels of potassium, decreased levels of calcium, increased levels of phosphate, and in later stages anemia. Bone health may also be affected. Long-term kidney problems are associated with an increased risk of cardiovascular disease.

Classification

Kidney failure can be divided into two categories: acute kidney injury or chronic kidney disease. The type of renal failure is differentiated by the trend in the serum creatinine; other factors that may help differentiate acute kidney injury from chronic kidney disease include anemia and the kidney size on sonography as chronic kidney disease generally leads to anemia and small kidney size.

Acute kidney injury

Main article: Acute kidney injury

Acute kidney injury (AKI), previously called acute renal failure (ARF), is a rapidly progressive loss of renal function, generally characterized by oliguria (decreased urine production, quantified as less than 400 mL per day in adults, less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); and fluid and electrolyte imbalance. AKI can result from a variety of causes, generally classified as prerenal, intrinsic, and postrenal. The underlying cause must be identified and treated to arrest the progress, and dialysis may be necessary to bridge the time gap required for treating these fundamental causes.

Chronic kidney disease

Main article: Chronic kidney disease

Chronic kidney disease (CKD) can also develop slowly and, initially, show few symptoms. CKD can be the long term consequence of irreversible acute disease or part of a disease progression.

Acute-on-chronic kidney failure

Acute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic kidney failure (AoCRF). The acute part of AoCRF may be reversible, and the goal of treatment, as with AKI, is to return the patient to baseline kidney function, typically measured by serum creatinine. Like AKI, AoCRF can be difficult to distinguish from chronic kidney disease if the patient has not been monitored by a physician and no baseline (i.e., past) blood work is available for comparison.

Signs and symptoms

Symptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or notice symptoms as they occur. When kidneys fail to filter properly, waste accumulates in the blood and the body, a condition called azotemia. Very low levels of azotaemia may produce few, if any, symptoms. If the disease progresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Kidney failure accompanied by noticeable symptoms is termed uraemia.

Symptoms of kidney failure include the following:

• High levels of urea in the blood, which can result in:
  • Vomiting and/or diarrhea, which may lead to dehydration
  • Nausea
  • Weight loss
  • Nocturnal urination
  • More frequent urination, or in greater amounts than usual, with pale urine
  • Less frequent urination, or in smaller amounts than usual, with dark coloured urine
  • Blood in the urine
  • Pressure, or difficulty urinating
  • Unusual amounts of urination, usually in large quantities
• A buildup of phosphates in the blood that diseased kidneys cannot filter out may cause:
  • Itching
  • Bone damage
  • Nonunion in broken bones
  • Muscle cramps (caused by low levels of calcium which can be associated with hyperphosphatemia)
• A buildup of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause:
  • Abnormal heart rhythms
  • Muscle paralysis
• Failure of kidneys to remove excess fluid may cause:
  • Swelling of the legs, ankles, feet, face and/or hands
  • Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)
• Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause:
  • Pain in the back or side
• Healthy kidneys produce the hormone erythropoietin that stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin, a condition known as anemia. This can result in:
  • Feeling tired and/or weak
  • Memory problems
  • Difficulty concentrating
  • Dizziness
  • Low blood pressure
• Normally, proteins are too large to pass through the kidneys, however, they are able to pass through when the glomeruli are damaged. This does not cause symptoms until extensive kidney damage has occurred, after which symptoms include:
  • Foamy or bubbly urine
  • Swelling in the hands, feet, abdomen, or face
• Other symptoms include:
  • Appetite loss, a bad taste in the mouth
  • Difficulty sleeping
  • Darkening of the skin
  • Excess protein in the blood
  • With high dose penicillin, people with kidney failure may experience seizures

Causes

Acute kidney injury

Acute kidney injury (previously known as acute renal failure) - or AKI - usually occurs when the blood supply to the kidneys is suddenly interrupted or when the kidneys become overloaded with toxins. Causes of acute kidney injury include accidents, injuries, or complications from surgeries in which the kidneys are deprived of normal blood flow for extended periods of time. Heart-bypass surgery is an example of one such procedure.

Drug overdoses, accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, may also cause the onset of acute kidney injury. Unlike chronic kidney disease, however, the kidneys can often recover from acute kidney injury, allowing the patient to resume a normal life. People suffering from acute kidney injury require supportive treatment until their kidneys recover function, and they often remain at increased risk of developing future kidney failure.

Among the accidental causes of renal failure is the crush syndrome, when large amounts of toxins are suddenly released in the blood circulation after a long compressed limb is suddenly relieved from the pressure obstructing the blood flow through its tissues, causing ischemia. The resulting overload can lead to the clogging and the destruction of the kidneys. It is a reperfusion injury that appears after the release of the crushing pressure. The mechanism is believed to be the release into the bloodstream of muscle breakdown products – notably myoglobin, potassium, and phosphorus – that are the products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemic conditions). The specific action on the kidneys is not fully understood, but may be due in part to nephrotoxic metabolites of myoglobin.

Chronic kidney disease

Chronic kidney disease (CKD) has numerous causes. The most common causes of CKD are diabetes mellitus and long-term, uncontrolled hypertension. Polycystic kidney disease is another well-known cause of CKD. The majority of people afflicted with polycystic kidney disease have a family history of the disease. Other genetic illnesses affect kidney function, as well.

Overuse of common drugs such as ibuprofen, and acetaminophen (paracetamol) can also cause chronic kidney damage.

Some infectious diseases, such as hantavirus, can attack the kidneys, causing kidney failure.

Genetic predisposition

The APOL1 gene has been proposed as a major genetic risk locus for a spectrum of nondiabetic renal failure in individuals of African origin, these include HIV-associated nephropathy (HIVAN), primary nonmonogenic forms of focal segmental glomerulosclerosis, and hypertension affiliated chronic kidney disease not attributed to other etiologies. Two western African variants in APOL1 have been shown to be associated with end stage kidney disease in African Americans and Hispanic Americans.

Diagnostic approach

Measurement for CKD

Stages of kidney failure

Chronic kidney failure is measured in five stages, which are calculated using a patient’s GFR, or glomerular filtration rate. Stage 1 CKD is mildly diminished renal function, with few overt symptoms. Stages 2 and 3 need increasing levels of supportive care from their medical providers to slow and treat their renal dysfunction. Patients in stages 4 and 5 usually require preparation of the patient towards active treatment in order to survive. Stage 5 CKD is considered a severe illness and requires some form of renal replacement therapy (dialysis) or kidney transplant whenever feasible.

Glomerular filtration rate

A normal GFR varies according to many factors, including sex, age, body size and ethnic background. Renal professionals consider the glomerular filtration rate (GFR) to be the best overall index of kidney function. The National Kidney Foundation offers an easy to use on-line GFR calculator for anyone who is interested in knowing their glomerular filtration rate. (A serum creatinine level, a simple blood test, is needed to use the calculator).

Use of the term uremia

Before the advancement of modern medicine, renal failure was often referred to as uremic poisoning. Uremia was the term for the contamination of the blood with urine. It is the presence of an excessive amount of urea in blood. Starting around 1847, this included reduced urine output, which was thought to be caused by the urine mixing with the blood instead of being voided through the urethra. The term uremia is now used for the illness accompanying kidney failure.

References

External links

• Connecting dialysis community around the World (US)
• National Kidney Foundation (US)
• The Kidney Foundation of Canada(CA)

UpToDate Contents

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• 1. 鈍的尿生殖器外傷：初期評価およびマネージメント blunt genitourinary trauma initial evaluation and management
• 2. 急性腎障害（急性腎不全）のマネージメントの概要 overview of the management of acute kidney injury acute renal failure
• 3. 急性腎障害（急性腎不全）または慢性腎臓病患者に対する診断的アプローチ diagnostic approach to the patient with acute kidney injury acute renal failure or chronic kidney disease
• 4. 挫滅関連の急性腎障害（急性腎不全） crush related acute kidney injury acute renal failure
• 5. 小児における急性腎障害：臨床的特徴、病因、評価、および診断 acute kidney injury in children clinical features etiology evaluation and diagnosis

English Journal

• Exosomal ATF3 RNA Attenuates Pro-Inflammatory Gene MCP-1 Transcription in Renal Ischemia-Reperfusion.

• Chen HH1, Lai PF, Lan YF, Cheng CF, Zhong WB, Lin YF, Chen TW, Lin H.
• Journal of cellular physiology.J Cell Physiol.2014 Sep;229(9):1202-11. doi: 10.1002/jcp.24554.
• Transcriptional repressor activating transcription factor 3 (ATF3) is induced by various stress stimuli, including inflammation-induced renal injury. In addition, ATF3 also down-regulates adhesion molecules like intercellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), and mono
• PMID 24420912

• Smad7 inhibits AngII-mediated hypertensive nephropathy in a mouse model of hypertension.

• Liu GX1, Li YQ1, Huang XR, Wei LH2, Zhang Y2, Feng M2, Meng XM2, Chen HY2, Shi YJ1, Lan HY.
• Clinical science (London, England : 1979).Clin Sci (Lond).2014 Aug;127(3):195-208. doi: 10.1042/CS20130706.
• The TGFβ (transforming growth factor β)/SMAD and NF-κB (nuclear factor κB) signalling pathways play a key role in hypertensive nephropathy. The present study examined whether targeting these pathways by SMAD7, a downstream inhibitor of both pathways, blocks AngII (angiotensin II)-induced hyperte
• PMID 24511990

• DNA damage response in renal ischemia-reperfusion and ATP-depletion injury of renal tubular cells.

• Ma Z1, Wei Q1, Dong G1, Huo Y2, Dong Z3.
• Biochimica et biophysica acta.Biochim Biophys Acta.2014 Jul;1842(7):1088-96. doi: 10.1016/j.bbadis.2014.04.002. Epub 2014 Apr 12.
• Renal ischemia-reperfusion leads to acute kidney injury (AKI) that is characterized pathologically by tubular damage and cell death, followed by tubular repair, atrophy and interstitial fibrosis. Recent work suggested the possible presence of DNA damage response (DDR) in AKI. However, the evidence i
• PMID 24726884

Japanese Journal

• 日本外傷学会腎損傷分類2008(JAST分類2008)に基づいた鈍的腎外傷207例の初期治療選択因子の検討

• 日本泌尿器科学会雑誌 = The Japanese journal of urology 107(1), 13-20, 2016-01
• NAID 40020707926

• Tensin2-deficient mice on FVB/N background develop severe glomerular disease

• Journal of Veterinary Medical Science advpub(0), 2016
• NAID 130005124522

• Angiotensin-Converting Enzyme Inhibitor Prevents the Worsening of Renal Function in the Late Phase after Percutaneous Coronary Intervention

• Journal of Atherosclerosis and Thrombosis 23(2), 233-240, 2016
• NAID 130005122033

Related Links

• Renal Trauma - Medscape Reference

20 Oct 2011 ... Renal trauma may manifest in a dramatic fashion for both the patient and the clinician. The incidence of renal trauma somewhat depends on the patient population being considered. Renal trauma accounts for approximately ...

• Acute kidney injury - Wikipedia, the free encyclopedia

Acute kidney injury (AKI), previously called acute renal failure (ARF), is a rapid loss of kidney function. Its causes are numerous and include low blood volume from any cause, exposure to substances harmful to the kidney, and obstruction of ...

Related Pictures

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★リンクテーブル★

リンク元	「腎損傷」「腎外傷」
関連記事	「injury」「renal」

「腎損傷」

　　[★]

英

renal injury

同？

腎破裂 renal rupture

関

腎外傷 renal trauma

分類

参考1改変

• I型：腎被膜下損傷(腎挫傷) subcapsular injury：腎被膜の断裂なし。保存的治療

• Ia型：被膜下血腫 subcapsular hematoma
• Ib型：実質内血腫 intraparenchymal hematoma

• II型：腎表在性損傷(腎裂傷) superficial injury：腎皮質の損傷のみ。保存的治療
• III型：腎深在性損傷(腎断裂) deep injury：腎皮質～腎髄質の損傷。緊急手術が必要となる場合がある。

• IIIa型：単純深在性損傷 simple deep injury
• IIIb型：複雑深在性損傷 complex deep injury

• IV型：腎茎部血管損傷：腎動脈・腎静脈の損傷。手術の適応

治療

• I型,II型：保存的治療
• 血圧が安定しない、腹腔内蔵器の損傷を合併、IV型：外科的治療の適応 (SURO.152)

参考

• 1. 日本外傷学会臓器損傷分類2008

http://www.jast-hp.org/sonsyoubunruilist.pdf

「腎外傷」

　　[★]

英

renal trauma, renal injury

関

腎損傷

「injury」

　　[★]

• n.

• 傷害、損傷、外傷、受傷
• wound or trauma; harm or hurt; usually applied to damage inflicted on the body by an external force.

関

damage、injure、insult、lesion、spoilage、trauma、traumatic、traumatic injury、wound

　 　 　 　 　

「renal」

　　[★]

• adj.

• 腎臓の、腎性の、腎の

関

kidney、renally