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  <head>
    <title>020-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Acute kidney injury, chronic kidney disease, and renal pharmacology">
      <outline text="Recognising acute kidney injury">
        <outline text="Hours to days, versus months for chronicity"/>
        <outline text="Rising creatinine, falling urine output, or both">
          <outline text="Creatinine rises only after filtration falls"/>
          <outline text="Fluid balance dilutes or concentrates it"/>
        </outline>
        <outline text="Oliguria can occur without structural damage"/>
        <outline text="Non-oliguric injury can still be severe"/>
        <outline text="Classify perfusion, intrinsic injury, obstruction, with overlap"/>
        <outline text="Review baseline, sepsis, surgery, contrast, medicines"/>
      </outline>
      <outline text="Reduced perfusion and haemodynamic injury">
        <outline text="Haemorrhage, dehydration, vasodilation, low cardiac output"/>
        <outline text="Autoregulation balances afferent and efferent tone">
          <outline text="Fails beyond range or when drugs block compensation"/>
        </outline>
        <outline text="Non-steroidal drugs reduce afferent dilation"/>
        <outline text="Renin-angiotensin blockers reduce efferent constriction"/>
        <outline text="Modest change may be filtration, progression needs review"/>
        <outline text="Sepsis: microvascular, inflammatory, metabolic dysfunction"/>
        <outline text="Venous congestion raises interstitial pressure"/>
      </outline>
      <outline text="Intrinsic renal disease">
        <outline text="Acute tubular injury from ischaemia, sepsis, toxins">
          <outline text="Cells detach and obstruct tubular lumens"/>
          <outline text="Granular casts, then a high-output recovery phase"/>
        </outline>
        <outline text="Acute interstitial nephritis is often drug-related">
          <outline text="Fever, rash, eosinophilia frequently absent"/>
        </outline>
        <outline text="Glomerulonephritis: haematuria, protein, hypertension, oedema">
          <outline text="Rapidly progressive disease destroys function quickly"/>
        </outline>
        <outline text="Thrombotic microangiopathy injures endothelium"/>
        <outline text="Pigment nephropathy from myoglobin or haemoglobin">
          <outline text="Rhabdomyolysis: creatine kinase, potassium, calcium, acidosis"/>
        </outline>
      </outline>
      <outline text="Obstruction">
        <outline text="Prostate, stones, tumours, clots, strictures"/>
        <outline text="Unilateral obstruction may preserve creatinine"/>
        <outline text="Early blockage may lack dilation, chronic dilation persists"/>
        <outline text="Post-obstructive diuresis loses salt and water">
          <outline text="Monitor and replace a proportion of losses"/>
        </outline>
      </outline>
      <outline text="Immediate management and dialysis">
        <outline text="Stop nephrotoxins and adjust drug doses"/>
        <outline text="Restore perfusion, treat infection, relieve obstruction"/>
        <outline text="Diuretics do not treat a laboratory category"/>
        <outline text="Replacement for refractory potassium and acidaemia">
          <outline text="Toxins and uraemic complications, not a creatinine value"/>
        </outline>
        <outline text="Intermittent haemodialysis removes solute rapidly"/>
        <outline text="Continuous therapy suits unstable patients"/>
      </outline>
      <outline text="Chronic kidney disease">
        <outline text="Staged by filtration category and albuminuria">
          <outline text="Both predict progression and cardiovascular risk"/>
        </outline>
        <outline text="Causes: diabetes, hypertension, glomerular, inherited disease"/>
        <outline text="Chronicity from old results, imaging, anaemia, bone"/>
        <outline text="Remaining nephrons hyperfilter and hypertrophy">
          <outline text="Intraglomerular stress and proteinuria drive fibrosis"/>
        </outline>
        <outline text="Slowing: pressure, albuminuria, glucose, blockade, cessation"/>
      </outline>
      <outline text="Systemic complications">
        <outline text="Sodium retention, potassium and acid accumulation"/>
        <outline text="Low erythropoietin and iron restriction cause anaemia"/>
        <outline text="Phosphate, vitamin D, calcium, parathyroid remodelling"/>
        <outline text="Uraemic toxins affect nerves, platelets, appetite"/>
        <outline text="Cardiovascular risk from calcification and load"/>
      </outline>
      <outline text="Renal prescribing">
        <outline text="Dose follows filtration, stability, dialysis, binding"/>
        <outline text="Reduce amount, extend interval, or both"/>
        <outline text="Loading dose follows volume of distribution"/>
        <outline text="Toxicity: haemodynamic, tubular, crystal, interstitial"/>
        <outline text="Monitor the expected injury, not undirected tests"/>
        <outline text="Dialysis removes small, unbound, low-volume drugs"/>
      </outline>
      <outline text="Assessment and investigation">
        <outline text="Ask about urine, swelling, stones, family, medicines"/>
        <outline text="Examine pressure, volume, bladder, skin, access"/>
        <outline text="Integrate blood trends, urinalysis, protein quantification"/>
        <outline text="Ultrasound, immune tests, microbiology, selected biopsy"/>
        <outline text="Urgency: rapid loss, active sediment, heavy protein"/>
      </outline>
      <outline text="Access, transplantation, and prevention">
        <outline text="Fistula durable but slow, graft faster but riskier"/>
        <outline text="Catheter is immediate but risks infection"/>
        <outline text="Haemodialysis: hypotension, cramps, disequilibrium"/>
        <outline text="Peritoneal dialysis: peritonitis, hernia, membrane failure">
          <outline text="Cloudy effluent with pain needs urgent sampling"/>
        </outline>
        <outline text="Transplant needs immunosuppression and surveillance">
          <outline text="Rejection may be a silent creatinine rise"/>
        </outline>
        <outline text="Conservative care treats symptoms and plans ahead"/>
        <outline text="Discharge is not proof of renal recovery"/>
        <outline text="Pregnancy, contrast, surgery, infection are high risk"/>
      </outline>
    </outline>
  </body>
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