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  <head>
    <title>020-02 Kidney injury phenotypes, recovery trajectories, and replacement decisions</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Kidney injury phenotypes, recovery, and replacement decisions">
      <outline text="Injury as a syndrome">
        <outline text="Loss of filtration or urine, not one lesion"/>
        <outline text="Haemodynamic, tubular, interstitial, glomerular, vascular, obstructive"/>
        <outline text="Pre-renal label suggests intact responsive tissue">
          <outline text="Prolonged stress becomes structural injury"/>
          <outline text="Tubular injury keeps reversible haemodynamic components"/>
        </outline>
        <outline text="Assess perfusion, congestion, exposure, sediment, trajectory"/>
        <outline text="Oliguria is earlier evidence but confounded"/>
      </outline>
      <outline text="Haemodynamic and congestive phenotypes">
        <outline text="Reduced filling activates sympathetic and hormonal responses">
          <outline text="Restoring pressure can reverse it before injury"/>
        </outline>
        <outline text="Congestion lowers the filtration gradient">
          <outline text="Impaired lymphatic drainage and sodium retention"/>
          <outline text="Repeated fluid for a rising creatinine worsens it"/>
        </outline>
        <outline text="Abdominal and airway pressure alter renal venous return"/>
      </outline>
      <outline text="Tubular injury and repair">
        <outline text="Lost polarity, redistributed transporters, obstructed lumens"/>
        <outline text="Back-leak, inflammation, vasoconstriction sustain low filtration"/>
        <outline text="Surviving cells dedifferentiate, migrate, proliferate">
          <outline text="Polyuric phase precedes restored concentrating capacity"/>
        </outline>
        <outline text="Maladaptive repair causes capillary loss and fibrosis">
          <outline text="Biochemical recovery can hide reduced reserve"/>
        </outline>
        <outline text="Pigment injury: toxicity, obstruction, vasoconstriction">
          <outline text="Potassium and calcium hazards precede creatinine"/>
        </outline>
      </outline>
      <outline text="Interstitial, glomerular, and vascular urgency">
        <outline text="Interstitial nephritis often lacks the classic triad"/>
        <outline text="Active sediment raises glomerular urgency">
          <outline text="Delay converts inflammation into crescents and scar"/>
        </outline>
        <outline text="Thrombotic microangiopathy: endothelium, platelets, haemolysis">
          <outline text="Selected mechanisms need time-critical specific treatment"/>
        </outline>
        <outline text="Vascular disease can give a bland urine"/>
      </outline>
      <outline text="Obstruction and decompression">
        <outline text="Continuing urine does not exclude obstruction"/>
        <outline text="Early blockage shows little hydronephrosis"/>
        <outline text="Chronic dilation persists without active pressure"/>
        <outline text="Decompression causes haematuria and diuresis">
          <outline text="Replace a proportion, not every millilitre"/>
        </outline>
      </outline>
      <outline text="Chronic progression and risk">
        <outline text="Filtration category and albuminuria are two dimensions">
          <outline text="Albumin predicts cardiovascular events"/>
          <outline text="Rate of change is the third dimension"/>
        </outline>
        <outline text="Hyperfiltration raises single-nephron pressure">
          <outline text="Filtered protein activates inflammation and fibrosis"/>
        </outline>
        <outline text="Blockade and cotransporter inhibition lower glomerular load">
          <outline text="Early filtration dip, better long-term trajectory"/>
        </outline>
        <outline text="Atypical patterns should not end investigation"/>
      </outline>
      <outline text="Dialysis and the decision to start">
        <outline text="Diffusion for solute, transmembrane pressure for water"/>
        <outline text="Clearance rises with flows, membrane, and time"/>
        <outline text="Rapid urea fall can swell the brain"/>
        <outline text="Continuous therapy trades speed for steady control">
          <outline text="Clotting and interruption reduce delivered dose"/>
        </outline>
        <outline text="Peritoneal dialysis uses capillaries and glucose gradient">
          <outline text="Cloudy effluent needs urgent sampling"/>
        </outline>
        <outline text="Start on refractory physiology, not creatinine">
          <outline text="Potassium, acidity, volume, uraemic effects, toxin"/>
          <outline text="Modality fits stability, urgency, access, plan"/>
        </outline>
      </outline>
      <outline text="Planning before replacement">
        <outline text="Preparation does not begin just before dialysis"/>
        <outline text="Share progression rate and replacement possibility"/>
        <outline text="Transplantation, home therapy, in-centre dialysis, conservative care"/>
        <outline text="Explained against values and daily life"/>
        <outline text="Access, vaccination, anaemia and bone-mineral care"/>
        <outline text="Nutrition, medication education, symptom relief"/>
        <outline text="Frailty: travel burden, function, home life, carers"/>
      </outline>
      <outline text="Kidney biopsy">
        <outline text="Will the result change treatment and prognosis"/>
        <outline text="Bleeding risk, kidney size, blood pressure"/>
        <outline text="Anticoagulation, platelet count, alternative diagnoses"/>
        <outline text="A small sample can miss patchy disease"/>
        <outline text="Chronic scarring mixes with active lesions"/>
        <outline text="Allocate to light, immunological, electron microscopy"/>
        <outline text="Give the pathologist timeline and urine findings"/>
      </outline>
      <outline text="Prescribing and transitions">
        <outline text="Separate loading from maintenance dosing"/>
        <outline text="Critical illness and circuits change distribution"/>
        <outline text="Secretion inhibitors raise creatinine without injury"/>
        <outline text="Haemodynamic fall can still protect long term"/>
        <outline text="True toxicity hits tubules, interstitium, vessels, crystals"/>
        <outline text="Staged reintroduction after acute injury"/>
        <outline text="Final plan states mechanism, trajectory, monitoring"/>
      </outline>
    </outline>
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