Renal and Pre-renal failure : differences

                                    pre-renal                renal

fractional    
Na excretion           <1%                         > 2%

Urinary Na               <20                           > 40

Urine osmol              > 500                      < 350

Creatinine                 > 40                       <20



In pre-renal cause, the kidney itself has no pathology but loss of function of kidney is due to decreased perfusion of kidney. Eg. Shock, hypovolaemia, hypotension, bleeding.
Incontrast in renal cause, there is primary pathology in kidney which cause loss of kidney function.

Fractional Na excretion is the fraction of sodium filtered by kidney excreted in urine.

Fraction Na excretion: In pre renal cause, the tubular epithelium is functionalmn it can reabsorp the Na and can concentrate the urine. Therefor fractional Na excretion is low, urinary Na is low and urine osmolality is high.


blood urea and creatinine:
        Creatine is not reabsorped in tubules. whatever filtered by kidney is excreted.
  In pre-renal, there is decrease in GFR~ decrease creatinine excretion and hence creatinine accummulate in body.

urea is increased due to two reason:
            1.) Decrease in GFR directly cause decrease in urea excreation.
             2.) Due to decreased GFR, proximal tubule gets more time to reabsorb filtered urea.
             
so there will be disproportionate increase in creatinineand urea in pre-renal kidney failure.





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Patient preparation for Endoscopy

I will mainly describe about the preparation of patient and procedure of performing endoscopy to a patient. 

let me begin with basic parts of endoscope. It may differs in some aspects but they are all basically same.

Components of Endoscope

                           

                           1. Insertion tube with camera

                           2. light guide connector

                           3. Central body with remote and switches

* The length and size of insertion tube depending upon whether it is     lower  or upper GIT endoscope.

The length of upper GIT endoscope is 1 m and that of lower is 1.6 m. 

  

                                  Preparations and procedure.

                           1. Upper GIT endoscopy.(OGD)

fasting for 6 hrs overnight. Usually from 10 p.m till next morning is pretty well acceptable.

Just before insertion of tube, the spray called xylcoine(anaesthia) is sprayed into patient's mouth and wait for sometime.

Patient is made to lie in the left lateral position and tube is inserted and visualized.

                           2.Sigmodoiscopy

In this case also the patient is asked to fast for 6 hr starting from 10 p.m. The next morning at around 5 a.m, the patient is given kleen enema rectally and asked to hold it for 45 minutes before going to toilet.

This is also done in left lateral position with right hip and knee flexed and left leg in extend position. 

The lignocaine gel is applied around the anus.

Then lignocaine gel is applied to insertion tube and it is then inserted.

                         3. Colonoscopy

Prior to 7 days of procedure , the patient should stop taking any anticoagulants.

Prior to 3 days, ask the patient to be on low fiber diets.

1 day before the procedure, the patient should be admitted to ward and then:

        i. Give 4 sachets of kleen enema.( no solid food )

        ii. Each sachet should be dissolved in 1liter of water and drink  

            it within 15 minutes( usually starts from 2 pm)

       iii. Then again in next 2 hr, patient will drink another sachet 

            and by 8 p.m, he must finish his enema.

      iv. Meanwhile patient is asked to take 1litre of water in between  

           the enema.

          

                             Disinfection of Endoscope

To prevent spread of infections, disinfection and sterilization is done before procedure. 

Wash manually with water before disinfecting.

The chemical used is Perasafe .

If we keep endoscope soaked in it for 5 minutes, it will just disinfect.

If we keep  for 10 mins, it will sterilize and it remains sterilized for 24 hr.

sample collecting tubes and bottles

This is my first article and your feedback of any type for the betterment of my article will be warmly welcomed. 
Following stuff which I am going to write is what is exactly happening at Ragama teaching hospital.
Following images are manually taken from the ward by myself and with some colleagues .Their usages were exactly what nurses told me.
Mistakes are inevitable so is deficiency. so correct me and add more onto my works.
I will mainly be talking about haematological and urine specimen collecting tubes and bottles.
       

1. Urine culture bottle.

    wide mouth, screw cap, and its empty ( no media or any chemical)



  2. Blood culture media

     Its special bottle with brain heart infusion. blood is drawn and put into this tube aseptically.
 Amount of blood drawn:
             i. Neonates     1 ml
             ii. Children     3-5 ml
             iii. Adults       6-10 ml
 We should send this to lab immediately. NEVER refrigerate.


3. Plain tubes

They are plain without any label or chemicals in it. 

It is mainly use to collection and transport of serum. For eg, sample for serum electrolytes.

For ESR they use these tubes and bottles but they add sodium citrate to it as follows:

      1.6ml blood + 0.4 ml sod citrate. so total volume comes to 2 ml.

The main difference is that bottles are use to send sample to night lab and tube for day lab.

4. EDTA tubes

   These tube has red label on its body. it contains 0.2 ml of EDTA.

 It is mainly use for doing  prothrombin time and full blood count.

   Volume collected :  1.8 ml blood +0.2 EDTA

    5. Sugar bottles

    This bottles looks like a bottle in 3 but if look closeup we can see white powder in it.( here we can't appreciate it). that powder is sodium fluoride. And also these bottles are marked as "S" manually for easy identification.

   use for blood sugar measurement. RBS, FBS and PPBS.

5ml of blood is drawn for measuring sugar level.

          thank you....enjoy reading

         Tshering penjor 21st batch.