Anatomy and Physiology of Urinary System (13:16)
Kidneys monitor the body's electrolytes, blood pressure, minerals, and pH, and correct any discrepancies. Carla Moschella reviews the mechanics behind the kidneys including the renal artery, medulla, interstitium, afferent arteriole, ureter, glomerulus, and collection ducts. Nephrons remove or add substances to the blood depending on need and excrete waste through urine.
Glomerular Filtration Rate (12:49)
The GFR measures the level of kidney function and determines the stage of disease; seven liters of blood should be filtered per hour. Moschella describes why creatinine levels, 24- hour urine collections, the Cockroft-Gault equation, and Blood Urea Nitrogen are not accurate testing methods and prefers the Chronic Kidney Disease Epidemiology equation. New research into cystatin C and fibroblast growth factor testing may be available clinically in a few years.
Nephrologists should not look at color or appearance. Moschella reviews findings gathered including specific gravity, osmolality, protein, glucose, and blood levels. Albumin in urine is the first sign of chronic kidney disease.
High blood pressure affects the urinary, cardiovascular, and neurological systems. Moschella reviews recent findings made by the Joint National Commission; lifestyle changes can reduce kidney disease.
Kidneys Initiate High Blood Pressure (07:19)
Kidneys sense a drop in blood pressure and secrete renin to increase fluid retention; most adults will develop hypertension at one point in their life. Glomeruli can adjust their own pressure by changing the diameter of the afferent and efferent arterioles.
Medication for Hypertension (17:19)
Thiazide diuretics, beta-blockers, ACE inhibitors, ARB receptors, and calcium channel blockers help prevent and slow the progress of kidney disease. Hospitals contract with a particular manufacturer. Moschella reviews the benefits and drawbacks of using the medications.
John Landis (01:14)
Landis is known for "Animal House," "Blues Brothers," and other hit comedies. He discusses some of his Beverly Hills neighbors, which include Denzel Washington and Sidney Poitier.
Chronic Kidney Disease (10:59)
National Health and Nutrition Examination Survey recently reported that American's kidney health has improved in the last decade. GFRs less than sixty are indicative of 50% kidney function in CKD patients over a period of three months. Individuals afflicted with hypertension, diabetes, and autoimmune diseases are more susceptible. The CDK-epi equation can help predict and track the diagnosis.
CKD Assessment (10:40)
Treatment methods include blood pressure control, an ACE inhibitor, and ARB receptors. Moschella describes screening techniques including urinalysis, watching blood pressure, ultrasound testing, MRI, helical CT, biopsy, and intravenous pyelogram. Compare images for a healthy and dysfunctional kidney.
Landis knew he wanted to be a director from a young age. He sought out many of his idols as a teenager; the likes of Alfred Hitchcock and Frank Capra. Mentor Bundy Martin landed him an opportunity to work abroad on “Kelly's Heroes.”
Glomerular Causes of Chronic Kidney Disease (14:31)
Nephrotic syndrome indicates that the kidneys are struggling. Moschella describes diabetic nephropathy and focal segmental glomerulosclerosis diagnoses and treatment. If a patient is pre-eclamptic, perform a 24-hour urine test.
Tubulointerstitial Causes of Chronic Kidney Disease (23:57)
Moschella describes chronic hypokalemia, Autosomal Dominant Polycystic Kidney Disease, Vesicoureteral Reflux, and Analgesic Neuropathy diagnoses and treatment. Diuretics, lithium, and other medications can cause damage. Compare images for unhealthy kidneys.
Stage One and Two of Chronic Kidney Disease (11:28)
The National Kidney Foundation sponsored the KDOQI guidelines for CKD and update sections regularly. Send a client to a nephrologist by the time they hit stage three. Moschella reviews the framework for treatment.
Stage Three of Chronic Kidney Disease: Before Lunch (22:09)
Complications in later stages include anemia, low hemoglobin count, malnutrition, low albumin, phosphorus, and potassium levels. Patients with glomerular diseases may benefit from a low protein intake.
First Time Directing (02:12)
Landis was denied membership into the Directors Guild of America despite testing highly. The snub inspired him to direct independently; he and collaborators made "Schlock" for $60,000. It was the first time he worked with makeup artist Rick Baker.
Stage Four and Five of Chronic Kidney Disease (07:00)
Patients begin to exhibit electrolyte fluid acid-base issues, metabolic acidosis, and have trouble breathing. Switch from thiazide diuretics to furosemide. Moschella explains when to begin dialysis and stopping dialysis if you can no longer control metabolic abnormalities.
Finding Projects (03:54)
Landis appeared as a guest on "The Tonight Show with Johnny Carson." He collaborated with a sketch comedy troupe for “Kentucky Fried Movie.” Working on that comedy led to a two-movie deal that included “Animal House.”
Acute Kidney Injury (21:45)
AKI is an abrupt loss of kidney function where fluids and electrolyte levels go awry; hospital stays and surgical procedures carry an increased risk. Risk factors include multiple co-morbidities, lack of oxygen or blood flow to kidneys, and older people. Pre-renal, post-renal, and intrinsic are the three categories.
Acute Interstitial Nephritis (05:13)
Patients present as if they have an allergic reaction or an infection and will possess an elevated eosinophil count on their CBC. White cell casts appear in the urine. The Prognosis is much better than other acute injuries.
Acute Glomerulonephritis (18:29)
GN can be acute or chronic and is caused by post-infections or diseases such as hepatitis C, Berger's disease, and lupus. A nephrologist should see all acute kidney Injuries. Moschella reviews causes and treatment options.
The technology may change, but motion picture production has remained the same for a century. Landis, Dan Akroyd, and John Belushi collaborated on "The Blues Brothers" before "Saturday Night Live." Baker turned Eddie Murphy into an elderly Jewish man and other characters for "Coming to America."
Renal Replacement Therapy (17:23)
Getting a preemptive kidney transplant is preferred because the body undergoes a lot of trauma during dialysis. Moschella reviews the procedure, benefits, and complications of hemodialysis. Patients should obtain an arteriovenous fistula or graft three months prior to beginning dialysis.
Peritoneal Dialysis (06:42)
This type of renal replacement therapy can be performed at home. Moschella reviews the procedure, benefits, and complications. Continuous cyclic is done through a pump while sleeping.
Kidney Transplant (18:44)
Most transplants are performed with deceased donors. Patients will not be seen by a center before their GFR drops below thirty and cannot be listed on UNOS until it is below twenty. Coordinators match donors and organs by human leukocyte antigen testing, age, overall health, and previous donations.
Pros and Cons of Renal Replacement Therapy (10:49)
Transplant patients require a huge time commitment for the three months post-surgery. Complications include infection and increased cancer risk. Moschella explains how to discuss with families when to end care, provides a formula to estimate the patient's chances of living six months, and takes questions from the audience.
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