Chapter XIV N00-N99 Genitourinary System N00-N39 Urinary .

Chapter XIVN00-N99 Genitourinary SystemChapter XIVN00-N39 Urinary Systemนพ.บิัก์ �รรม รพ.สวรร์ประชาัก์ นครสวรร์นพ.บิัก์ �รรม รพ.สวรร์ประชาัก์ นครสวรร์12Symptoms and SignsSummary nary incontinenceUrinary retentionUrethral dischargeICD-10R34R35R35R30.0R31R32R33R36Oliguria: urine 400 ml/24 h; Anuria: urine 100 ml/24 h3Chapter XIVN17-N19 Renal Failureนพ.บิัก์ �รรม รพ.สวรร์ประชาัก์ นครสวรร์4

Renal FailureAcute Renal FailureAcute Kidney InjuryAcute Tubular NecrosisPrerenal AzotemiaChronic Kidney DiseaseRenal Insufficiency‘Failure’ is not falling downbut is staying down !!AnonymousOliguria: 400 ml/24 hours, Anuria 75 ml/hours [100 ml]"Renal failure(N17-N19)"56Renal FailureAcute Renal FailureUse additional external cause code (Chapter XX), if desired, to identifyexternal agent.Excludes: congenital renal failure ( P96.0 )drug- and heavy-metal-induced tubulo-interstitial and tubularconditions ( N14.- )extrarenal uraemia ( R39.2 )haemolytic-uraemic syndrome ( D59.3 )hepatorenal syndrome ( K76.7 )· postpartum ( O90.4 )prerenal uraemia ( R39.2 )renal failure:· complicating abortion or ectopic or molar pregnancy( O00-O07 , O08.4 )· following labour and delivery ( O90.4 )· postprocedural ( N99.0 )N17Acute renal failureIn ICD-10 system,‘Etiology' is the “First Priority”.7A clinical syndrome characterized by rapid reduction in renalexcretory function underpinned by variety of causedARF is defined by the glomerular filtration rate is reduced .decrease urine nitrogenous wasted accumulates in the body .uremia metabolic and electrolytes disturbancesReserved for patients who have lost renal functionto the point that life can no longer be sustainedwithout intervention and need renal replacementtherapy.8

Acute Kidney InjuryA clinical syndrome characterized by rapid reduction in renalexcretory function underpinned by variety of causedAKI causes are generally divided into Pre-renal Renal (intrinsic) Post-renalUsed to describe the milder as well as severeforms of acute renal dysfunction in patients.AKI vs ARFAKI ARF ?Acute Kidney InjuryAcute Renal FailureDefined as an abrupt change inserum creatinine and/or urine outputand classified according the RIFLEcriteria or AKIN criteriaDefined as renal function inadequateto clear the waste products ofmetabolism despite the absence ofcorrection of hemodynamic ormechanical causesIntended to describe the entirespectrum of disease from beingrelatively mild to severeClinical manifestations of renalfailure include the following- Uremic symptoms- Hyperkalemia- Hyponatremia- Metabolic acidosis910RIFLE Criteria & AKIN CriteriaAcute Kidney InjuryA clinical syndrome characterized by rapid reduction in renalexcretory function underpinned by variety of causedAcute Kidney Injury CriteriaAny of the following- Increase in serum creatinine 0.3 mg/dL within 48 h- Increase in serum creatinine 1.5x baseline within 7 d- Urine volume 0.5 mL/kg/h x 6 hKDIGO 20121112

Acute Renal FailurePrerenal ARF: Functional disturbanceDecreased renal perfusion without cellular injuryPrerenal azotemia, Acute renal failure (unspecified)Renal-Intrinsic ARF: Structural damageProlonged renal ischemia, Nephrotoxicity, Infectious processesAcute tubular necrosis, Acute interstitial nephritis, Acuteglomerulonephritis, Vascular occlusionsPostrenal ARF: ObstructionObstruction to the urinary outflowAcute Tubular Necrosis (ATN)Ischemic typeProlonged renal ischemiaToxic typeEndogenous toxinsRhabdomyolysisHemolysisExogenous toxinsAntibiotics e.g. aminoglycosides, amphotericin BRadiocontrast agentsHeavy metals e.g. cis-platinum, mercuryPoisons e.g. ethylene glycol1314Nephrotoxic Renal FailureAcute Renal FailureN14Drug- and heavy-metal-induced tubulo-interstitialand tubular conditionsUse additional external cause code (Chapter XX), if desired, toidentify toxic agent.N14.0Analgesic nephropathyN14.1Nephropathy induced by other drugs, medicaments andbiological substancesNephropathy induced by unspecified drug, medicament orbiological substanceN14.2N14.3Nephropathy induced by heavy metalsN14.4Toxic nephropathy, not elsewhere ��น1. ีการเ่มของ BUN มากก่าเิม 10 � creatinine เ่มมากก่าเิม 1 ิลิกัม่อเดิิตร �2. �้อยก่า 30 ิลิิตร่อ่วโมง หือ400 ิลิิตร่อัน หือเ็น non-oliguria (ัสสาวะออกมากก่า400 ิลิิตร ็ไ้กรีิิจัย่า Acute kidney injury (AKI) ใ้ตรวจสอบ่าเ็น Prerenal azotemia [R39.2] หือ Acute renal failure [N17.9]16

Prerenal �ว- BUN:creatinine ratio เ่าับหือมากก่า 20:1- Urine specific gravity มากก่า อ่างรวดเ็วภายใน 1–2 ันักตรวจพบสาเหุ เ่น การขาดำ ้องเีย ภาวะ็อกันึกสาเหุ �ก Prerenal azotemia เ็นการิิจัย่วมAcute Renal Failureการันึก acute renal failure ��เหุไ้ �พาะ้นัวอ่าง NSAIDs-induced renal failureContrast media-induced renal failureHemolytic-uremic syndromeHepatorenal syndromeโดนไ่้องันึก Acute renal failure �ไ่ทราบสาเหุ ใ้ันึก Acute renal failure ic Renal FailureAcute Kidney Injuryีประัิ Chronic kidney diseaseีการเ่มของ BUN, creatinine มากก่าเิม- BUN เ่ม้นอ่าง้อย 10 ิลิกัม่อเดิิตร และ- creatinine เ่ม้นอ่าง้อย 1 �ก Acute renal failure �ันึก Chronic kidney disease � Acute-on-End stage renal diseaseไ่้องสุป Acute renal failure เ็นการิิจัย19Summary DiagnosisRenal insufficiencyPrerenal azotemiaAcute kidney injuryAcute renal failureAcute tubular necrosis (ATN) – no specific causedNSAIDs-induced ATNRadiocontrast-induced ATN or renal failureAntibiotic-induced ATN or renal failureAKI due to obstructive uropathy20ICD-10N19R39.2N17.9N17.9N17.0N14.0 Y45.N14.1 Y57.5N14.1 Y40.N17.8 N13.-

Acute Kidney InjurySummary DiagnosisSLE with renal failureThrombotic thrombocytopenic purpura with renal failureHenoch-Schonlein purpura with renal failureHemolytic-uremic syndromeHepatorenal syndromePostpartum hepatorenal syndromePostpartum renal failurePostoperative renal failureTraumatic anuria, Traumatic rhabdomyolysisICD-10M32.1 N08.5M31.1 N08.5D69.0 N08.2D59.3 N08.2K76.7O90.4O90.4N99.0T79.6Chronic Kidney DiseaseChronic kidney disease (CKD) is defined based on the presenceof either kidney damage or decreased kidney function for three ormore months, irrespective of the causeCKD is defined by the presence of kidney damage or decreased kidney function for three or more months irrespective of the causeไ่้องใ้รัส N17.x �2122Chronic Kidney DiseaseChronic Kidney DiseaseChronic kidney disease (CKD) is defined by the presence of kidney damage or decreased kidney functionKidney damage renal biopsy or imaging studies or inferred from markers such asa. urinary sediment abnormalities orb. increased rates of urinary albumin excretionDecreased kidney function glomerular filtration rate (GFR) 60 mL/min/1.73 m223Chronic kidney disease (CKD) is defined by the presence of kidney damage or decreased kidney functionImaging abnormalities U/S, CT, MRI, isotope scan, angiography Hydronephrosis due to obstruction Cortical scarring due to infarcts, pyelonephritis or reflux Renal masses or enlarged kidney due to infiltrative dis. Renal artery stenosis Small and echogenic kidneys in later stages of CKD Polycystic kidneys24

Chronic Kidney DiseaseChronic kidney disease (CKD) is defined by the presence of kidney damage or decreased kidney functionUrinary sediment abnormalities RBC casts in proliferative glomerulonephritis WBC casts in pyelonephritis or interstitial nephritis Oval fat bodies or Fatty casts in diseases with proteinuria Granular casts and renal tubular epithelial cellsAlbuminuriaUrine albumin-to-creatinine ratio 30 mg/g urine dipstick: trace or 1 25Chronic Kidney DiseaseChronic kidney disease (CKD) is defined based on the presenceof either kidney damage or decreased kidney function for three ormore months, irrespective of the causeDiagnostic CriteriaDuration 3 months, based on documentation withGlomerular filtration rate (GFR) 60 mL/min/1.73 m2orKidney damage, as defined bystructural abnormalities orfunctional abnormalities other than decreased GFR26Chronic Kidney Diseasewith kidney damage2728

Chronic Kidney DiseaseSummary DiagnosisChronic kidney diseaseChronic kidney disease stage 1Chronic kidney disease stage 2Chronic kidney disease stage 3Chronic kidney disease stage 4Chronic kidney disease stage 5End stage renal ronic Kidney ��วยโรคไตเ้อัง: �มไ้: ��นการิิจัย่วมไ้Volume overload [E87.7]Uremic encephalopathy [G92]Uremic neuropathy [N18.5 G63.8]Uremic pericarditis [N18.5 ricemiaMetabolic �ษาเ่ง่วน2930ESRD PatientESRD Patient้างไตทาง่อง้อง �รงพยาบาลคราว้: Peritoneal dialysis status หือ CAPD statusฟอกเือด �รงพยาบาลคราว้: Hemodialysis status หือ Renal dialysis status: Arteriovenous fistula status หือ AVF �ทาง่อง้อง �คราว้: Peritoneal dialysis care หือ CAPD ��เือด �คราว้: Hemodialysis care3132

ESRD PatientSummary DiagnosisESRD PatientICD-10Peritoneal dialysis status / CAPD statusHemodialysis statusAVF statusZ99.2Z99.2Z99.2Hemodialysis carePeritoneal dialysis care / CAPD careZ49.2Z49.1Summary ProcedureICD-9-CMVenous catheterisation for hemodialysisHemodialysis38.9539.95Arteriovenous shunt [AVF]Arteriovenous graft ��ารันึกำิิจัย (Diagnostic �นของ้อน่วObstruction: hydronephrosis [ไ่รวม hydroureter]Chapter XIVN20-N23 Urolithiasisนพ.บิัก์ �รรม รพ.สวรร์ประชาัก์ นครสวรร์35Urinary tract infection: upper UTI [pyelonephritis, pyonephrosis, ureteritis]: lower UTI [cystitis, urethritis]36

Urolithiasis(upper part)Renal Colic / Ureteric �าง �ะเพศ � �่ไ้ลดอาการปวดลง น่าี้อน่วSummary DiagnosisRenal stoneRenal stone with hydronephrosisRenal stone with UTIRenal stone with hydronephrosis with UTIUreteric stoneUreteric stone with hydronephrosisUreteric stone with UTIUreteric stone with hydronephrosis with UTIRenal stone with ureteric stoneRC & UC with hydronephrosisRC & UC with hydronephrosis with UTI3738Urolithiasis(upper part)Urolithiasis(lower part)Summary DiagnosisRenal stoneRenal stone with hydronephrosisRenal stone with UTIRenal stone with hydronephrosis with UTIICD-10N20.0N13.2N20.0N13.6NEW .Renal stone with Acute pyelonephritis : N20.0 N10Summary DiagnosisVesical stoneVesical stone with cystitisVesical stone with urethritisICD-10N21.0N21.0N21.0Urethral stoneUrrethral stone with urethritisN21.1N21.1Urolithiasis in schistostomiasisXanthine stoneNephrocalcinosisB65.x N22.0E79.8 N22.8E83.5 N29.8Renal colicUreteric 3.6N20.2N13.2N13.6N23N2340