Renal

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Anonymous
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226702
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Renal
Updated:
2013-07-11 13:16:43
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Renal
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Renal
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  1. Hypernatremia
    • 6D's: diuresis, dehydration, DI, DOCs, diarrhea, disease-kidney/SCD
    • Volume status:
    • Hypertonic gain: hypertonic saline/tube feeds or inc aldosterone
    • Pure water loss, Hypotonic fluid loss: diuretic, diarrhea
    • Rx: Hypovol: D5W or if unstable VS- NS
    • euvol: D5W or 1/2 NS, Hypervol:D5W and diur
  2. Hyponatremia
    • Almost always due to inc ADH
    • Classify by serum osm
    • High >295: hypergly, hypertonic infusion
    • Nml 280-95: hypertriglyc, pseudohyponat
    • Low: >280: most cases
    • Rx: If hypervol: water restrict or replace cortisol if adrenal insuf, replace thy if hypothy, euvol:water restict
    • Hypovol: NS replacement
  3. When to use hypertonic saline for hyponatremia?
    If patient seizes due to hyponat, if na <120
  4. Hyperkalemia
    • >6.5 requires CBIGK
    • Calcium gluconate first
    • Bicarb
    • Insulin
    • Glucose
    • Kayexalate
    • B agonist also promote reuptake of K
  5. Hypokalemia
    • causes: insulin, B2 agonist, gi loss, diuretic(loop/thiazide)
    • Muscle weak/cramp/ileus
    • T wave flattening, u wave
    • Rx: 20 meq/hr K replacement
    • replace magnesium too
  6. Hypercalcemia
    • usually hyperparathy and malignancy other causes CHIMPANZEES
    • bones, groans, psychiatric overtones
    • Rx: iv hydration, furosemide (loop)
  7. Hypocalcemia
    • hypoparathyroidism, malnut, hypomag, acute pancreatitis, vit d def, digeorges
    • cramps, tetany
    • chvostek sign, trousseau sign
    • prolonged qt
    • Oral calcium, mag replacements
  8. Renal tubular acidosis
    • I: distal,problem with H+ secretion, low K+ high urine ph, rx replace bicarb, complications: stones
    • II: proximal: prob with hco3 reabs, low K, urine ph variable, rx: thiazide, volume
    • IV: distal, aldosterone def/resistance, hyperkalemia, low urine ph, rx: furosemide, mineralcorticoid replacement
  9. Causes allergic interstitial nephritis
    penicillin, sulfas, furosemide, hctz, will take 5-10 days to cause inc creatinine
  10. Causes ATN
    • ischemic or nephrotoxic
    • Nephrotoxic: NSAIDS, aminoglyco, amphotericin, cisplatin, cyclosporine
  11. ATN vs prerenal azotemia BUN/Cr, FeNA, Una, Urine osm
    • ATN: Bun:cr <20:1
    • FeNA >1%
    • Una >20
    • Ur osm <300

    • Prerenal: Bun:cr >20:1
    • Fena <1
    • Una <20
    • Ur osm >500
  12. acute renal failure BIT
    • BIT: Bun/Cr if already have do renal us for hydronephrosis/stone etc
    • Next get UA then urine NA/fena/urosm
  13. Indications for urgent dialysis
    • Acidosis
    • Electrolyte abnormalities: hyperk
    • Ingestion:salicylate, theophylline, methanol, li, barb, ethylene gly
    • Overload of fluid
    • Uremic sx: pericarditis, encephalopathy, bleeed, nausea, myoclonus, pruritus
  14. Hyaline cast
    normal finding but increased amount suggests dehydration/prerenal failure
  15. Red cell casts, dysmorphic red casts
    glomerulonephritis, intrinsic renal failure
  16. muddy brown casts
    atn
  17. white casts, eosinophils
    allergic interstitial nephritis, atheroembolic dz
  18. white cells and white casts
    pyelonephritis, post renal failure
  19. Chronic kidney dz
    • >3 months of one of the following: GFR<60, urinary abnormalities(proteinuria/hematuria) or structural abnormalities
    • MC DM, HTN and glomerulonephritis
    • Sx: when GFR <30 sx of uremia, azotemia, fluid retention, hyperkalemia, AOCD, hemostasis, hypocalc, hyperphosphatemia
    • Rx: Act, DDAVP if bleeding, fluid restriction, low NA/K intake, dialysis/transplant
  20. How to prevent contrast induced nephropathy
    Nacetylcysteine, fluid, nahc03
  21. Loops
    • furosemide, ascending loop of hence, inhibit na/k/2cl transporter
    • SE: dec K, dec CA, ototoxic, sulfa allergy
  22. Thiazide
    • hctz, chlorthalidone, DCT
    • inhibit na/cl transporter
    • dec na, dec k, inc glucose, hypercalc, hyperuricemia
    • sulfa, pancreatitis
  23. K+ sparing diuretics
    • spironolactone, trimterene, amiloride
    • Cortical collecting tubule
    • Aldosterone receptor antagonist-spironolactone
    • SE: metabolic acidosis, hyperkalemia
  24. Nephritic syndrome
    • glomerulonephritis, <1.5 g/day proteinuria
    • Sx: oliguria, micro hematuria/macro, htn, edema
    • Dx: UA shows hematuria and proteinuria, dec gfr, inc bun/br
    • Causes: post infectious, IgA, wegeners, goodpasture, alport
    • rx: salt and water restriction, diuretics, sometimes CST
  25. Post infectious glomerulonephritis
    • group a b hemolytic infection 2-6 wks prior, can be throat/impetigo then cola urine/oliguria/edema
    • low C3, ASO titer, lumpy bumpy if
    • Rx: diuretics to prevent fluid overload
    • 1st test-UA next ASO
  26. IgA nephropathy
    • bergers dz, after uri or gi infection, usually males see infection and then 1-2 days later hematuria(vs post strep which 1-3 wks later get hematuria)
    • and normal C3(strep low c3)
    • Rx: glucocort in some, ace if proteinuria
  27. Wegeners granulomatosis
    • granulomatous inflamm of urt and kidney/necrotizing vasculitis
    • rx: fever, weight loss, hematuria, hearing loss, resp and sinus x, hemoptysis
    • Labs: c-anca=BIT, some ig deposits
    • Rx: high dose CST and cytotoxic agents
  28. Goodpastures
    • rapidly progressing, pulm hemorr, males in 20s
    • hemoptysis, no URT involvement
    • linear anti GBM deposits on IF, hemosiderin dilled macrophages in sputum
    • Rx: plasma exchange, pulsatile steroids
  29. Alport
    • boys 5-20, hearing loss and eye cant hold lens +hematuria
    • GBM splitting on EM
    • Rx: renal failure
  30. Nephrotic syndrome
    • proteinuria >3.5 g/day, edema, hypoalbuminemia, hyperlipidemia
    • Causes: MC dz, FSGN, Membranous nephropathy, diabetic nephropathy, lupus nephritis, renal amyloidosis, membranoproliferative nephropathy
    • Rx: protein and salt restriction, acei, ppv23 vacc, some immunosupp help
  31. Focal segmental glomerulosclerosis
    • IV drugs, hiv, obesity
    • young african american male with htn
    • microscopic hematuria, sclerosis in capillaries
    • rx: prednisone, ace, cytotoxic rx
  32. membranous nephropathy
    • mc in caucasian adults, causes: tumors, immune complex disease, assoc with HBV, syphilis, malaria, gold
    • spike and dome appearance due to igG and C3 deposits on BM
    • prednisone and cytotoxic rx
  33. diabetic nephropathy
    • kimmelstiel wilson lesions, thickened gbm mesangial matrix
    • rx ace or arb, control sugars
  34. lupus nephritis
    • mesangial prolif, subendo or subepi immune complex deposition
    • rx: prednisone and cytotoxic rx
  35. renal amyloidosis
    • amyloid fibrils, apple green birefringence with congo red, MM or rhematoid/RB
    • Rx: prednisone and melphalan
  36. membranoproliferative nephropathy
    • assoc with HCV, SLE, endocarditis
    • Tram track of BM, all types have low c3
    • Rx: CST and cytotoxic agents
  37. Nephrolithiasis
    • MC: calcium oxalate, pain may radiate to testes or vulva, constantly shifting patient
    • non contrast CT is best, if pregnant or kid do US
    • Struvite: urease org, proteus, staghorn calc, rx with surg
    • Uric acid: cant see on Xray
    • Cystine: hexagonal crystal, +urinary cyanide nitropruss test, rx with hydration
  38. Kidney stone cut off for treatments
    • <5mm can pass through urethra
    • .5cm to 3cm: ESWL
    • >3cm surg
  39. PKD
    • AD:most common, asx until >30, inc risk of cerebral aneurysm
    • AR: less common, more severe, infants and young kids: renal failure/liver fibrosis and portal htn

    • Both: pain/hematuria, HTN, cysts, berry aneurysms
    • IF DEVELOP HEADACHE R/O SAH!!

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