(1.2) Approach to Oliguria and Proteinuria [CIS] Flashcards
CC: 70yoM presents to an ER w/ decreased urine output and bilateral lower extremity edema x 1 month
What is your broad differential diagnosis (DDx)?
- Cardiac [cardiorenal syndrome, cor pulmonale, valvular abnormalities etc…]
- Pulmonary [acute pulmonary embolus, pulmonary renal syndrome]
- Renal [AKI, CKD, Nephrotic, Nephritic]
*obviously there are way more, but these are the heavy hitters
CC: 70yoM presents to an ER w/ decreased urine output and bilateral lower extremity edema x 1 month
What questions do you want to ask?
- Fluid intake?
- Orthostatic symptoms?
- Drugs?
- Family hx of kidney disease?
(just some examples)
What are the hallmark physical exam findings for heart failure?
HTN
Tachypnea
SpO2 low
S3 gallop
JVD
Bilateral crackles in lungs
Bilateral edema
Why should you be cautious when interpreting BNP in the setting of renal failure?
People that have renal dysfunction WILL HAVE ELEVATED BNP…
Having an elevated BNP is not synonymous with HF
***Make sure to interprete BNP with previous trends
Hyperkalemia makes the membrane potential ____ negative
Hyperkalemia makes the membrane potential LESS negative
What is the initial treatment of hyperkalemia?
Calcium gluconate 1000mv IV once (this antagonizes the cardiac action potential)
Regular insulin 10 units and 50 ml of 50% Dextrose (this shifts the [K+] intracellularly)
What are the general management recommendations for AKI?
- Avoid nephrotoxins
- Renal dose all medications
- Avoid hypotension
- Avoid dehydration
What are examples of nephrotoxins?
- NSAIDs
- IV iodine contrast
- ACEi
- ARB
- Aldosterone blockers
- Renin inhibitors
- Certain antibiotics
“Renal dose all medications”
What medication would you discontinue?
Metformin due to AKI
***Metformin is NOT toxic to kidney, rather it is cleared by the kidney and can accumulate and potentially lead to lactic acidosis
CC: 50 yoF presents to an ER with decreased urine output and dark urine x 3 days
What is your broad differential diagnosis (DDx)?
- Cardiac [cardiorenal, valvular abnormalities, pericarditis]
- Pulmonary [pulmoary renal syndrome]
- Hypovolemia
- Medication side effect
- Renal [AKI, CKD, Nephrotic syndrome, nephritic syndrome]
What do the following PE findings indicate?
Low BP, Tachycardia, Oral mucosa dry w/ tongue fissuring, Jugular veins are flat
Hypovolemia
If you have ___________ long enough, it can lead to acute tubular necrosis (ATN)
If you have pre renal azotemia long enough, it can lead to acute tubular necrosis (ATN)
