Day 3 5/14/15 Flashcards
Normal Na Level
140 mEq/L
-low suggests avid tubular sodium reabsorption ( 40 mEq/L)
Normal K Level
4.5 mEq/L
Normal Cl Level
104 mEq/L
Normal Total CO2
27 mEq/L
Normal Glucose Level (Fasting)
90 +/- 30 mg/dL
Normal Creatinine Level
1.0 mg/dL
-usually viewed in concert with plasma creatinine; a UCr/PCr value greater than 20 suggests avid tubular water reabsorption, a value less than 10
suggests less avid water reabsorption
Normal BUN Level
12 +/- 4 mg/dL
Normal Phosphorous Level
4 mg/dL
Normal Ca Level
9.5 mg/dL
Normal Cholesterol Level
140-200 mg/dL
Normal Osmolality Level
285 mosm/kg
Acute Kidney Injury
- rapid reduction in glomerular filtration rate manifested by a rise in plasma creatinine (Pcr) concentration and urea
- results in reduced clearance of waste products
- produces state called azotemia
3 Types of Acute Kidney Injury
- pre-renal azotemia- dec. in GFR due to dec. in renal plasma flow and/or renal perfusion pressure
- post-renal azotemia or obstructive neuropathy- dec. in GFR due to obstruction of urine flow
- intrinsic renal disease- dec. in GFR due to direct injury to kidneys
Uremia and Sx
- signs and sx of multiple organ dysfunction caused by retention of uremic toxins and lack of renal hormones due to acute or chronic kidney injury
- sx: nausea, vomiting, abdominal pain, diarrhea, weakness and fatigue
Azotemia
-buildup of nitrogenous wastes in blood, ex. BUN and creatinine
Oliguria
-urine volume
Anuria
-urine volume
___________ is the most common cause of an abrupt call in GFR in a hospitalized pt.
-prerenal azotemia
Causes of Pre Renal Azotemia
Dec. ECF Volume
- renal losses
- third space losses
- GI losses
- hemorrhage
Inc. ECF Volume
- dec. cardiac output: CHF, MI, valvular disease, pericardial tamponade
- systemic arterial vasodilation: cirrhosis, sepsis, medication, autonomic neuropathy
Causes of Post Renal Azotemia
- obstruction of ureters
- bladder outlet obstruction
- urethral obstruction
Intrinsic Renal Diseases That Cause AKI
- vascular diseases: cholesterol emboli, renal vein thrombosis
- glomerular diseases: acute glomerulonephritis, hemolytic uremic syndrome
- interstitial diseases: acute interstitial nephritis, infection, myeloma kidney
- tubular diseases: ischemic or nephrotoxic acute tubular necrosis (ATN)
Pre Renal Signs and Symptoms
- intravascular volume depletion
- dec. weight
- flat neck veins
- postural changes in BP/pulse
- cardiac dysfunction
- edema
- pulmonary rales
- S3 gallop
Signs and Sx of Intrinsic Renal Disease
- hx of exposure to renal insults associated with ATN
- hypotension
- surgery w/ large blood loss
- transfusion rxns
- exposure to radiocontrast dye
Signs and Sx of Post Renal Disease
-anuria, intermittent anuria, large swings in urine flow rate
In general, a ____ FEN suggests prerenal azotemia.
low
Common Causes of Death in Acute Tubular Nephritis
- infections
- gastrointestinal bleeding
Nephrotic Syndrome Management
- low salt diet
- diuretics
- BP control
- cholesterol lowering drugs
- ACE inhibitors to dec. proteinuria
- Vit D replacement
- normal or slightly low protein diet
Nephrotic Syndrome Classification
- proteinuria (>3.5 g/d)
- hypoalbuminemia
- edema (even around eyes)
- hyperlipidemia
- lipiduria
Causes of Idiopathic Nephrotic Syndrome
- minimal change disease (most common in children)
- focal glomerular sclerosis
- membranous nephropathy
- membranoproliferative GN
- other proliferative GN
- also diabetes, amyloid and light chain disease, SLE
Minimal Change Disease
- presentation
- lab
- associations
- phathophys
• Presentation:
- Peak Incidence 2-6 years old
- Male-female 2-1
- Edema, ascites
- Hypertension (20%)
• Lab:
- Renal function normal or slightly depressed
- Urinalysis: 4 + protein, hyaline casts, microscopic hematuria rare
- Normal Light Microscopy
- Negative Immunofluorescence
- EM with foot process fusion
• Associations:
- History of allergy/atopy
- Hodgkin’s lymphoma
- Nonsteroidal drugs (idiosyncratic reaction)
• Pathophys:
- ? T cell disorder
- Loss of charge barrier

Focal and Segmental Glomerulosclerosis
• Presentation:
- most common cause of nephrotic syndrome in young adults and AAs
- proteinuria
- hypertension
- urinary sediment often with RBCs
- may be idiopathic or related to previous minimal change disease
- IV heroin, HIV, etc.
- Lab:
- Associations:
- usually idiopathic
- may occur in subjects w/ HIV
• Pathophys:
- not mediated by immune complexes
- may be due to circulating factor (suPAR)
- pathology factor APO lipoprotein L1
• Tx: steroids (for 6 months); relapse is high.
Membranous Nephropathy
• Presentation:
-presents w/ nephrotic syndrome
• Lab:
-histology looks like “burning bush”
• Associations:
- idiopathic 2/3 cases (due to antibodies to phopholipase A2 on podocyte)
- hep B
- drugs (gold, mercury)
- SLE
- cancer
• Pathophys:
-up to 50% progress to chronic kidney disease if not tx
Membranoproliferative GN
• Presentation:
-two types
• Lab:
- light microscopy: mesangial proliferation and GBM thickening
- IF type 1: granular deposits IgG, C3, +/- C4
- IF type 2: granular deposits C3
- EM type 1: subendothelial deposits
- EM type 2: dense intramembranous depsits
• Associations:
- type 1: hep C infection
- type 2: complement disorder
• Pathophys:
-Hep C type 1: 70% response to interferon
Clinical Classification of Nephritic Syndrome
- dec. renal function
- hypertension
- RBC casts
- edema
- proteinuria (
Complications of Nephrotic Syndrome
- inc. coagulation factors leads to hypercoagulable state
- inc. risk bacterial infections
Clinical Features of Glomerulonephritis
- inflammatory injury of glomeruli
- infiltration leukocytes
- deposition of immune proteins
- disturbed function of affected tissue
- rapidly progressive
- nephritic
- pulmonary-renal syndrome
- crescentic GN
Mechanisms of Injury in Glomerulonephritis
- deposited immune complexes
- antibodies specific for renal antigens
- other causes of inflammation within glomeruli
- GN is usually caused by immune-mediated glomerular injury
Algorithm for Dx Glomerulonephritis
- definitive dx require kidney biopsy
- blood tests
- urinalysis
Tx for Glomerulonephritis
- immunosuppressive drugs: prednisone, cyclophosphamide, rituxumab, etc
- plasma exchange
4 Causes of Glomerulonephritis
- IgA nephropathy
- lupus nephritis
- anti-GBM disease
- ANCA associated vasculitis
