FINAL Flashcards
afferent and efferent arterioles
-MAP < 90 -> decrease filtration
-20-25% of CO received by kidneys
imaging
-US- first choice
-CT w/o contrast- CKD, renal insufficiency (toxic), kidney stones
-X-ray- KUB, not often used
-cystography- balloon catheter injects contrast -> shoes retrograde flow -> chronic UTI, pyelonephritis
-urinary pyelogram- IV contrast, x-rays taken at intervals, functional image -> shows narrowing
-CT with contrast- IV, renal artery stenosis (string of beads sign)
-ureteroscopy- endoscopic exam via urethra into bladder
eGFR variables
-age
-gender
-weight
-plasma/serum creatinine
-cystatin C- high corresponds to decreased renal function
nephrotic syndrome
-proteinuria, low serum protein
-swelling -> leg if standing, coccyx if laying
-damage to podocytes* -> increase GFR
-hyperlipidemia, hypercoagulability, edema, hypoalbuminemia
-dx- 24 hour urine -> 3-3.5 with serum albumin < 2.5
-PRIMARY nephrotic is dx of exclusion
-minimal change disease- MC in children!, bx of glomerulus only shows on electron microscopy
-focal segmental glomerulosclerosis- MC in adults, tissue scarring of glomeruli on microscopy (only some)
-MC 2NDARY causes- diabetes, lupus, sarcoidosis
nephritic syndrome
-blood in urine
-decrease urine quantity
-HTN
-low perfusion
-damage to epithelial lining of glomerulus -> low GFR
-post-strep glomerulonephritis
-Focal proliferative
-Alport Syndrome
-SLE
-IgA nephropathy
-Chronic hepatic failure
-Celiac sprue
-Diffuse Proliferative
-Membranoproliferative:
-Hepatitis B/C
-SLE
-Sickle cell disease
-> Rapidly progressing glomerulonephritis
nephrotic syndrome tx
-tx underlying cause
-prednisone 8 weeks then taper down for 4 weeks
-immunosuppressives- cyclophosphamide
-hyperlipidemia- diet restriction, statins
-hypercoagulbaility- LMWH
-edema- loop diuretic, limit protein, limit water, limit sodium
-hypoalbuminemia- dietary protein
good pastures
-autoimmune
-hemoptysis and hematuria/proteinuria
-nephrotic/nephritic sx
-malaise, fever, chills
-anti-GBM (glomerular basement membrane antibodies)
-tx- plasmapheresis
-immunosuppressants- cyclophosphamide, prednisone, rituximab
-mortality is 100% with no tx
-5 year survival 80% with tx
-bimodal age distribution
normal sodium values
-plasma osmolality - 275-290
-Na- 135-145
-ADH stimulation at 280-290
-thirst- 295
hypovolemia: ECF is normal or expanded
-third spacing
-CO is decreased
-hypoalbuminemia and capillary leakage
-sepsis
hypovolemia: causes, dx and tx
-osmotic diuresis, diuretics, salt wasting syndrome, hypoaldosteronism,
-dry mouth, AMS, headache, light headed
-pre-renal azotemia- >20:1 -> GI condition/bleeding
-urinary Na- <20
-urinary osmolality- > 450
-SG- 1.015
-tx:
-oral rehydration if mild
-normal saline, D5W, FFP
hyponatremia: high, normal, low plasma osmolality
-HIGH: hyperglycemia, mannitol
-NORMAL: hyperproteinemia, hyperlipidemia, s/p bladder irrigation with glycine
-LOW w/ urine osmolality < 100:
-primary polydipsia, reset osmostat
-LOW w/ urine osmolality > 100:
-HIGH ECF- CHF, cirrhosis, nephrotic syndrome, renal insufficiency
-NORMAL ECF- hypothyroidism, adrenal insufficiency, SIADH
-LOW ECF w/ urine Na > 10- salt wasting syndrome, nephropathy, vomiting, diuretics, hypoaldosteronism
-LOW ECF w/ urine Na < 10- extrarenal loss, remote diuretics, remote vomiting
hyponatremia labs, tx
-check plasma osmolality, urine osmolality, urine Na and K
-tx-
-correct underlying disorder
-high ECF- diuretics, fluid restriction
-normal ECF- fluid restriction
-low ECF- fluids and diuretics
-ASYMPTOMATIC- 0.5-1/hr and 10-12 for first 24 hrs
-SYMPTOMATIC- hypertonic saline 1-2/hr and 10-12 for first 24hrs
hypernatremia causes
-RENAL:
-osmotic diuresis- mannitol, urea, glucose
-loop diuretics
-NDI or CDI
-EXTRARENAL:
-skin
-respiratory
-GI
-LABS:
-urinary osm > 800
-TX:
-tx underlying cause
-drink water
-0.5-1/hr and 10-12/24hrs
-1 hr after tx monitor every 2-3 hrs
NDI
-X linked recessive or autosomal mutation
-acquired:
-meds- LITHIUM!
-hypercalcemia
-hypokalemia
-pregnancy 2/3 trimester*
-tx-
-tx underlying cause
-low salt with thiazide
-NSAID
-amiloride for lithium pts
hyperkalemia
-K SHIFT:
-rhabdo/crush injury
-burns
-hemolysis
-sepsis
-hypertonicity
-DKA
-metabolic acidosis
-meds- digoxin, beta blockers, succinylcholine, arginine
-DECREASED EXCRETION:
-chronic renal failure!
-diabetic nephropathy
-hypoaldosteronism
-sickle cell ds
-interstitial nephritis
-type 4 RTA
-heparin
-end stage AIDS
-adrenal insufficiency
-meds- ACE, trimethoprim, NSAIDs, spironolactone, trimterene, pentamadine
-EXCESSIVE INTAKE
hyperkalemia labs and tx
-urine- K and Cr
-peaked T waves
-check glucose
-FEK < 10% - renal cause
-FEK > 10% - extrarenal cause
-trans-tubular K gradient < 6-8- renal cause
-gradient > 8- extrarenal cause -> EXCEPTION CRF
-TX:
-tx underlying cause but dont delay tx -> tx FAST
-calcium gluconate- immediate to 2 hrs
-glucose and insulin- mins-3-4 hrs
-albuterol nebulized- mins- 1-2hrs
-loop diuretic- lasts 6 hours
-kayexalate (sodium polystyrene sulfonate)- several hrs
-if renal failure/acid base disorder/tx fails -> hemodialysis
-CHRONIC TX- dietary restriction, diuretics, fludrocortisone in hypoaldosteronism
hypokalemia
-RENAL:
-hyperaldosteronism - HTN
-renovascular HTN
-cushings
-licorice
-congenital abnormality- 11beta, 17 alpha hydroxylase deficiency
-metabolic alkalosis
-diuretics
-HYPOMAGNESEMIA
-renal tubular acidosis
-fanconi syndrome
-interstitial nephritis
-genetic disorders- bartter’s and liddle’s (HTN) syndrome
-gitelmans- low BP
-K SHIFT:
-insulin excess
-postprandial
-iatrogenic
-alkalosis
-beta adrenergics
-hypokalemic periodic paralysis
-EXTRARENAL:
-zollinger-ellisons syndrome
-villous adenoma
-vomiting/diarrhea
hypokalemia labs and tx
-magnesium
-EKG
-ABG
-24 hr urine K:
-<30- extrarenal cause
->30- renal cause
-transtubular K gradient:
-<2 nonrenal cause
->3 renal cause
-TX:
-stable- eval meds, intake, underlying causes
-K replacement if pt cant eat low Na diet, N/V/D, cant stop diuretic or lax, drug related hypokalemia
-if tx doesnt work -> Mg replacement
-oral preferred -> if vomiting -> IV
-K suspended in saline no more than 40/hr
-20-40 requires cardiac monitoring
bartter’s syndrome vs gitelmans vs liddles
-BARTTERS:
-hypokalemia
-increase urine output
-Calcium
-Potassium
-Sodium
-Magnesium
-Chloride
-gitelmans:
-low BP
-hypokalemia
-normal urine output
-Potassium
-Sodium
-Magnesium
-Chloride
-liddles- HTN
Mg replacement
-Consider magnesium deficiency in cases of hypokalemia refractive to treatment and:
-CHF
-Digoxin toxicity
-Chemo:Cisplatin
-Loop Diuretics
