Final Review Flashcards
Proteinuria, azotemia, hypertension (sometimes)
Azotemia (elevated BUN, SCr & CyC)
early chronic kidney disease (CKD)
Hyperkalemia, hyponatremia, hyperaldosterone, edema, HTN
Anemia, dyslipidemia, hypocalcemia, high phos, high iPTH
Neuropathy, fatigue, acidosis, dementia, nausea
signs & symptoms of late CKD
Hematuria (micro or macro), oliguria, migratory edema, HTN, fever, constitutional (N/V, HA, anorexia, pallor)
Acute glomerulonephritis (AGN)
Start in eyelids & face usually Always pitting Progress downward arm & leg edema Migratory (face in AM, clear in afternoon, legs PM) type III hypersensitivity
edema of AGN
Bloody sputum, chest pain, cough, dyspnea (come first)
Next will have hematuria
Anti-glomerular basement membrane (GBM)
Goodpasture’s s/d
Proteinuria, hypoalbuminemia, dyslipidemia
NO azotemia or HTN
24 hour protein urine >3g
nephrotic syndrome
Check SCr or SCyC, BUN, electrolytes, blood pressure
Rule out diabetes
Repeat urine protein, SCr, BUN, electrolytes, BP in 1 month
Can refer to nephrologist after 2 elevated readings
asymptomatic proteinuria work up
HTN, HA, Inc. Urination
HypoKalemia, Dec. Vision,
Plasma aldosterone:plasma renin activity ratio greater than >30.
Conn’s syndrome (Primary Hyperaldosteronism)
Intermittent, severe pain in low back or flank or abdomen
May have nausea
Move around a lot
Gross or microscopic hematuria, proteinuria
ureteral colic
Dx: Imaging (renal US or CT scan)
Edema, oliguria or anuria, HA, fatigue, anorexia, N/V, arrhythmias
acute kidney injury (AKI)
Send to hospital immediately
May need surgery or dialysis
Diuretics do not improve outcomes in absence of volume overload
Hematuria, Oliguria, Azotemia (elevation of (BUN) & serum creatinine levels, HTN, proteinuria, Edema in kids
Nephritic s/d
Most common, especially in SE Asia, Mediterranean
Cause: dysglycosylation of IGA1 immune complexes glomerular deposition inflammation hematuria, proteinuria, renal failure
IGA Nephropathy
Herbs: aloe vera gel, Artemisia absinthium, astragalus, codonopsis, cordyceps, Centella
IGA Nephropathy
Immune complex & complement mediated, more common in women & African American.
Labs: ANA sensitive, anti-Sm specific
Lupus nephritis
Herbs: astragalus, flax, turmeric
Lupus nephritis
Delay 10-20 days after infection (unlike IgAN)
Rapid onset edema, HTN, oliguria, heavy proteinuria, hematuria, low urine sodium
Labs: elevated ASO titers, reduced complement
Post-Infectious GN
Nephrotic syndrome w/ peak incidence 24-36 months
Electron microscopy: foot processes swollen & fused. Biopsy normal
Clinical: look for allergies, intestinal permeability, probiotics, restrict sodium
Minimal change GN
Herbs: lespedeza cuneata, angelica sinensis, astragalus membranaceus, codonopsis pilosula
TX: corticosteroids
Minimal change GN
S/SX: nephrotic syndrome, acute nephritis, asymptomatic proteinuria, recurrent painless gross hematuria
Membranous & Membranoproliferative GN
associated w/ Hep BV
Membranous GN
associated w/ Hep CV
Membranoproliferative GN
Herbs: croton draco, pueraria montana, petasites hybridus, alisma orientale, ephedra, ulex europaeus
Membranous & Membranoproliferative GN Herbal complement inhibitors:
PRA < 0.65 ng/ml/hr
Direct Renin <5
More common in elderly, blacks and Hispanics
Contraindicated = Glycyrrhiza
Volume Hypertension
Elevated morning (0800-1000) plasma aldosterone concentration to PRA ratio is main clue, followed by oral salt challenge followed by urine aldosterone concentration.
Hyperaldosteronism*
PRA > >0.65 ng/ml/hr
Direct Renin >5
Renin-angiotensin-induced vasoconstriction/inflammation
Contraindicated = diuretics
Renin Hypertension
Most common in children <6, absence of HTN, absence of hematuria, normal complement, normal renal function
S/SX: Foamy urine, wt. gain->edema (periorbital (eyes) first then abdomen, feet, ankles), inciting event (URI/Bug bite), tachycardia, peripheral vasoconstriction, oliguria, decreased GFR, increased renin, aldosterone, NE,
Minimal Change Disease
TX: empiric steroid therapy
Nephroprotective herbs, renal adaptogens, high dose fish oil, curcumin
massive proteinuria, hypoalbuminemia, edema (URI/Bug bite), hyperlipidemia, hyperlipiduria
Indicate glomerular damage, systemic T cell activation
Diagnosis: urinary protein >50 mg/kg/d & hypoalbumineia
Nephrosis: (Pediatric Nephrotic Syndromes)
hematuria, oliguria, azotemia, HTN
Inflammation of kidneys, more common in childhood & adolescence
Types: post infectious glomerulonephritis, IgA nephropathy
Nephritic: (Pediatric Nephritic Syndromes)
Caused by prior infection GAS. Immune complexes to GAS deposit in GBM leading to autoimmunity
S/SX: antecedent illness, most children asymptomatic
PE: edema, gross hematuria, HTN
Labs: hematuria, skin culture, stretozyme test
Post-Streptococcal Glomerulonephritis (PSGN)
Pathophysiology: chronic hyperglycemia, AGE deposit in mesangial cells, glomerular capillary damage, AGE antibodies (Advanced Glycated End-products). All of this will cause glomerular sclerosis, protein leakage, blood sludging leading to tubular destruction, loss of charge barrier, increased capillary pressure. (Kimmelstiel-Wilson lesions)
Blacks, asians, Native Americans
Early: Isolate proteinuria, Dec. GFR, HTN
Dx:
Urine albumin >300 mg/d
Diabetic Nephropathy
Retinopathy Inc. chances of Nephropathy w/Albumineria.
Treat acute ureteral colic, what agents (herbs, drugs, minerals, hydrotherapy,) would you use?
Primary action is spasmolytic (will give pain control)
Herbs: amni visnaga, Piscidia piscipula, gelsemium sempervirens, hyoscyamus
Drugs: Alpha blockers (tamsulosin)
Minerals: magnesium
Hydrotherapy: hot compress to back, hot bath
Can be dissolved pH 6.5-7 Vegetarian diet, w/ high fluid intake Potassium citrate Combine w/ spasmolytics & diuretics if ureteral colic
Acute uric stones
Generally require surgical removal & antibiotics
Urine acidification helpful
Cranberry to prevent UTIs
Urea-splitting organisms (proteus, providencia or pseudomonas)
Struvite stones
Radiolucent stones, precipitate from an acidic urine
Related to conditions (leukemia, diabetics etc.)
High does enzymes, ketogenic diet & thiazide diuretics increase risk
Dehydration risk factor
Orange to red diapers can be clues about uric acid stones in infants
Uric acid stones
Magnesium ammonium phosphate stones
Precipitate from alkaline urine
Associated w/ chronic UTI (gram negative rods)
Treat the infection, image quickly (frequently impact & need surgery)
Struvite stones
Low methionine diet may be useful, but hard to do (legume based protein sources, potassium rich foods)
D/t metabolic defect of tubular reabsorption of cysteine
Cysteine stones
Limit Potassium and Sodium
Inc. Carb base diet
Anemia->Dec. nephrons=Endocrine dysfxn= dec EPO
CKD stage 4-5
Calcium Wasting
Inc. Phosphorus absorption
Inc. PTH levels
CKD stage 3
