Lecture 3 Flashcards
Long-term autoimmune disorder that may affect the skin, joints, kidneys, brain, and other organs.
Body’s immune system mistakenly attacks healthy tissue, leading to long-term (chronic) inflammation.
MC in AA and asians
SLE, malar rash
how to dx lupus nephritis
bx
pheo triad
Headache, palpitations, and diaphoresis
best imaging to detect a pheo
CT
suspect in pts with HTN, hypokalemia, alkalosis
hyperaldosteronism
aldosterone > 20 ug indicates
hyperaldosteronism
hypertensive emergency
SBP > 180, DBP > 120, resulting in end organ damage
reduce by no more than 25%
hypertensive urgency
AKA Hypertensive crisis
SBP > 180, DBP > 120 without acute organ dysfunction
Seen in Pts with Prolonged HTN >150/90 but not in the malignant phase
Usually older Pts
benign arteriolar nephrosclerosis
2 MC forms of RAS
Artherosclerotic ischemic renal disease Fibromuscular dysplasia (young women)
“Horse-shoe kidney”
Kidneys fuse across the midline usually at the lower poles
renal fusion
Presents early in life
Associated with Oligohydraminos
Can be seen with Potter’s facies
autosomal recessive PCKD
Seen with abnormality of the short arm of chromosome 16 and 4
“Hereditary nephritis”
Familial disease
Associated with Hearing Loss before age 30
Male X linked dominant trait
Alport’s syndrome
M/C cancer of the kidneys
M/C tumor type
M/C bladder cancer
RCC
clear cell
transitional cell
nrl PSA
<4
increse of >0.75 per year indicates aggressive
issues with PSA
PSA increases with time
Cannot differentiate between slow and aggressive cancers
Snow ball effect. Often leads to more invasive and expensive work-ups / treatments
androgen deprivation tx for prostate cancer
lupron
kidney cancer of kids
Missing iris, urinary tract problems and hemihypertrophy are congenital anomolies associated
Wilm’s tumor
fluid retention serum hypoosmolality dilutional hyponatremia concentrated urine in the presence of normal or increased intravascular volume normal renal function
SIADH
what is happening with SIADH
ECF volume expands, plasma osmolality declines and GFR increases
Sodium levels decline(dilutional hyponatremia)
how to dx SIADH
Diagnosis of SIADH is made by simultaneous measurement of urine and serum osmolality
serum osm is lower than urine osm
how to tx SIADH
chronic SIADH
fluid restriction, hypertonic saline
declomycin
central DI
ADH deficiency
low urine osm, high serum osm
how to determine central vs nephrogenic DI
Administering ADH is diagnostic (if kidneys respond and urine output drops= central DI. If no decrease in UO= nephrogenic DI)
how to tx DI
fluids/electrolytes
vasopressin
DDAVP long term
indications for dialysis
Volume expansion that cannot be controlled by diuretics
Hyperkalemia refractory to medication
Severe acid-base imbalances refractory to medication
Severe azotemia (BUN > 80-100), uremia,
Seizure/coma
CC <10 and serum Cr >9
Short term treatment used in ICU patients with acute or chronicrenal failure, more frequently used for Acute
CVVH
Vascular Insufficiency resulting from AVF (fistula) or AVG
steal syndrome
decreased wrist-brachial index
