Nephro-electrolytes Flashcards
SIADH:
Urine Na
Urine osmolarity
Urine Na > 20
Urine osmolarity > 400
Hyponatremia with low urinary Na
Urinary Na < 20
Hypovolemic: Extrarenal losses Vomiting Diarrhea Third spacing of fluids Burns Pancreatitis Trauma
Hypervolemic:
Nephrotic syndrome
Cirrhosis
Cardiac failure
Which electrolyte disbalances potentiate digoxin toxicity
HyperCalcemia
HypoKalemia
HypoMagnesemia
What reduces Dygoxin toxicity
HyperMagnesemia
HypoCalcemid
Treat with specific antibody in severe cases!
SIADH WATER RESTRICTION
Formula and 3 categories
(UNa + UK) / SNa
< 0.5 — 1 liter
0.5 - 1 — 500 ml
> 1 — will not respond
High dose prolonged penicillin may lead to:
Hypokalemia
Metabolic alkalosis
Rhabdomyolisis electrolyte disorders
Hypocalcemia
HyperPhosfatemia
hyperKalemia
Gitelmans
Alcalosis
HypoKalemia
HypoCalciUria
Liddle’s
HypoKalemia
Hypertension
Metabolic alkalosis
(ENaC activation, mineralcorticoid like)
RTA II
NOT READY !!
1 Proximal - glucozuria, aminoaciduria, posphaturia
Salicylate poisoning
High anion gap metabolic acidosis + respiratory alcalosis
Lithium intoxication
Low anion gap
Nephrogenic diabetes insipidus
Low anion gap
Lithium intoxication (cation)
Hypoalbuminemy (anion)
Hyperviscozity and hypercholesterolemy (Na and Cl levels deviation)
Unmeasured cations (immunoglobulins in MM)
PPI
HypoMagnesemia: weakness, prolonged QT
HypoMagnesemia
ECG changes
Associated electrolyte disturbances
Drugs that can cause
PR and QT prolongation, negative or flat T
Hypokalemia
PPI - not absorbed
Drugs causing HypoMagnesemia
PPI - low GI absorption
Diuretics Furosemide Thiazides low renal reabsorbtion Osmotic diuretics Cyclosporine Aminoglycosides Amphotericin B
Refeeding syndrome electrolytes
HypoMagnesemia ➡️ hypoKalemia
HypoPhosphatemia
Acute interstitial nephritis
15 % of Acute renal failure
Allergic interstitial nephritis - drug allergy
Fever, rash, periferic eosinophilia , oliguria
7-10 days after antibiotic treatment (beta lactams usually)
Urine -piura, hematuria, white blood cell casts
Stop drug
Steroids shorten course no survival benefit
PolyCystic Kidney
AutosomalDominantPKD
ESRD 60%
Hepatic cysts, diverticulosis, mitral prolapse
ds Family history 2 cysts any side or one side at age 15-29 2 cysts at each side at age 30-59 4 on each side if 60 +
40 % will have macroHematuria
20% have stones
Nephrotic syndrome deseases
Minimal change FSGS Membranous MPGN Diabetic nephropathy Amyloidosis
FSGS
Causes
Viruses HIV Hepatitis Parvovirus Hypertension Reflux Cholesterol emboli Drugs: heroin, analgesics, bisphosphonates, extasy Oligomeganephronia Renal dis genesis Alport’s - collagen IV defect. Hearing loss Sickle cell Lymphoma Radiation
Membranous glomerulonephritis
causes
Oncology of breast, lung , colon
Infection: HBV, HCV, siphilis, malaria, schistosomiasis
Rheumatic: lupus, RA, IGG4
Drugs: gold, mercury, NSAIDs, probenicid
HyperCalcemia causes
PTH
1-25 vit D
HyperThyroidism and long laying- bone resorption
Drugs: vit A, thiazides, antiEstrogens
Bisphosphonates FSGS or membranous
FSGS
GFR to start dialysis
Lower 10
Hypophospatemia causes: drugs and toxins
- Drugs or toxins
a. Ethanol
b. Acetazolamide, other diuretics
c. High-dose estrogens or glucocorticoids
d. Heavy metals (lead, cadmium, saccharated ferric oxide)
e. Toluene, N-methyl formamide
f. Cisplatin, ifosfamide, foscarnet, rapamycin
