Nephro & Electrolytes Flashcards
What are the pre-renal causes of AKI?
- Hypovolemia
- Decreased CO
- Reno-vascular diseases
- Systemic vasodilation (sepsis)
- Cirrhosis (hepato-renal syndrome)
What are the causes of renal AKI?
- TUBULAR: Acute tubular necrosis, Contrast nephropathy, Aminoglycoside toxicity
- GLOMERULAR: RPGN, post-infectious glomerulonephritis, TTP, Hemolytic-Uremic syndrome (HUS)
- INTERSTITIAL: NSAIDS, infiltrative
What are the post-renal causes of AKI?
- BPH
- Nephroliathiasis
- Neoplasm
- Retroperitoneal fibrosis
What are the indications of acute dialysis?
- Acidemia
- Electrolyte imbalance (hyperkalemia)
- Intoxication (NSAID overdose)
- O (volume overload, like severe CHF)
- U (uremia, uremic symptoms)
What are the causes of chronic kidney disease?
- Diabetes (30%)
- Hypertension (25%)
- Chronic glomerulonephritis (15%)
- Interstitial nephritis, polycystic kidney disease, obstructive uropathy
- Any cause of AKI may lead to CKD if prolonged or if treatment delayed.
What are the intrarenal causes of hematuria?
- Tumor
- Infection
- Stones
- Trauma
- Glomerular disease (IgA nephropathy)
- Too much exercise
- Polycystic kidney disease
What are the extrarenal causes of hematuria?
- Tumor
- Trauma
- Stricture
- Systemic diseases (SLE, RA, GPA, HUS, Goodpasture)
- Bleeding disorder
- Medication
What are the causes of an anion-gap metaolic acidosis?
- Starvation ketoacidosis
- Alcoholic ketoacidosis
- Diabetic ketoacidosis
- Paracetamol
- Increased urea
- Lactic acidosis (starvation, hypovolemia)
- Ethanol, methanol
- Salicylates
What are the causes of non anion gap metabolic acidosis?
- GI loss: Diarrhea
- Renal loss
What are the causes of metabolic alkalosis?
- Vomitting
- Diuretics
- Villous adenoma of colon
- Adrenal disorders
- K deficiency
- Cushing
What are the causes of respiratory acidosis?
- COPD
- Airway obstruction
- NMD
- Brainstem injury
- Drugs: narcotics
- Respiratory muscle fatigue
What are the causes of respiratory alkalosis?
- Anxiety
- P/E
- Pneumonia
- Asthma
- Sepsis
- Hypoxia (can lead to increased RR)
- Mechanical ventilation
- Pregnancy (increased serum progesterone can causer hyperV)
- Liver disease (cirrhosis)
- Medication (salicylate toxicity)
- Hyperventilation syndrome
What are the causes of hypercalcemia?
- Hyperparathyroidism
- Renal failure
- Paget disease
- Malignancies
- Vitamin D intoxication
- Thiazide diuretics
- Lithium
- Sarcoidosis
How does hypercalcemia present?
- Stones (chronic hypercalciuria)
- Bones (aches, pain, osteitis fibrosa cystica)
- Grunts and groans (muscle pain, weakness, pancreatitis, PUD, gout, constipation)
- Psychiatric overtones (depression, fatigue, anorexia, sleep disturbance, anxiety, lethargy)
What are the causes of hypocalcemia?
- Hypoparathyroidism
- Renal insufficiency: less vitamin D production
- Vitamin D deficiency
- Hyperphosphatemia: calcium phosphate deposition
- Hypomagnesemia
- Acute pancreatitis: calcium deposits
- Blood transfusion w/ citrated blood (calcium binds to citrate)
- Osteoblastic metastases (bones)
- DiGeorge syndrome (chromosome 22 deletion)
What are the causes of hyperkalemia?
- Renal failure
- Hypoaldosteronism (Addison’s, ACE-inhibitors, spironolactone)
- Cell lysis
- Acidosis
- Rhabdomyolysis, chemotherapy, hemolysis, burns (cell breakdown)
- GI bleeding
- Insulin deficiency (insulin usually brings K into cells) and hyperglycemia (promotes insulin to work)
- Rapid administration of BB
What is the clinical presentation of hyperkalemia?
- Arrhythmias, peaked T wave, prolonged PR, wide QRS, v-fib
- Muscle weakness, paralysis
- Decreased deep tendon reflexes
- Respiratory failure
- Nausea/vomiting/diarrhea
What are the causes of hypokalemia?
- Vomitting and nasogastric drainage
- Diarrhea
- Dereased potassium absorbption
- Diuretics
- Hyperaldosteronism
- Glucocorticoids
- Mg defficiency
What are the causes of HYPOVOLEMIC hypernatremia?
- Diuretics
- Diarrhea
- Sweating too much
What is the most common cause of EUVOLEMIC hypernatremia?
Diabetes insipidus
What are the causes of HYPERVOLEMIC hypernatremia?
- Iatrogenic
- Glucocorticoids
What are the causes of EUVOLEMIC hyponatremia?
- SIADH
- Psychogenic polydipsia
- Hypothyroidism
- Post-op
What are the causes of HYPERVOLEMIC hyponatremia?
- CHF
- Nephrotic syndrome
- Liver disease
What are the causes of hypertonic hyponatremia?
- Hyperglycemia
- Manitol, sorbitol, etc after surgery
- Hematuria
- Proteinuria
- Hypoalbuminemia
- Oliguria (GFR decreases, Cr increases, Urea increases)
- Edema (salt and water retention)
- Hypertension
What’s your DX?
Nephritic syndrome
- Proteinuria (“nephrotic range” >3.0 g/24 h)
- Hypoalbumimenia
- Edema
- Hyperlipidemia
- Lipiduria
What’s your DX?
Nephrotic syndrome
What are the most common nephrotic glomerular diseases?
- Minimal change disease
- Focal segmental glomerulosclerosis
- Membranous glomerulopathy
- Membranoproliferative glomerulonephritis
What are the most common nephritic glomerular diseases?
- Post-infectious glomerulonephritis
- IgA Nephropathy
- Membranoproliferative glomerulonephritis
- Crescentic glomerulonephritis (vasculitis)
- Anti-GBM Disease
What is the general approach to an acid-base problem?
- pH
- Respiratory process – check pCO2
- Metabolic process – check bicarbonate
- Calculate anion gap
- Ajust anion gap with albumin if necassary
- Delta-delta gap
- Osmolar gap
