nephrology Flashcards
Prevention of kidney injury due to tumor lysis syndrome following chemotherapy
Allopurinol, Hydration, Rasburicase
When is dialysis required for patients with ATN
Fluid overload Metabolic acidosis Encephalopathy percarditis hyperkalemia
treatment of Rhabdomyolysis
Hydration
mannitol
Bicarbonate
Drug(s) that causes ototoxicity
Loop diuretics such as furosmide
Also caused by aminoglycoside antibiotics
Hepatorenal syndrome lab work shows
Very low urine sodium (20:1)
Treatment of hepatorenal syndrome
Midodrine
Octreotide
Albumin
Presentation of atheroembolic acute kidney injury
Blue/purplish skin lesions in the fingers and toes
livedo reticularis
ocular lesions
-occurs in a patient who undergoes coronary angioplasty and several days later develops renal failure
Lab tests for Atheroembolic disease
Eosinophilia
Low complement levels
Eosinophiluria
elevated ESR
Most accurate diagnostic test for atheroemboli
biopsy of on of the skin lesions
- usually shows cholesterol crystals
treatment of atheroemboli
No specific therapy
Presentation of AIN
Fever
Rash
Eosinophilia
arthralgia
What is different about urinalysis on NSAIDs causing AKI
NO EOSINOPHILS are seen in the urine
AIN: labs
Eosinophilia
Eosinophiluria
BUN:Cr <20:1
Una and FeNa: increased
AIN: best initial test and most accurate test
Best initial: UA - shows WBCs
Most accurate: Hansel and Wright stain - determines the type of WBC- eosinophils
AIN treatment
Resolves spontaneously with stopping the offending agent or controlling infection and autoimmune diseases
- if still no response: STEROIDS
- Sever disease: dialysis
Presentation of Papillary necrosis
Sudden onset of flank pain, fever and hematria in a patient taking NSAIDs with underlying diseases that affect kidney function:
Sickle cell disease
diabetes
urinary obstruction
Chronic pyelonephritis
How do NSAIDs cause Papillary necrosis
by analgesic mediated vasoconstriction of medullary blood vessels which causes death of the cells in the papillae
Papillary necrosis: best initial test
UA which shows RBC, WBC, and necrotic kidney tissues
Papillary necrosis: most accurate test
CT scan - shows abnormal internal structures of the kidney from the loss of the papillae
Papillary necrosis teatment
None
Dital RTA (type I)
Distal tubules cannot generate HCO3 therefore acid cannot be excreted in the tubules from the serum.
No acid in the tubules= increase urine PH
decrease serum K+
most accurate test for RTA type 1
Acid load test:
-acid is infused into the patients blood with ammonium chloride. A healthy person will pill it out into the tubules making the urine acidic. In RTA type 1, patient is unable to excrete acid into tubules therefore urine stays basic
Treatment of RTA type 1
Replace bicarbonate along with K+ supplements
What causes RTA type 1
Autoimmune disease (RA, SLE, sjogren syndrome) Drugs (amphotericin B and Lithium)
Complications of RTA type 1
Nephrocalcinosis (Calcium Oxalate stones)
What causes RTA type 2
Amyloidosis Meyloma Fanconi syndrome acetazolamide heavy metals
Labs seen in RTA type 2
urine PH- is initially high (>5.5), once all the HCO3 is lost in the urine, PH decreases (<5.5)
urine HCO3- due to inability to reabsorb HCO3, it is lost in the urine therefore urine HCO3 is low
Serum K+ is low due to increased exchange at the distal tubules
most accurate test for RTA type 2
HCO3 load test: give patients HCO3 and test urine PH
-Urine PH will rise due to inability to reabsorb in the PCT
Treatment of RTA type 2
Thiazides
Thaizides cause volume depletion which enhances HCO3 reabsoprtion
Type IV RTA pathophysiology
Decrease in the amount of Aldosterone which leads to Na loss and K and H retention
What causes RTA type IV
Diabetes
Addisons disease
Sickle cell disease
Renal insufficiency
Diagnosis of RTA type IV
High urine Na despite a Na depleted diet
RTA type II complications
Osteomalacia and Rickets
Treatment of RTA type IV
Fludrocortisone (mineralocorticoid)
RTA: urine anion gap
Positive
RTA- defect in acid excretion into the urine so the amount of Cl (acid buffer) in the urine is diminished. This gives a + number when calculating Na-Cl.
Diarrhea: Urine anion gap
Negative
-Diarrhea is associated with metabolic acidosis therefore the kidney tries to compensate be increasing acid excretion. There is more acid in the urine. More acid in the urine means more Cl (buffer) in the urine. Na-Cl becomes negative!
Normal anion gap (6-12) is seen in :
RTA, TPN, and Diarrhea
Elevated anion gap is seen in:
MUD PILES
What is emphysematous pyelonephritis
- a complications of pyelonephritis seen in diabetic women
- there is air in the renal parenchyma–usually due to gram negative organism such as E.coli
Treatment for emphysematous pyelonephritis
Antibiotics and surgery
Perinephric abscess: radiologic finding
- focal, hypodense, mass like lesion
- followed by liquefaction, which walls off the center of the pyelonephritic area leaving a hyperdense rim of contrast surrounding the walled-off abscess cavity.
