Nephrology Flashcards
Treatment for IgA Nephropathy
ACE-i or ARB for antiproteinuric therapy
When to initiate immunosuppression (glucocorticoids) for tx of nephrotic syndrome?
Proteinuria > 1000mg/24hr
How do you calculate serum osmolality?
(2xNa) + Glucose/18 + BUN/2.8
Hyponatremia: Isovolemic Hypotonic (low serum osm <275)
Excess water intake (Urine osm <100) or SIADH (Urine osm>100)
Lack of ADH
Diabetes Insipidus, present with polyuria and nocturia (Nephrogenic is when renal receptors don’t respond to adh)
Increased ADH
-response to true or sensed reduction in effective arterial blood volume with resulting fluid retention
-SIADH
Dilute urine means a lack of ADH
why are patients with chronic diarrhea and malabsorption at risk for forming calcium oxalate stones?
- diarrhea = metabolic acidosis…less urine inhibition of crystallization (urine citrate)
- Diarrhea = volume depletion = increased concentration of ca and ox
- Malabsorption: Calcium binds fat instead of oxalate = more oxalate in urine
How do you treat calcium oxalate stones?
(Potassium) Citrate supplementation: its a base so helps treat the metabolic acidosis = increased urinary citrate which binds urinary calcium
hallmark of nephritic syndrome (i.e. anca-associated)
hematuria
proteinuria
leukocytes in urine sediment
desired UOP in rhabdo patients
200-300 cc/hr
When do you give calcium to a patient with rhabdo?
- only when at risk of arrhythmia from K
- don’t treat hypocalcemia because there is rebound hypercalcemia (release of calcium from damaged muscles)
Approach to preventing contrast-induced nephropathy in patients with CHF
Compensated (exam wnl): Give IV fluids
Decompensated: Hemodynamic monitoring with continuation of diuretics
If BP control requires an additional >5mmgh reduction, it is unlikely to be achieved by increasing the single agent from : ___ - ___. Instead, a better strategy is:
50-100%. Better to add another drug. 75% of an agent’s BP lowering effect is achieved with 50% OF MAX DOSE
___ is a direct vasodilator and is associated with sodium and water retention, and reflex tahchycardia. BP med
Hydralazine…reserved for resistant hypertension or hypertensive urgencies
Next step in newly diagnosed membraneous glomerulopathy
Look for secondary causes, i.e. syphilis, hepatitis, lupus. Age-appropriate cancer screening, esp >65yo. If its primary, 1/3 spontaenously remit in 3-6 months so no need to start steroids. Watch out for clots in these patients.
