OMED Renal Flashcards
Big picture concept: pre-renal AKI is a problem with…
perfusion:
a) the pump: MI, CHF
b) leaky pipes: 3rd spacing of fluid, anything causing albumin to go down (nephrotic syndrome, cirrhosis, proteinopathies, malnutrition etc)
c) holes in the pipes (the 3 Ds) diuresis, diarrhea, dehydration, and hemorrhaging
d) clog: fibromuscular dysplasia, renal artery stenosis
Big picture concept: post renal AKI is a problem with…
obstruction: stones, cancer, BPH, neurogenic bladder
Big picture concept: intra-renal AKI is a problem with…
a. glomerulus- glomerulonephritis b. tubules: Acute Tubular necrosis c. interstitium: Acute interstitial nephritis
Glomerulonephritis
RBC casts, but must rule out nephrotic syndrome
AIN
white blood cell casts + eosinophils caused by infections and drug reactions (antibiotics like sulfa, cephalosporins and penicillins)
ATN
muddy brown casts think ischemia or exposure to toxins (IV contrast and myoglobin in particular)
three phases of ATN
ATN is a COP
- prodrome - creatine rises
- oliguric phases - urine output declines
- polyuric phases - urine output excessive
elevated creatinine: first step
rule out pre-renal causes
urine sodium < 10% FeNa < 1% Fe Uria < 35 %
Pre-renal AKI if Bun/Cr is also > 20 give IV fluid if fluid down, refrain IV fluid if too much fluid
elevated creatinine: second step
if no pre-renal–> rule out post renal with U/S or CT scan to look for hydroureter or hydronephrosis
elevated creatinine: third step
pre-renal and post-renal ruled out. treat as intra-renal even though only biopsy confirms order U/A
Indications for Dialysis
AEIOU
- Acidosis
- Electrolytes (Na/K)
- Ingestion (toxins)
- overload (CHF/edema)
- uremia (pericarditis)
CKD stage 1 GFR and action
above 90, prevent their progression
CKD II GFR and action
60-89, prevent progression
CKD stage III GFR and action
30-59, complication management
CKD stage IV GFR and action
30-15, complication management
CKD stage V GFR and action
under 15- End stage renal disease (ESRD)
When do you begin to see complications in CKD?
30 and under
When do you prepare for dialysis in CKD?
GFR 40
When did you put in a fistula for a CKD patient?
GFR 40
types of Dialysis
hemodialysis and peritoneal
The goal BP in CKD
< 130/80
use ACEI or ARBS
CKD patient treatment for…
- hyperparathyroidism….
- hyperphosphatemia….
- HTN….
- Vit D….
- Dialysis….
- hyperparathyroidism….cinacelcet
- hyperphosphatemia….Sevelamer
- HTN….ACE/ARBs, CCBs, clonidine
- Vit D….Ca + Vit D3
- Dialysis….hemodialysis or peritoneal dialysis
Treatment of hyponatremia
- mild
- moderate
- severe
- Mild: treat underlying condition
- moderate: IVF NS
- severe: 3% Nacl
Treatment of hypernatremia
- mild
- moderate
- severe
- mild: PO H20
- moderate: IVF NS
- severe: D5W
- Calculating Serum Osmolarity
- What should normal serum Na be?
- Serum Osmoles = (2𝑥𝑁𝑎) + (Glucose/18)+(BUN/2.8)
- above 135
Sodium correction should occur no faster than
0.25mmol/hr
Volume resuscitation is done with
Normal Saline or Lactated ringers; it’s provided as a bolus.
Maintenance fluid is administered as any combination of……. with or without…….
any combination of 1⁄2 NS, 1⁄4 NS, with or without D5.
Euvolemic Hyponatremia
RATS
Renal Tubular Acidosis is assessed with a urinalysis
Addison’s disease with cortisol
Thyroid disease with a TSH.
