Renal Flashcards
Indications for Dialysis?
Acidemia Electrolytes Intoxication (ASA) Overload of fluid Uraemia
What to do about renal failure?
Pre-renal = Fluids Post-renal = Catheter/ image/ tx for obstruction Intra-renal = Refer
Types of intra-renal injury
ATN (due to prolonged and irreversible ischemia to the kidney) - like a stroke to the kidney - check pre-renal function
Toxic - figure out what it is, call poison control - can cause a RTA
More of a chronic picture?
- Med review - make sure not causing problem for kidneys
- Diabetes?
- Autoimmune - send to nephrologist (this is where the nephrotic (more of a albumin problem)vs nephritic (more of a GFR problem)
CKD classification and staging.
Urine sodium with diuretics?
Not useful as the diabetics make the sodium high - hypovolemic hypevolemia
Young female with a fever?
Need to rule out pyelonephritis
Criteria for AKI
Increase creatine - 25% increase of baseline within 48 to 72 hours
Decreased urine output over 6 hours 1 ml/kg/hr
- recall that Cr is a delayed marker for AKI
Medications causing acute interstitial injury
PPI, NSAIDS, Antibiotics, Penicillins
Signs of ATN
Muddy brown casts in the urine (granular), protein (smaller amounts).
Signs of GN
Red blood cell casts, less than 1g/ day of protein
Criteria for nephrotic syndrome
3.5 g/ day protein , low albumin, edema.
Will also see hyperlipidemia - compensatory mechanism of the liver
Primary - MCD, membranous, FSGS
Nephritis causes
Pauci-immune - ANCA,
Immune - Lupus
In interstitial disease sign?
WBC casts - look for on urine microscopy.
CIN AKI?
Contrast induced kidney injury - a pre-renal picture - has a hyper osmolar effect and sends vessels into spasm - stop ACE/Metformin, give lots and lots of fluids. Will see rise within a few days
Emboli to the kidney vasculature
Cholesterol from a CABG - or Angio - delayed - 10-14 days, with WBC and granular cast, look for other sites of emboli, rash, eosinophils
Tx for AKI
If suspect pre-renal - challenge 1L and then see if they produce urine, if there is no urine, you should give a lasix challenge
Indication for dialysis
Acidosis (refractory)
Electrolytes (K)
Overload
Uraemia (encephalopathy) (pericarditis)
Kidney manage HCO3 by?
Can resorbed, can excrete H+ and make new HCO3, can breakdown glutamine, makes NH4 which will also generate HCO3
Is it metabolic or respiratory acid/alk- what do you look at?
Acid
PCO2 >40 -resp
HCO3 <24 - met
Alk
PCO2 <40 - resp
HCOS >24 - met
How much should Bicarbonate compensate in metabolic acidosis
Should be 1 for every 1 of CO2
ACR
Anything less than 2 is normal, best way to interpret is to multiply by 10 for estimated 24 hour. Need a serum albumin too.
Consider PCR - in relation to ACR - if this is high when the ACR is low, then there is some other protein coming out.
Nephrotic Syndrome work up
HIV, Heps, SPEP/UPEP, ANA, anti-dsDNA, C3/C4 consider Bx