Renal And Genitourinary

Question 1

ESRD Presentation and symptoms

Answer 1

Uremia: N/V, anorexia, aLOC
Volume Overload
Osteodystrophy 2nd to Vit D loss of production and 2nd hyperpara
Systemic Calcification
Anemia
Bleeding, depleted vWF
Encephalopathy
Immune Suppression

Tx: If bleeding DDAVP, cryoprecipitate, Tranfusion to target of 70

Question 2

Dialysis Emergencies

Answer 2

Hypotension:
- 2nd to fluid loss / shifts
- R/o MI, tamponade, bleeding, hyperK, air embolism, anaphylaxis

Bleeding:
- As in ESRD DDAVP, cryo, transfusion and protamine for heparinization

Dialysis Disequilibrium Syndrome (H/A N/D, muscle cramping)
- Cerebral edema 2nd to shifts.
- Self resolving. Saline and Mannitol do not help

Fistula Issues:
- Puncture site bleeding (pressure / not occlusion)
- Surgicell or similar
- Aneurysm
- Pseudoaneurysm
- Thrombosis (consult vasc immediately)
- High-output heart failure. AV shunting
- Infection (Vanco / Tobra bomb / Ceftriaxone

Question 3

Reasons to admit for kidney stones

Answer 3

Infectious symptoms / septic stone
Acute renal failure
Solitary kidney
Refractory pain and N/V