Renal. AUR+crystAKI+protein+dial (07-29) (1) Flashcards
AUR.
urine volume?
oliguria =< 0,5 ml/kg/hr
AUR. common complication of what? 2
surgery and anesthesia
AUR. risk factors? nonsugical
advancing age
male sex
concomitant drugs (opioids, anticholinergics)
BPH
history of neurologic disease
AUR. risk factors related to surgery?
abdominal, pelvic surgeries, abdominal arthroplasty
-> Bladder distention during general anesthesia
-> epidural anesthesia
-> high fluid intake during surgery
AUR. clinical presentation? 4
suprapubic discomfort
bladder spasms
suprapubic fullness
HTN and tachy due to SNS stimulation
AUR. diagnosis?
also what to rule out?
portable bladder scan
>300 ml urine
if inconclusve -> cath
(nelabai supratau kas cia parasyta)
urinalysis to rule out UTI
AUR. treatment?
foley cath
Crystal induced AKI. etiologies?6
acyclovir
sulfonamides
methotrexate
ethylene glycol
protease inhibitors
uric acic (tumor lysis syndrome)
Crystal induced AKI. what viral medications? 2
acyclovir, proteoase inhibitors
Crystal induced AKI. what syndrome may cause?
tumor lysis syndroem due to uric acid release
Crystal induced AKI. clinical presentation?
usually asymptomatic
AKI => 7d of starting drug
Crystal induced AKI. clinical presentation. what urinalysis?
hematuria, pyuria, crystals
Crystal induced AKI. clinical presentation. what increases risk?
increased risk with volume depletion, CKD
Crystal induced AKI. management? 3
discontinue of drug
volume repletion
loop diuretics
Crystal induced AKI. what symptoms if they present?
hematuria, pyuria, crystaluria, flank pain
UW. Dialysis. 5 groups of indications?
Acidosis
Electrolyte abnormalities (severe or symtomatic hyperK)
Ingestion
Overload
Uremia
UW. Dialysis. Acidosis. what ,,criteria” in uw table?
Metabolic acidosis
pH < 7,1 refractory to medical therapy
UW. Dialysis. electrolites. Symtomatic hyperkalemia?
ECG changes or ventricular arrhytmias
UW. Dialysis. electrolites. Severe hyperkalemia?
> 6,5 refractory to medical therapy
UW. Dialysis. Ingestion of what? 4
Toxic alcohols (methanol (M), ethylene glycol (E))
Salicylate (S)
Lithium (L)
Sodium valproate, carbamazepine
(I) isopropranolol
SLIME
UW. Dialysis. overload?
Volume overload refractory to diuretics
UW. Dialysis. uremia. what symtomatic?
Encephalopathy, pericarditis, bleeding
UW. Dialysis. what lithium levels and symtoms?
Serum > 4
or
> 2,5 mEq/l with signs of lithium toxicity (seizures, depressed mental status) or inability to excrete lithium (renal disease, decompensated HF)
UW. proteinuria. 4 types?
Selective glomerular
Non-selective glomerular
Tubular
Overflow
UW. proteinuria. selective mechanism?
loss of negative charge of basement membrane, small
to medium sized proteins (mostly albumin).
UW. proteinuria. non-selective mechanism?
increased permeability to macromolecules.
Macromolecules like transferrin and IgG present.
UW. proteinuria. tubular mechanism?
small proteins on mass spectrometry like beta 2 microglobulin.
UW. proteinuria. overflow mechanism?
Bence-Jones, hemoglobin, myoglobin.
UW. proteinuria. the most common cause?
transient (intermitent)
UW. proteinuria. what to do if suspect?
repeat urine dipstic twice.
UW. proteinuria. what causes transient (intermitent)?
Can be caused by fever, exercise, seizures, stress, or volume depletion.
UW. proteinuria. done dipstic twice. still persists?
If proteinuria persists or any of the initial studies are abnormal –> refer to
nephrologist.
UW. proteinuria. done dipstic twice. still persists. further investigation after nephrologist?
Further investigation: 24-hour urinary collection for protein, renal
ultrasound, and renal biopsy.
UW. proteinuria. what common in adolescent boys?
Increased protein excretion when patient is in upright position. Returns to
normal in recumbent position.
UW. proteinuria. also there may be persistent proteinuria (buvo ta lentele su range, bet vertes kitam BS kazkur yra)
.
UW. proteinuria. algo.
Asymptomatic, isolated proteinuria –> first moning urine –> elevated protein/Cr ratio –>?
Evaluate for glomerular/parenchymal disease
UW. proteinuria. algo.
Asymptomatic, isolated proteinuria –> first moning urine –> normal protein/Cr ratio –>?
do urinalysis and evaluate protein.
normal protein/Cr ratio –> positive protein on urinalysis –> ?
orthostatic proteinuria
normal protein/Cr ratio –> negative protein on urinalysis –> ?
transient proteinuria
