Renal CIS Case 2 Flashcards
Consider DDx of hemoptysis in a previously young healthy individual
Dat laundry list doe:
diffuse alveolar hemorrhage infection neoplasm (not common in young pt) drug or toxin induced bronchiectasis PE granulomatrosis with polyangiitis mitral valve stenosis
DDx is pt with hematuria (previously healthy)
laundry list 2
SLE churg strauss syndrome post strep glomerulonephritis IgA nephropathy alport syndrome
DDx of lower extremity edema
laundry list 3
renal etiology liver etiology CHF DVT venous insufficiency obstructive sleep apnea medication induced
difference btwn goodpasture and anti glomeurlar basement membrane disease
anti GBM has only renal involvement
ask about exposure during history of renal pt or pulmonary pt like
chemical or other environmental exposures (work or hobby exposure that could be playing a role)
vicero-somatic reflex of lungs
T2-T7
vicero-somatic reflex of kidneys
T10-T11
red cell casts =
glomerulonephritis
if microscopic evaluation shows no RBCs but positive blood, think what
myoglobinuria or rhabdomyolysis
what is an SCD and ATP
same thing, different name
sequential compression device
antithrombotic pumps
what kind of catheter:
indwelling catheter, highest risk of iatrogenic infection, helpful in unconscious or altered mental stauts pt, urinary incontinence, during surgery, or pt with post renal obstrcution from prostate enlargement
foley
what kind of catheter:
intermittent catheter, less risk of infection than foley but risk still present
straight
what kind of catheter:
external catheter for men, significantly less risk of infection
good alternative to the others
condom catheter aka texas catheter
what kind of catheter:
indwelling catheter, risk of infection, done for urinary retention secondary to urethral injuries, urethral obsturction (BPH) or prostate cancer, bladder neck masses
suprapubic catheter
for suspected goodpastures, what labs to check in addition to regular labs
anti GBM and c-ANCA and p-ANCA
treatment and considerations for goodpatures
laundry list 4
follow ABGs, hemoglobin/hct H/H treat first with steroids consider need for intubation with resp distress consider need for blood transfusion consider pulmonary and nephrology consults CT chest no contrast ekg kidney biopsy dialysis plasmapheresis to clear GBM antibodies
what do you not want to give with goodpastures
no aspirin, nsaids or cox-2 inhibitors
type and screen
determine ABO and Rh groups RBCs
look for potentially hemolyzing antibodies
type and cross match
after type and screen done
final step in determination of compatibility of blood of donor and that of recipient before transfusion by placing donor’s cells in recipients serum
what kind of catheter:
urine contanment device that fits over or adheres to genitalia and is attached to a urinary drainage bag. soft flexible sheath that fits over the penis
external catheter (condom catheter)
