Renal/Urology - 5% Flashcards
Metabolic Acidosis (high Anion Gap)
Acid-Base Disorders
pH < 7.3 and HCO3 < 20
determine Anion Gap = Na - (Cl- + HCO3)
- Carbon monoxide, cyanide, Congenital Heart Dz
- Aminoglycosides
- Toluene/glue sniffing
- Methanol
- Uremia
- DKA/ETOH/Starvation
- Paracetamol/Acetaminophen, paradelhyde
- Iron/Isoniazide
- Lactic acidosis
- Ethanol/Ethylene gylcol - Antifreeze
- Salicylates/ ASA/Aspirin
Metabolic Acidosis (normal Anion Gap)
Acid-Base Disorders
pH < 7.3 and HCO3 < 20
Excess production or ingestion of HCO3
Need to determine whether High Anion Gap Met Acidosis or Normal = 8 to 12 mEq/L
Eti:
- MCC diarrhea
- Type 2 Renal Tubular Acidosis
- Spironolactone
Compensation via hyperventilation = decr CO2
Metabolic Alkalosis
Acid Base Disorders
pH > 7.4 and HCO3 > 26 mEq/L
Eti:
- Loop diuretics
- Antacid
- Vomiting
- Aldosterone
- up
Compensation - increase CO2 = hypoventilation/decrease breathing
Respiratory Acidosis
Acid Base Disorders
pH < 7.3 and pCO2 > 45
Acute Resp Acid
- pH - very llow
- HCO3 - slightly ele or normal
Chronic Resp Acid
- pH - close to nl
- HCO3 - very ele > 30
Eti: Hypoventilation
- Airway obstruction
- Sedative use
- Acute lung dz
- Chronic lung dz
- Opioid
- Weakening resp muscle
Compensation - increase HCO3 retention/reabsorption via kidneys = takes 24 hrs
aka decr HCO3 excretion
Respiratory Alkalosis
Acid Base Disorders
pH > 7.4 and pCO2 < 35
CO2 decr < 36 mmHg = Decr HCO3 & decr H+
Eti: Hyperventilation
- Panic attacks
- Anxiety attacks
- Salicylates
- Tumor
- Pulm Embolism
- Hypoxia
Compensation - decrease HCO3 retention/reabs via kidneys aka incr HCO3 excretion, get rid of more HCO3
Acute Renal Failure - Intrinsic
Direct damage to kidneys
Eti - nephrotoxic drugs (aminoglycosides), cyclosporine, Tumor lysis syndrome, Vasculitis (SLE, Sarcoidosis), crystals from gout, Myoglobin from rhabdo
Three different types
1. Acute Tubular Necrosis /MC
- necrosis of renal tubules d/t ischemia or nephrotoxic drugs
- MCC - Rhabdo
- UA - epithelia cell casts and muddy brown casts*, hyperK, hyperphosphatemia
2. Acute Interstitial Nephritis (AIN)
- Inflammatory or allergic reaction in the interstitium
- eti NSAIDs, sulfa, penicillin, bacterial infx
- UA - WBC Casts**, eosinophilia, Incr IgE
3. Acute Glomerular Nephritis aka NEPHRITIC SYNDROME
- Immunologic inflammation of the Glomerular = protein and RBG leakage
- Many ETI - IgA Nephropathy, Post infectious GABHS,
- UA - hematuria*, coca cola urine (GABHS), proteinuria, oliguria
- Fever, flank pain
Dx
- U Na > 40
- BUN:Cr 15:1
- FENa high > 2%
Tx - IV fluids to remove drugs, Lasix to get kidneys moving
Acute Renal Failure - Postrenal
Obstruction downstream from kidneys
Eti: kidney stones, BPH, tumors, congenital abnormalities
Sxs:
- Anuria or oligouria
- pain from hydronephrosis - abd discomfort
Dx:
- KUB, X ray or CT scan
- Serum Cr and BUN follows pre-renal pattern of azotemia 20:1
Tx:
- Bladder cath
- remove obstruction (stones)
Acute Renal Failure - Pre-Renal
eti, sxs, dx, tx
MCC of AKI
usu d/t hypovolemia or hypoperfusion; NSAIDs, IV contrast, ACEI or ARBS
Sxs:
- decr skin turgor
- hypotensive
- ortho hypotension
- dry mucosa
Dx:
- Urine osmolality High
- Urine Na < 20
- BUN:Cr > 20:1**
- FENa low < 1%
Tx
- reversible - correct underlying condition
- replenish fluids and maintenance
Acute Renal Failure Criteria
Sudden change in kidney fx in a day or week
RIFLE Criteria
Risk
- Incr Cr x 1.5 or GFR decre > 25%;
- UO < 0.5 ml/kg/hr x 6 hr
Injury
- Incr Cr x 2 or GFR decr > 50%;
- UO < 0.5 ml/kg/hr x 12 hr
Failure
- incr Cr x 3 or GFR decr > 75%;
- UO < 0.3 ml/kg/hr x 24 hr or anuria x 12h
Loss
- persistent ARF - complete loss of renal fx > 4 wks
ESRD
Goodpasture’s Syndrome
Acute Glomerulonephritis
Autoimmune, production of anti-GBM (basement membrane of endothelial cells in glomeruli)
Type of Rapidly progressive GMN
Sxs:
- Hemoptysis
- hematuria - Kidney failure
Dx:
- UA - nephritic findings
- RBC casts
- Mild proteinuria
- Anti-GBM antibodies
- Linear IgG deposits
Tx:
- Plasmapheresis = remove circ abs
- cyclophosphamide
- CS
- remission w/in a few weeks
IgA Nephropathy (Berger’s Syndrome)
Acute Glomerulonephritis
MCC GMN world wide’ M>W, 20-40s, Asian pop
IgA complexes deposit in mesangial cell in glomeruli
Sxs:
- gross hematuria
- preceded 1-2d w/ URI or GI
- typically benign
Dx:
- RBC casts
- Renal bx - IgA deposit in diffuse pattern in mesangium
Tx:
- Control BP
- ACE-I for proteinuria
- CS if rapid decr in renal fx
Post Infectious Strep Glomerulonephritis
Acute Glomerulonephritis
Eti - GABHS from Strep pharyngitis or Impetigo; MC kids 2-13yo
Sxs:
- 2 wks post infection
- Nephritic syndrome
- coca cola urine
- rise In CR and BUN
- Periorbital edema
Dx:
- Hematuria
- low C3 complement
- high ASO titers
Tx:
- resolves in 4 wks
- Symptomatic tx - tx HTN and edema with loop diuretics
- Dialysis if rapid progression to RF
Vasculitis
Acute Glomerular Nephritis
Rapidly Progressive GMN
A/w granulomatosis with Polyangitis (Wegeners’s) or microscopy polyarteritis nodosa (vasculitis of small renal arteries)
Sxs:
- flu like syndrome - fever, arthralgias, anorexia, wt loss
- +/- hemoptysis or pulmonary hemorrhage
Dx
- +ANCA Antibodies
Tx
- cyclophosphamide + corticosteroids (methylprednisolone)
Horseshoe Kidney
Congenital Renal Disorders
Kidney fused together to form horseshoe in womb
a/w with Turner’s syndrome
Sxs
- Usy asymptomatic
- N, abd discomfort
- Kidney stones, UTIs
- Incr risk of Renal Cancer
Dx
- Palp bilaterally
- Incidental finding on imaging
- US, Intravenous pyelogram, CT or MRI
Tx
- No tx needed, tx complications
- Symphysiotomy - unpopular nowadays
Hydronephrosis
Congenital Kidney Disorders
Water inside the kidney - distention and dilation of renal pelvis and calyces d/t obstruction of urine free flow from kidney =
> atrophy of kidney
Sxs
- severe back pain
- difficulty urinating
- +/- CVA tenderness, r-> groin
Dx
- UA - ele pH, ele Cr, BUN
- PE w/ palpable abd or flank mass
- IV Urogram, US, CT or MRI for cause of obstruction
Tx
- Remove obstruction, drain urine
- Upper urinary tract - nephrostomy tube
- if chronic - insertion of ureteric stent or pyeloplasty
- Lower UT - urinary catheter insertion or suprapubic cath
