-
BUN / Creatinine ratio in prerenal ARF?
greater than 15 or 20
-
Causes of prerenal ARF?
- Dehydration
- Sepsis
- Heart Failure
- Liver failure
-
Renal causes of ARF?
- 1. Glomerulonephritis
- 2. Goodpastures Syn
- 3. IV contrast
- 4. Lupus
- 5. Rhabdomyolysis
- 6. Toxins and meds
- 7. Wegener Granulomatosis
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Causes of Nephritic Syndromes.
- Postinfectious Glomerulonephritis
- IgA Nephropathy
- Goodpastures Syn
- Alports Syn
- Idiopathic Crescentic Glom..
- Lupus Nephritis
- Wegeners Granulomatosis
-
Causes of Nephrotic Syndrome
- Minimal Change disease
- Focal segmental glomerular sclerosis
- Membranous Glomerulonephritis
- Membranoproliferative Glomerulonephritis
- Diabetic Nephropathy
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Child or adolescent with strep infection 10-20 days previously, oliguria, dark urine, HTN; high streptolysin titer, low C3; IgG and C3 on basement membrane. Dx?
Postinfectious Glomerulonephritis
-
Rx for postinfectious glomerulonephritis?
Supportive (treat edema and htn)
-
Adult patient, low fever, dark urine and flank pain, oliguria, infection < 5 days previously; increased serum IgA. Dx?
- IgA Nephropathy
- (Bergers Disease)
-
Rx for IgA nephropathy?
- ACE-I
- Statins
- Corticosteroids if proteinuria increases
-
Young man with dyspnea, hemoptysis, myalgias, oliguria, dark urine. Dx?
Goodpastures Syn
-
Rx for Goodpastures?
- Plasmapheresis
- Corticosteroids
- Immunosuppressive agents
-
Oliguria, dark urine, high-frequency hearing loss; + BUN and Cr; proteinuria, hematuria, pyuria; basement membrane breaking up. Dx?
Alports Syn
-
Cause of Alports Syn?
Hereditary defect in collagen IV
-
Rx for Alports Syn?
- Nothing to stop RF
- ACE-I can stop proteinuria
- Transplant can lead to Goodpastures
-
Very rapid renal failure; weakness, nausea, weight loss; dyspnea, hemoptysis, myalgias, fever; + ANCA.
Idiopathic Crescentic Glomerulonephritis
-
Rx for Lupus Nephritis?
- Corticosteroids or immunosuppressive agents can delay failure
- ACE-I and statins reduce proteinuria
-
Pt over 40 with weight loss, hemoptysis, nasal perforation, hematuria, fever; + c-ANCA. Dx?
Wegeners Granulomatosis
-
Rx for Wegeners Granulomatosis?
- Corticosteroids
- Cyclophosphamide
-
Young child post infection with edema and dark urine; proteinuria, hematuria, hyperlipidemia; flattening of foot processes. Dx?
Minimal Change disease
-
Adult with edema, foamy urine, dyspnea, hx of IV drug use / HIV risks; hematuria, proteinuria, HTN, Hyperlipid; kidney sclerotic changes. Dx?
Focal Segmental Glomerular sclerosis
-
Rx for Focal Segmental Glomerular sclerosis?
Corticosteroids, cytotoxic agents, ACE-I, Statins
-
Causes of Focal Segmental glomerular sclerosis?
Associated with drug use or HIV
-
Causes of membranous glomerulonephritis?
- Infection
- SLE
- Neoplasm
- Drugs
-
Causes of Membranoproliferative glomerulonephritis?
- Systemic Infection
- Autoimmune Disease
-
Kidney changes seen on Diabetic nephropathy?
- Basement membrane and Mesangial thickening
- (round nodules seen on nodular type)
-
Rx for Diabetic nephropathy?
- Treat DM
- Restrict dietary protein
- ACE-I
- tight BP control
-
Medicine causes of interstitial nephropathy?
- 1. B-lactams or sulfonamides
- 2. aminoglycosides
- 3. NSAIDs
- 4. PPI
- 5. Allopurinol
- 6. Diuretics
-
What can interstitial nephropathy lead to?
ATN
-
Adult pt reports with hx of mutiple UTIs, flank pain, dark urine; palpable kidneys, hematuria and proteinuria, HTN; +BUN and Cr, anemia. Dx?
Polycystic Kidney Disease
-
Rx for PKD?
- Vasopressin receptor antagonists and amiloride (- cyst size)
- Treat UTI and HTN
- Drain cysts to control pain
-
What complications are seen with polycystic kidney disease?
- Renal failure
- hepatic cysts
- intracranial aneurysms c subarachnoid hemorrhage
- mitral valve prolapse
-
Name the 5 different diuretic Types and the impact they have on electrolytes.
- Carbonic Anhydrase Inhibitors: +H -K
- Osmotic Agents: relative +Na
- Loop Diuretics: -K -Ca +Urea
- Thiazides: -K, +Ca, +Urea
- K sparing: +K
-
Name five different diuretic types with possible side effects.
- Carbonic Anhydrase Inhibitors: Mild metabolic acidosis, Nephrolithiasis
- Osmotic Agents: relative +Na
- Loop Diuretics: Ototoxicity
- Thiazides: Hypercalcemia
- K-Sparing: Gynecomastia, menstrual irregularity
-
Give an example of each type of diuretic.
- 1. Carbonic Anhydrase: Acetazolamide
- 2. Osmotics: Mannitol
- 3. Loop: Furosemide
- 4. Thiazide: Hydrochlorothiazide
- 5. K-sparing: Sprionolactone
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