-
differences between acute and chronic kidney injury
acute--normal size, normal Hct, normal calcium
-
what tests are done for renal cases
- urinanalysis
- chemistry
- renal ultrasound
-
bun/cr ratio is post renal azotemia
>15:1
-
what causes hemorrhagic cystitis
cyclophosphamide
-
what are the 4 causes of toxin induced renal insufficiency
- contrast
- amphotericin
- aminoglycosides
- chemotherapy
-
most accurate test for allergic interstitial nephritis?
- wright stain
- hamsels stain for eosinophils
-
most accurate test for rhabdomyolysis
urine myoglobin
-
on ccs cases for rhabdomyolysis
- urine myoglobin
- ua with microscopy
- serum k
- serum ca
- chemistries
- serum cpk
-
what to order for a contrast induced renal failure
magnesium levels
-
-
best initial test for crystal induced renal failure
best initial rx
- ua
- ethanol or fomepizole with immediate dialysis
-
how to prevent contrast induced renal failure
- fluids
- bicarb
- n-acetyl cysteine
-
what type of damage can be done with nsaids
- atn
- allergic interstitial nephritis
- nephrotic syndrome
- afferent arteriolar vasoconstriction
-
best initial test for good pastures
most accurate
- anti-basmeent membrane antibodies
- most accurate is biopsy showing linear deposits
-
rx for good pastures
plasmapharesis and steroids
-
best initial test for church strauss
most accurate
- cbc with eosinophilia
- biopsy
-
best initial rx for churg strauss
if not responsive
-
best initial test for wegeners
most accurate
-
best initial rx for wegeners
-
best initial test for pan
most accurate
rx
- angiography of abdominal vessels
- biopsy
- cyclophosphamide and steroids
-
who gets painless recurrent hematuira aka iga nephropathy?
best initial test-
most accurate
rx
- IgA nephropathy--Berger's diseas
- none
- biopsy
- steroids for acute episodes(worsening)
- ace for proteinuria
- fish oil may delay progression
-
rx for all proteinurias
ace inhibitors
-
best initial test for hsp
- purpura
- abdominal pain
- joints
- hematuria
- presentaiton of gi, renal, skin , join is best clue
- biopsy
-
rx for hsp
nothing, self resolving
-
best initial test for psgn
- anti-streptolysin
- anti-hylarunidase
- anti-dnase
-
rx for psgn
- antibiotcs
- control htn and fluid overload with acei and diuretics
-
-
how does cryoglobulinemia present
best initial test
- renal involvement
- joint pain
- purpuric lesions
cryoglobulin component levels--igM and low c4
-
best initial for lupus nephritis
most accurate
biopsy here is neccessary to determine the extent of injury
-
lupus nephritis biopsy showing
sclerosis
mild
severe
- sclerosis-nothing
- mild--steroids
- severe--mycophonetil and steroids
-
how is nephrotic syndrome defined
best initial test for nephrotic
accurate
- hyperproteinuria
- hyperlipidemia
- edema
- thrombois due to antithrombin, protein c,
- urinalysis showing high protein
- urine spot protein: creatinine ratio of 3.5:1
-
who gets membranoproliferative
minimal change disease
focal segmental
mesangial
membranous
- hep c
- kids
- hiv blacks, heroin
-
best initial therapy for primary causes of nephrotic syndrome
steroids
-
if nephrotic syndrome doesnt get better after 3 months, next step
cyclophosphamide
-
next step in a pt with proteinuria
repeat ua
-
reasons for mild proteinuria transient
chf, fever, exercise, infection,
-
how do you work up orthostatic proteinuria
split urine protein--collect in the am and then in the afternoon
-
if there is no orthostatic or other reasons for proteinuria, next step
- do spot protein:cr ratio, if >3.5:1
- do biopsy
-
dialyzable drugs
- lithium
- ethylene glycol
- aspirin
-
how are compications of uremia like
high phosphate
anemia
high mg
low ca handled
- calcium acetate, calcium carbonate, sevelamer
- epo
- mg restriction
- vit d supplementation
-
3 causes of nephrogenic insipidus
- hypokalemia
- high ca
- lithium toxicity
-
rx for hypernatremia
bolus ns
-
dx of central and nephrogenic di
decrease in amount of urine and increase in osmolality of urine iwht central and administration of ddavp
-
causes of hypervolemic hyponatremia
euvolemic
hypovolemic
hypervolemic--chf, nephrotic, cirrhosis
euvolemic---siadh--hypothyroid
hypovolemic--diuretics, vomiting, diarrhea, burns and sweating, addisons
-
rx for hyponatremia from adh from cancer
demeclocycline
-
adh blockers
- tolvaptan
- conivaptan for rx of euvolemic hyponatremia
-
aldosterone
bb
spironolactone
insulin
tmp-smx
aceI
digoxin
-
what is hte sequence of ekg changes from high k
- high t wave
- no p wave
- wide qrs
-
causes of high mg
effects of high mg
- kidney failure
- ingestion of mg containing laxatives
- muscular weakness
- loss of deep tendon reflexes
-
rx for high mg
- saline
- restricting of mg intake
- dialysis
-
causes of low mg
low mg causes
- loops
- alcohol withdrawal
- gentamycin
- cisplatin
low ca and cardiac arrhythmias
-
what electrolyte is needed for pth release
mg
-
rx for aspirin overdose
bicarb to alkalanize urine
-
2 causes of normal anion gap met acidosis
-
rta 1 vs rta 2 rta 4
- rta1- cants excrete h in distal tubule
- rta2- cant absorb bicarb in proximal tubule
- rta4-- aldosterone deficiency
-
test for rta 1
test for rta 2
test for rta4
- give iv acid, urine stays basic rta 1
- give bicarb, urine turns basic rta 2
- high urine sodium in rta 4
-
difference between diarrhea and rta
urinary anion gap is + in rta
-
test for urge and stress incontinence?
urge--urodynamic studies
stress---observe urine leakage with coughing
-
ccs tests for ht
- ekg
- eye
- cardiac exam
- urinalysis
-
bp is not controlled with thiazide
add another drug
-
when do you investigate for causes of htn
htn onset in yougn or old <30 or >60
refractory to 2 medications
-
best initial test for renal artery stenosis
most accurate
duplex ultrasound
most accurate renal angiogram
-
best initial rx for renal artery stenosis
renal artery stenting and angioplasty
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