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Flashcards in Day 3 5/14/15 Deck (40):
1

Normal Na Level

140 mEq/L

-low suggests avid tubular sodium reabsorption ( 40 mEq/L)

2

Normal K Level

4.5 mEq/L

3

Normal Cl Level

104 mEq/L

4

Normal Total CO2

27 mEq/L

5

Normal Glucose Level (Fasting)

90 +/- 30 mg/dL

6

Normal Creatinine Level

1.0 mg/dL

-usually viewed in concert with plasma creatinine; a UCr/PCr value greater than 20 suggests avid tubular water reabsorption, a value less than 10
suggests less avid water reabsorption

7

Normal BUN Level

12 +/- 4 mg/dL

8

Normal Phosphorous Level

4 mg/dL

9

Normal Ca Level

9.5 mg/dL

10

Normal Cholesterol Level

140-200 mg/dL

11

Normal Osmolality Level

285 mosm/kg

12

Acute Kidney Injury

-rapid reduction in glomerular filtration rate manifested by a rise in plasma creatinine (Pcr) concentration and urea
-results in reduced clearance of waste products
-produces state called azotemia

13

3 Types of Acute Kidney Injury

1. pre-renal azotemia- dec. in GFR due to dec. in renal plasma flow and/or renal perfusion pressure
2. post-renal azotemia or obstructive neuropathy- dec. in GFR due to obstruction of urine flow
3. intrinsic renal disease- dec. in GFR due to direct injury to kidneys

14

Uremia and Sx

-signs and sx of multiple organ dysfunction caused by retention of uremic toxins and lack of renal hormones due to acute or chronic kidney injury
-sx: nausea, vomiting, abdominal pain, diarrhea, weakness and fatigue

15

Azotemia

-buildup of nitrogenous wastes in blood, ex. BUN and creatinine

16

Oliguria

-urine volume

17

Anuria

-urine volume

18

___________ is the most common cause of an abrupt call in GFR in a hospitalized pt.

-prerenal azotemia

19

Causes of Pre Renal Azotemia

Dec. ECF Volume
-renal losses
-third space losses
-GI losses
-hemorrhage

Inc. ECF Volume
-dec. cardiac output: CHF, MI, valvular disease, pericardial tamponade
-systemic arterial vasodilation: cirrhosis, sepsis, medication, autonomic neuropathy

20

Causes of Post Renal Azotemia

-obstruction of ureters
-bladder outlet obstruction
-urethral obstruction

21

Intrinsic Renal Diseases That Cause AKI

-vascular diseases: cholesterol emboli, renal vein thrombosis
-glomerular diseases: acute glomerulonephritis, hemolytic uremic syndrome
-interstitial diseases: acute interstitial nephritis, infection, myeloma kidney
-tubular diseases: ischemic or nephrotoxic acute tubular necrosis (ATN)

22

Pre Renal Signs and Symptoms

-intravascular volume depletion
-dec. weight
-flat neck veins
-postural changes in BP/pulse
-cardiac dysfunction
-edema
-pulmonary rales
-S3 gallop

23

Signs and Sx of Intrinsic Renal Disease

-hx of exposure to renal insults associated with ATN
-hypotension
-surgery w/ large blood loss
-transfusion rxns
-exposure to radiocontrast dye

24

Signs and Sx of Post Renal Disease

-anuria, intermittent anuria, large swings in urine flow rate

25

In general, a ____ FEN suggests prerenal azotemia.

low

26

Common Causes of Death in Acute Tubular Nephritis

-infections
-gastrointestinal bleeding

27

Nephrotic Syndrome Management

-low salt diet
-diuretics
-BP control
-cholesterol lowering drugs
-ACE inhibitors to dec. proteinuria
-Vit D replacement
-normal or slightly low protein diet

28

Nephrotic Syndrome Classification

-proteinuria (>3.5 g/d)
-hypoalbuminemia
-edema (even around eyes)
-hyperlipidemia
-lipiduria

29

Causes of Idiopathic Nephrotic Syndrome

-minimal change disease (most common in children)
-focal glomerular sclerosis
-membranous nephropathy
-membranoproliferative GN
-other proliferative GN
-also diabetes, amyloid and light chain disease, SLE

30

Minimal Change Disease
-presentation
-lab
-associations
-phathophys

• Presentation:
-Peak Incidence 2-6 years old
-Male-female 2-1
-Edema, ascites
-Hypertension (20%)

• Lab:
-Renal function normal or slightly depressed
-Urinalysis: 4 + protein, hyaline casts, microscopic hematuria rare
-Normal Light Microscopy
-Negative Immunofluorescence
-EM with foot process fusion

• Associations:
- History of allergy/atopy
- Hodgkin’s lymphoma
- Nonsteroidal drugs (idiosyncratic reaction)

• Pathophys:
- ? T cell disorder
- Loss of charge barrier


31

Focal and Segmental Glomerulosclerosis

• Presentation:
-most common cause of nephrotic syndrome in young adults and AAs
-proteinuria
-hypertension
-urinary sediment often with RBCs
-may be idiopathic or related to previous minimal change disease
-IV heroin, HIV, etc.

• Lab:

• Associations:
-usually idiopathic
-may occur in subjects w/ HIV

• Pathophys:
-not mediated by immune complexes
-may be due to circulating factor (suPAR)
-pathology factor APO lipoprotein L1

• Tx: steroids (for 6 months); relapse is high.

32

Membranous Nephropathy

• Presentation:
-presents w/ nephrotic syndrome

• Lab:
-histology looks like "burning bush"

• Associations:
-idiopathic 2/3 cases (due to antibodies to phopholipase A2 on podocyte)
-hep B
-drugs (gold, mercury)
-SLE
-cancer

• Pathophys:
-up to 50% progress to chronic kidney disease if not tx

33

Membranoproliferative GN

• Presentation:
-two types

• Lab:
-light microscopy: mesangial proliferation and GBM thickening
-IF type 1: granular deposits IgG, C3, +/- C4
-IF type 2: granular deposits C3
-EM type 1: subendothelial deposits
-EM type 2: dense intramembranous depsits

• Associations:
-type 1: hep C infection
-type 2: complement disorder

• Pathophys:
-Hep C type 1: 70% response to interferon

34

Clinical Classification of Nephritic Syndrome

-dec. renal function
-hypertension
-RBC casts
-edema
-proteinuria (

35

Complications of Nephrotic Syndrome

-inc. coagulation factors leads to hypercoagulable state
-inc. risk bacterial infections

36

Clinical Features of Glomerulonephritis

-inflammatory injury of glomeruli
-infiltration leukocytes
-deposition of immune proteins
-disturbed function of affected tissue
-rapidly progressive
-nephritic
-pulmonary-renal syndrome
-crescentic GN

37

Mechanisms of Injury in Glomerulonephritis

1. deposited immune complexes
2. antibodies specific for renal antigens
3. other causes of inflammation within glomeruli
-GN is usually caused by immune-mediated glomerular injury

38

Algorithm for Dx Glomerulonephritis

-definitive dx require kidney biopsy
-blood tests
-urinalysis

39

Tx for Glomerulonephritis

-immunosuppressive drugs: prednisone, cyclophosphamide, rituxumab, etc
-plasma exchange

40

4 Causes of Glomerulonephritis

-IgA nephropathy
-lupus nephritis
-anti-GBM disease
-ANCA associated vasculitis