definition: over hours to days, decrease in GFRby 25-50%, decrease in SrCr by 75-100% S/S: oliguric, normal to large size kidneys, hypervolemia, , maybe uremic syndrome for severe MGMT: determine cause and treat, d/c nephrotoxic drugs

definition: build up of waste products in blood, mostly urea s/s: myoclunus, oliguria, fatigue, asterics

definition: severe build up of urea s/s: urinous breath, pericardial rub, malaise, altered LOC, pale conjuctiva, HTN, SOB

definition: over 3 months of kidney dysfunction, decreased GFR s/s: asymtomatic until later stages, small kidneys causes: diabetes and HTN/ CVD staged 1-4, then ESRD stage 1: normal or elevated stage 2: 60-89 stage 3a: 45-59 stage 3b: 30-44 stage 4: 15-29 ESRD:

Types: pre-renal, renal, post renal most common type: pre-renal intrinsic: tubular necrosis, interstitial nephritis, acute glomerulonephritis Post-renal: obstruction, males, anticholinergic

CKD can cause hypocalcemia, hyperphosphorous, osteitis fibrosa cystica: hyperparathyroidism (osteoclast activation)MOST COMMON, bone pain, proximal muscle weakness osteomalacia: bones done' mineralize bone pain, or asymptomatic, difficulty walking adynamic bone disease: opposite of fibrosa cystica

HLK week 5 Flashcards by Emily Saunders

AKI

definition: over hours to days, decrease in GFRby 25-50%, decrease in SrCr by 75-100%
S/S: oliguric, normal to large size kidneys, hypervolemia, , maybe uremic syndrome for severe
MGMT: determine cause and treat, d/c nephrotoxic drugs

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Azotemia

definition: build up of waste products in blood, mostly urea
s/s: myoclunus, oliguria, fatigue, asterics

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uremia

definition: severe build up of urea

* s/s: urinous breath, pericardial rub, malaise, altered LOC, pale conjuctiva, HTN, SOB

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CKD

definition: over 3 months of kidney dysfunction, decreased GFR
s/s: asymtomatic until later stages, small kidneys
causes: diabetes and HTN/ CVD
staged 1-4, then ESRD
stage 1: normal or elevated
stage 2: 60-89
stage 3a: 45-59
stage 3b: 30-44
stage 4: 15-29
ESRD:

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AKI types

Types: pre-renal, renal, post renal
most common type: pre-renal
intrinsic: tubular necrosis, interstitial nephritis, acute glomerulonephritis
Post-renal: obstruction, males, anticholinergic

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CKD Bone changes

CKD can cause hypocalcemia, hyperphosphorous,
osteitis fibrosa cystica: hyperparathyroidism (osteoclast activation)MOST COMMON, bone pain, proximal muscle weakness
osteomalacia: bones done’ mineralize bone pain, or asymptomatic, difficulty walking
adynamic bone disease: opposite of fibrosa cystica

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Kidney transplant life expectancy

living donors: 1-5 yr: 95-80%

Deceased donors: 1-5 yr: 89-66%

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nephrotic characteristics

PROTEINuria! >3 g day in urine
so no protein in blood – hypoalbumineia
massive edema
can be normotensive
hyperlipidemia
mechanical issue
frothy urine

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nephritic characteristics

periorbital and scrotal edema
HTN!!!
RBC casts in urine
injury/ infection issue– angry
RPGN is severe end
1-3 g/ day proteinuria

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nephritic examples

post infectious GN -- strp 
IGA nephropathy-- Berger's-- Asi---- Henouch
goodpastures --basement membrane
SLE
Hep C
Pauci-immune --/ all polyangititis
interstitial nephritis

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nephrotic examples

minimal change disease -- common in kids
focal segmental glomerular sclerosis
diabetic nephropathy
HTN nephropathy
amyloidosis
HIV assc. nephropathy

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goodpasture

basement membrane
men>women, think young men 30-40
pulmonary renal syndrome,  
alveolar hemmoraging/ hemoptysis, RPGM
URI can preceed
treat w/ plasma exhance

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IGA nephropathy (nephritic)

Asians
1-2 days after URI
gross hematuria
asymptomatic to RPGN
can resolve or progress
treat w/ ACE/ARB

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post-infx GN (nephritic)

1-3 weeks after infx
strep!
hematuria, proteinuria, NEPRHITIC Symptoms
HUMPs on microsopy
treat : supportive, anti-HTN, NO steroids

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henouch (nephritic, IGA type)

kids
palpable purple purpura on legs, buttocks
males
GI symptoms, arthralgia
treat w/ aspirin (only time you treat kids w/ this), Rituimab

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pauci-immune (nephritic)

all the polyangiitis'
ANCA+
can present w/ nodules
hemptysis -> hospital
refractory sinus infx= wegeners
treatment= high dose corticosteroids, plasma exchange

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minimal change (nephrotic)

kids
90% of GN in kids in this
treat w/ steroids
no podocytes
in adults= secondary = lymphoma, lithium, NSAIDs

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Focal Segmental (nephrotic)

adults
no podocytes FOCALLY
genetic: Africans
treat: symptoms diuretics/ ACE/ARB, statins
can develop ESRD

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Analgesic Nephropathy (intrinsic AKI)

too many analgesics
s/s: sloughed papilla in urine, ringed shadow sign, volume depletion, hematuria, anemia, sterile pyruia, hyperkalemia. tubular and papilla damage
treat w/ d/c offending rx

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intersitial nephritis (intrinsic AKI)

3.3.3.
3 causes: drugs, autoimmune, infx
of immune, 3 S;s: SLE, Sjogrens, sarcoidosis
triad presentation: arthalgias, fever, rash
WBC casts, hematuria, pyuria, proteinuria
treatment: dialysis, treat underlying cause

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PKD (intrinsic AKI)

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genetic
lots of cysts on the kidney
s/s: ABD flank pain, hematuria, kidney stones, UTIs, family history, HTN
treat: bed rest, supportive, ADH antagonists

acute tubular necrosis (type of AKI)

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most common intrinsic AKI
muddy brown casts
Uremia: pericardial effusion/ tamponade, arrhythmias
hyperkalemia, hyperphosphatemia,
treat: diuresis, dialyze, plasma filtration, protein restiction

RAS (prerenal AKI)

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renal bruits
fibromuscular dyphasia in young woman -- HTN women under 40, beads on a string, 
asymetric kidney size
pre-renal AKI
new onset HTN, refractory HTN
treat- angioplasty,

diabetic nephropathy

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most common cause of ESRD

Lupus nephritis (nephritic)

can be presenting cause of SLE | immune complex deposit? we don't know -- direct cell mediated injury

HTN nephropathy (nephrotic)

HTN nephrosclerosis, from CHRONIC HTn, more common in Africans

amyloidsosis (nephrotic)

protiens clog shit up

cardiorenal syndrome

heart dx causes kidney dx or vice versa

pulmonary renal syndrome

like goodpastures of SLE, wegeners, syndromes involving lung and kidney

hepatorenal syndrome

AKI w/ liver disease, usually portal HTN, poor prognosis

HIV assc nephROathy

African descent thing, can be presenting symptom of HIV

hematuria definition

microscopic= 3 RBC/ HP field on more than 1 occasion macroscopic= smokey urine 90% non-renal cause

hematuria work up

``` urine dipstick if + then to UA centerfuge cytology RBC casts= glomerulonephritis CT, ultrasound ```

hematuria Ddx

cancer glomerular: Nephritic syndromes non-glomerular: cysts, stones, intersitial nephritis, lower GU tract

proteinuria

>3 g/ day = nephrotic >1 mg/ day = proteinuria workup: dipstick, UA, protein/cr ratio, kidney biopsy Function proteinuria: no tx benign Overload proteinuria: too many proteins like BenceJones glomerular proteinuria: diabetic nephropaty tubular proteinuria: ATN, anything intrinsic

creatinine

muscle byproduct, how we estimate GFR

anion gap

normal is 12 +/- 4 -- | tells you if acid/base balance is compensated

BUN

blood urea nitrogen-- made in liver, urea is nitrogenous waste product from ammonia measures level of nitrogen in blood indirectly by measuring urea

BUN/CR ratio

only done if BUN OR CR is elevated

hypo natremia: Isotonic

causes: pseudohyponatremia d/t hyperlipidemia, hyperproteinemia, hyperglycemia

hyponatremia: hypertonic

caused by hyperglycemia, mannitol, contrast agents

hypo natremia: hypotonic | causes

check volume status: hypovolemic: diarrhea, dehydration, hemmohage Euvolemic: SIADH, beer potomania, ecstacy, polydipsia hypervolemic: CHF, Cirrhosis

hypo natremia s/s

HA, nausea/ vomitting, malaise, cerebral edema, CNS abnomalities serum concentration

hypernatremia

always hypovolemic, hyperosmolality s/s: dehydration! orthostatic hypotension, oliguria, lethargy, irritability, seizures serum concentration >145

hypo kalemia

U waves, diuretics, laxitive abuse, diarrhea, Increased aldosterone, polyuria s/s: muscle weakness, fatigue, constipation, rhabdomyalisis, flacid paralysis have to correct hypomagnesia to fix this serum concentration

hyper kalemia

Sharp T waves, wideQRS, PR prolongation, hypoaldosteronisism, CKD 4/5, ACE/ARBs arrhtmymias, muscle cramping, weakness, parathesias, concentration >5

hypo calcemia

s/s perioral numbness, paresthesias, chvostek/ trousseau signs, muscle tetany prolonged QT interval, torsades common cause -- CKD. alsohypoalbuminia, respiratory alkalosis, decreased active vitamin D, hypoparathyroidism concentration

hyper calcemia

causes: hyperparathyroidism, malignancy s/s: stones, bones, groans, moans, psychiatric overtones mild >10.5

hypo phosphatemia

causes: alcoholism, alkalosis, diuretics, re-feeding syndrome s/s/: respiratory failure, muscle weakness, hypoxemia, enchepholapathy concentration

hyper phosphatemia

causes: CKD, malignancy s/s: hypocalcemia same concentration >4.5

hypo magnasemia

causes: diminished absorption/ intake, alcoholism, diabetes, pregnancy, s/s: tremors, muscle weakness, cramps, babinski, nystagmus, tachycardia serum

hyper magnasemia

causes: antacid abuse, advanced CKD s/s: mental obtundation, decreased DTRs, flacid paralysis, hypotension, cardiac arrest serum >3

HLK week 5 Flashcards

(52 cards)