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Nephro Flashcards

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1
Q

Trou anionique

A

Na - (HCO3 + Cl)

N = 7 - 16 (10+-4)

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2
Q

Quand mesurer Urée

A

IR

Ou

Oligurie

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3
Q

Rx pouvant donner IRE pre-renal si asso a stenose renale

A
  • IECA/ARA
  • Diurétique
  • Px naturel
  • Anti-inflam
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4
Q

Categories IRA renale

A 
1- gros vaisseaux
2- petits vaisseaux 
3- GNA
4- NTA
5- NIA
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5
Q

IR type renal atteint gros vaisseaux

A

Embolie ~> infarctus renal = tres douloureux

-imp: intervenir le temps qu’ils ont mal (angioscan)

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6
Q

IR type renal

Atteinte petits vaisseaux

A

Ddx: COVD, avortement septique, PTT-SHU, athéroembolie, micro-thrombus,
Svt post: coro, chx aorte, intervention vasculaire dans dernier mois
Indices: Indolore, orteils/doigts bleus, livedo, anémie hémolytique (augm LDH et Biliind, dim Hb et plaquettes, Schistofytes)

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7
Q

IR type renal

Secondaire a GNA

A

= tjrs Proteinurie + Hematurie
DDX + frqt: post-infectieux (staph), vasculite a Anca, LED, mx Berger (IgA)
Indice = HTA + IRA + Proteinurie + Hematurie

** Dx repose sur biopsie renale => eliminer le reste avant

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8
Q

IR type renal 2r NTA

A 
#1 = ischemique (2r a hypoTA prolongée)
#2 = non-ischemique (toxique = 48h post contraste
Rhabdo = ck>5000 +urine acajou
ATB: Tobra, vanco, amino)
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9
Q

IR type renal 2r NIA

A

= reaction allergique
Sct 7-10 jrs apres intro nv Rx
Les plus frqt: PNC, Anti-inflam, IPP, allopurinol

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10
Q

Bilan de base IRA

A 
1- fsc, uree/creat, electrolytes
2- ca, Po4
3-bilan septique: pre-renal
4- analyse urine: renal vs pre-renal
5- EPP
6- echo + uroscan: post-renal
7- GNA, NTA, NIA: Dx repose sur biopsie (r/o tout avant)
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11
Q

Def IRC

A

DFG <60 pour >3 mois

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12
Q

Bilan de base IRC

A 
1- FSC, electrolytes, u-C
2- Ca, Po4
3- EPP, chaines libres
4- Db
5- DLP
6- Analyse urine: inclus microalb + chaînes légères 
7- echo
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13
Q

Ddx hyponatremie osm srq normale

A 
Hyponatremie isoosmotique (pseudohypoNa)
-hyperlipidemie ou hyperproteinemie severe
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14
Q

Ddx hypoNa c osm srq augmentée

A

Hyponatremie hyperosmotique

  • hyperglycemie (10:3)
  • infusion hypertonique: mannitol, glycine, glycérol, sorbitol, ethanol, methanol, produits de contraste
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15
Q

Dx hypoNa hypoosmotique

Hypovolemique

A

Na urinaire

  • <20 = pertes extrarenales: GI (diarrhee, Vi, sgmt), 3e espace (peritonite), perte insensibles (cutanées, respiratoires)
  • > 40 = pertes renales: diurétique, diurèse osmotique, Nephropathie, acidoae tubulaire renale, insuffisance surrenalienne
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16
Q

Ddx hypoNa hypoosmotique

Isobolemique

A

Na urinaire
- <20 : polydypsie primaire (potomanie), apport faible osmoles (tea and toast, bière)

  • > 40: SIADH, hypothyroïdie, stress, insuffisance surrenalienne
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17
Q

Ddx hypoNa hypoosmotique

Hypervolemique

A

Na urinaire
- <20: cirrhise, IC, Synd Nephrotique, grossesse

  • > 40: IRA, IRC
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18
Q

Ddx HyperNa

Hypovolemique

A

Na urinaire
- <20 = pertes extrarenales: GI (diarrhee, Vo), insensibles (cutanée, respiratoire)

->40 = pertes renales: diurétique, diurèse osmotique (glucose, urée, mannitol), Diurèse post-obstruction

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19
Q

Ddx HyperNa isovolemique

A

Osm urinaire
-Dim = pertes renales: diabète insipide central vs nephrogenique

-augm = pertes extrarenales: pertes insensibles

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20
Q

Ddx hyperNa

Hypervolemique

A

Na urinaire >40

  • Iatrogene: slt hypertonique, comprimés NaCl/NaHCO3
  • Mineralocortico: hyperaldo 1r, Synd Cushing
  • Dialyse hypertonique
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21
Q

Ddx hypoK par shift transcellulaire

Study These Flashcards
A

1) Alcalose metabolique
2) Insuline
3) Catecholamines, ago beta2, théophylline
4) agents tocolytiques
5) uptake cellulaire: Injection B12, fctr stimulant prod Gr

22
Q

Ddx hypoK 2r a pertes renales c HtA

Study These Flashcards
A
  • Hyperaldo 1r (Synd Conn) ou 2r (mx renovasculaire, tumeur renale)
  • Hypercorticisme
23
Q

Ddx hypoK par pertes renales c TA N

Study These Flashcards
A

Check statut acidobasique
1- acidemie: ACD, acidose tubulaire renale
2- Variable: hypoMg, Vo
3- Alkalemie: diurétique (furosemide, HCTZ), anomalie tubulaire congenitale (Batter’s, Gitelman’s)

24
Q

Ddx HypoK par perte extra-renales

Study These Flashcards
A
  • GI: diarrhée, laxatif, adénome villeux, Vo

- Cutanées

25
CAT hyperK
1- ECG 2- Labos: fsc, creat, Ck, glycémie, gaz 3- reviser Rx: digoxine, transfusion 4- Tx
26
Tx hyperK
``` C BIG K DROP Ca gluconate Beta-agoniste, Bic Insuline Glucose Kayxalate Diurétique, Dialyse ```
27
Ddx hyperK | Facticd
- echantillon hemolyse - echantillon pris de veine ou coule IV c KCl - utilisation tourniquet prolongé - Leukocytose extrême >100 - thrombocytose extreme >100
28
Ddx hyperK par shift transcellulaire
Hemolyse intravasculaire Rhabdo/exercice intense Synd lyse tumorale Def insuline ~ acidocétose Acidemie Drogues: BB, overdose digitale, succunylcholine
29
Ddx HyperK par diminution excretion
- Dim DFG: IR, faible volume circulant, AINS en IR | - DFG N mais hypoaldosteronisme
30
Mnemonic acidose metabolique c trou anionique augmenté
A LA SA FIT MITE Alcool: methanol, ethanol, ethylene glycol Lactate Acidocétose: Db, ROH, jeune Salycilate, Strychnine Acetaminophene Fer IR Toluene Méthanol, IRC, Toluène, Éthylène glycol (trou osm augm >10)
31
Tx acidose metabolique
1- NaHCO3: si bic<10 ou pH <7.10-7.20, corriger perfusion en 4-8h 2- Tx causal
32
Ddx protéinurie physiologique
1- orthostatique: pas de protéinurie nocturne, resolution spontanée 2- transitoire: exercice, Fievre, IC
33
Ddx proteinurie pathologique
1- tubulointerstitielle 2- Glomerulaire 1r vs 2r 3- Surplus/overflow: MM, amyloidose, macroglobulinemie de Waldenstrom
34
Criteres syndrome nephritique
``` Proteinurie <3 g/j Hematurie macro ou micro Hta Oedeme Gr dysmorphique et cylindre hematique ```
35
Ddx syndrome nephritique aigue
Type 1: depot Ig anti-GBM lineraire Type 2: depot Ig granulaire ~ post-infectieux (1-3sem), lupus, IgA, membrano-proliferatif Type 3: GPA, GePA, polyangeite micro, GN isolée
36
Ddx syndrome nephrotique chronique
Nephropathie a IgA (Berger) Nephropathie hereditaire (Alport)
37
Critères syndrome nephrotique
``` Proteinurie >3g/j Possible urines mousseuses Oedeme Hypoalbuminemie Hyperlipidemie +_ lipidurie Etat hypercoag ```
38
Ddx synd nephrotique 2r
Diabète(la plus frqte) Anyloidose Pre-eclampsie M
39
Ddx syndrome nephrotique 1r
- membraneuse (cause #1 adulte): 1r ou 2r (tumeur solide, Lupus, VHB, syphilis, malaria, PNC, AInS) - Changement minime (cause #1 ped): 1r ou 2r (LH, Leucemie, AINS, Lithium, Pamidronate) - HSF: 1r ou 2r (nephropathie reflux, agénésie rénale, sequelle GN, obésité, VIH, Héroïne) - Nephropathie IgA
40
Rx causant VC renale
AINS Catecholamine Inhibiteur Calcinerine: cyclosporine, tacrolimus
41
MC NTA
Fievre, rash Atteinte pulmonaire et systemique HTA Fsc: recherche Ac Sediment urinaire: GR, cylindre hematique Analyse urinaire: protéinurie, Hburie, FeNa >1%
42
MC NIA
Fièvre Arthralgie, Rash Fsc: eosinophilie Sediment urinaire: Gr, leucocytes (cylindres), eosino (cylindres) Analyse urine: lgr-mod protéinurie, Hburie/pyurie
43
Complications IRA
1- Retention Hydrosodée: Anemie (hemodilution), Surcharge volemique (IC, HTA, OAP, OMI) 2- dysftn plaquettes: diathese hem 3- Accumulation acide: acidose metabolique 4- aN electrolytiques: hyperK, hyperPO4, Syndrome uremique (pericardite, prurit, No-Vo, osteodystrophie renale, encéphalopathie urémique, augm risque infection)
44
Tx IRA
1) cesser agent causal 2) optimiser volemie 3) Si myoglobinurie: hydratation + diurèse forcée 4) si NTA: Hte dose diurétique 5$ si NIA: stéroïdes + immunosup 6) dialyse si nec
45
Criteres dialyse IRA
- HyperK ou HyperPo4 severe - Acidose metabolique grave - pericardite/encephalite/uree >35 - Surcharge
46
Ddx IRC
1- nephropathie db 2- nephroangiosclerose ou nephropathie ischemique 3- glomerulopathie 4- autres: reins polykystiques, uropathie obstructive, mx fabry, NIC, rein myelomateux, dysplasie renale, nephrotoxicite (cyclosporine, tacrolimua)
47
Tx IRC | -reno-protecteur
- diete faible en proteine, K, PO4 - restriction hydrosodee - si proteinurie: IECA ou ARA - Si mx renovasc: angioplastie renale
48
Tx IRC | - Tx des consequences
1- Anemie: EPO si Hb <90 et DFG <30 2- Osteodystrophie renale: dim apport PO4 + viser PtH N 3- acidose metabolique: NaHCO3 0.5-2 mmol/kg die 4- HyperK: C BIG K DROP 5- FR cadiaque: TA, Statine, tabac 6- ajuster tout Rx c impact renal
49
Indication dialyse IRC
- DFG <10 ml/min - Surcharge volumique refractaire aux diurétiques - Evidence denutrition - No-Vo persistants - Péricardite - Encephalopathie urémique
50
Ddx hematurie
1- Hemato: coagulopathie, anemie falciforme
51
Critères d'hypoperfusion
``` AEC Tachypnee >20/ min Oligurie <0,5 cc/kg/h T <36 Extermités froides ou livedo reticulaire Hyperlactatemie ```

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