Nephrology Flashcards
(248 cards)
Pre Renal causes of Acute Kidney Injury (AKI)
MI, CHF
nephrosis, cirrhosis, gastrosis - all lower albumin
diuresis, dehydration, diarrhea, and da hemorrhage
fibromuscular dysplasia, renal artery stenosis
presentation of fibromuscular dysplasia in AKI
young women with secondary HT and renal failure
Post Renal causes of AKI
obstruction levels
- ureters - cancer and stones
- bladder - cancer, stones, neurogenic bladder
- urethra - cancer, stones, BPH, kinked foley, etc
Intra renal causes of AKI
glomerulonephritis
Acute interstitial nephritis (AIN)
Acute tubular necrosis (ATN)
glomerulonephritis and AKI
intrarenal cause
RBC casts - r/o nephrotic syndrome (>3.5 g protein per day and increased cholesterol and edema)
AIN and AKI
WBC casts, WBCs eosinophils
caused by infections and rxn to meds
- TMP-SMP, PCNs and cephalosporins
ATN and AKI
muddy brown casts
ischemia or exposure to toxins
IV contrast or myoglobin
–> tx = vigorous IVF
ATN phases
prodrome - increased Cr
oliguric - decreased urine output
polyuric - increased urine output
AKI workup
increased Cr –> r/o pre renal –> check:
- BUN/Cr –> if >20 = prerenal
- Una —> if <10 = prerenal
- Fena —> if <1% = prerenal
- Feurea —> if < 35% = prerenal
if Pre Renal –> volume down –> IVF
–> volume u –> diuretics
AKI workup if not pre renal
r/o post renal –> US or CT –> hydroureter or hydronephrosis –> if post renal –> tx = foley/ nephrostomy/sx—- > if NOT post renal –> intra renal
AKI workup if not post renal
Intrarenal –> Hx and PE –> UA –> Dx
- may have to do a biopsy to –> Dx
Acute indications for hemodialysis
A - acidosis E - electrolytes - Ca and K+ I - intoxications O - overload U - uremia
CKD stages
I - GFR >90
II - GFR 60-89
III - GFR 30-59 - complication management
IV - GFR 15-29 - prepare for dialysis - put in AV fistula if HD is next step
V - GFR <15 - ESRD - perform dialysis
types of dialysis
HD - 3/wk - 4hrs in length
Peritoneal dialysis - every night - 6-8hrs in length
preventing progression of CKD
HTN - goal <130/<80 - ACE-I or ARB
DM - goal A1c <7 - blood glucose 80-120 - oral meds (not metformin or insulin)
Proteinuria - ACE-I or ARB + low protein diet
complications of CDK
Anemia secondary hyperparthyroidism mineral bone disease volume overload metabolic acidosis
anemia of CKD
kidneys make EPO - decreased EPO - decreased Hgb
pt asymptomatic Hgb <12
dx - of exclusion
tx - iron supp, EPO, transfusions - goal Hgb >10
secondary hyperparathyroidism of CKD leading to mineral bone dz path
increased PO4 + decreased Ca –> increased PTH –> increased bone reabsorption –> mineral bone disease
presentation and dx of secondary hyperparathyroidism in CKD
asymptomatic, if Ca x PO4 >55 -> risk for caclphylaxis (ulcerations of skin)
dx - BMP - Ca and PO4
tx of secondary hyperparathyrodism in CKD
phosphate binders - sevelarer - decreased PO4 —> decreased PTH
calcimimetics = cinacalecet
Ca and Vit D
Volume overload in CKD
Metabolic acidosis in CKD
tx - loop diuretics and add thiazides if needed
met acid - bicarb - 10-20 –> tx - oral bicarb
tx of hyponatremia
mild - dz specific
moderate - IVF
severe - 3% NaCl
tx of hypernatremia
mild - PO H2O
moderate - IVF
Severe - D5W (half of nml saline)
signs and symptoms of various Na levels
mild - asymptomatic
moderate - N/V, confusion, HA
severe - coma, seizure