do not correct hyponatremia faster than ______________
8mEq/L/day
do not correct hypernatremia faster than _____________
10mEq/day
location of type 2 RTA
Proximal tubule
location of type 1 RTA
Distal tubule
location of type 4 RTA
collecting duct
defect type of type 2 RTA
impaired HCO3 reabsorption
defect type of type 1 RTA
impaired H+ excretion
defect type of type 4 RTA
lack of/ no response to aldosterone
minimum urine pH of type 2 RTA
PH <5.5
minimum urine pH of type 1 RTA
pH >5.5
minimum urine pH of type 4 RTA
pH <5.5
which RTA do you see stones
type 1 RTA
RTA with high serum K+
type 4 RTA
BUN/Cr ratio >20 indicates
prerenal AKI
FeNa <1% or FEUrea<35%
prerenal AKI
muddy brown granular cast
ATN
white cell casts
AIN
envelope-shaped crystal on UA
Ethylene glycol
most common cause of CKD
DM
Indication of hemodialysis
- A: Severe acidosis
- E: Electrolyte imbalances (severe hyperkalemia)
- I: Intoxicants (encephalopathy not otherwise explained, lithium)
- O: Overload (severe volume overload refractory to diuretics)
- U: Uremic symptoms (uremic pericarditis, pleuritis)
URI symptoms + hematuria
• IgA nephropathy (Berger’s disease)
• Hematuria + hemoptysis only
• Goodpasture’s syndrome
Hematuria + deafness
• Alport syndrome (hereditary nephritis)
children > adults; abdominal pain + purpura (w/o
thrombocytopenia or coagulopathy) + arthralgias + renal disease
HSP/IgA vasculitis:
MAHA, thrombocytopenia, bloody diarrhea, acute renal injury→ renal
failure; risks: age <5yrs. or > 75 yrs., shiga toxin-producing E. coli often
implicated from raw meat, unpasteurized milk
HUS:
MAHA, thrombocytopenia, altered mental status, abd. pain/N/V, renal
involvement common but less severe presentation
TTP:
lung involvement,
sinus involvement, skin/purpura findings, neurologic dysfunction. ANCA+
glomerulonephritis
Granulomatosis with polyangiitis (formerly Wegeners):
atopy/asthma,
eosinophilia, renal involvement →ANCA+ glomerulonephritis
Eosinophilic granulomatosis with polyangiitis (Churg Strauss):
arthralgias, rashes/ulcers, HTN, abd. pain, renal
insufficiency, neurologic dysfunction.
• Lungs usually spared
• Not associated with ANCA
• Associated with Hep B and Hep C infection
Polyarteritis nodosa:
Hyaline cast
Dehydration or normal
