Palmer Clin Med Flashcards
(47 cards)
What are findings that can point to analgesic nephropathy considering the nonspecific renal picture?
most patients women between 30-70
Hx of headaches or back pain leading to use
other somatic complaints - malaise, weakness
ulcer like symptoms or hx of PUD
What are the histologic findings of lead nephropathy?
early PROXIMAL tubule injury
intranuclear inclusion bodies of lead-protein complex
What finding is present in lead nephropathy that is different than most other syndromes with similar symptoms?
increased uric acid in blood
lots present with gout too
use chelation test to diagnose
What two other syndromes are commonly present in patients with Sjogrens syndrome presenting with chronic TIN?
Type 1 RTA
nephrogenic DI
What is the definition of CKD?
GFR <60 or evidence of kidney damage for more than 3 months
What does persistent proteinuria in the setting of normal or increased GFR indicate?
stage 1 CKD
What happens with sodium and water imbalance in CKD and how should it be managed?
limited range for excretion
monitor salt intake - be careful of patients weight, give more if losing, give less if gaining
GFR <20 needs diuretics too
Follow Na and adjust water intake if necessary
How are diuretics used in management of CKD?
thiazides and K sparing not potent enough
K sparing can cause hyperkalemia
use loops - furosemide! - high doses due to decreased delivery - can add metolozone
What kind of potassium imbalances are present in CKD and how should they be managed?
normal until GFR <10
hyperkalemia at later stages suggests TIN or RAAS disturbance
low K diet, then admin of loop diuretic (increases distal Na delivery)
if acidotic - admin bicarb - increases distal Na and causes K to shift into cells
If K is still high after all the initial therapies, what may have to be given?
Kayexalate = sodium polystyrene sulfonate - K binding resin
give with bowel cathartic to prevent constipation - but not one with Mg (risk of hyperMg with CKD)
How is metabolic acidosis involved in CKD?
can’t regenerate bicarb, decreased ammonium, decreased H+ excretion
non gap early, anion gap later
can lead to bone resorption and protein catabolism
sodium bicarb tablets - monitor for volume overload
What management is available for maintaining phosphate levels at normal in CKD?
low phosphate diet
phosphate binders - high CaPhosphate product use non Ca binder, low use calcium containing binder
then normalize calcium
then look at PTH
What metabolic bone diseases are present in CKD?
osteitis fibrosis cystica (high PTH) - high bone turnover, Brown tumors
osteomalacia - increased unmineralized osteoid - usually accompanied by high turnover dz = mixed osteodystrophy
adynamic bone dz - stage 5 CKD, low turnover, can happen with any therapies aimed at decreasing PTH
If a patient’s anemia is not responsive to admin of Epo, what other causes should be considered?
iron deficiency
osteitis fibrosa cystica
Al overload
What are the cardiovascular manifestations of uremia?
pericarditis
volume overload
HTN
Accelerated atherosclerosis
What are the skin manifestations of uremia?
pruritis
skin pigmentation
What are the neurologic manifestations of uremia?
encephalopathy
seizures
peripheral neuropathy
What are the GI manifestations of uremia?
nausea, vomiting
gastritis, colitis
What are the pulmonary manifestations of uremia?
pleuritis
pneumonitis
What are the endocrine manifestations of uremia?
menstrual disturbance, anovulation
decrease in testosterone and spermatogenesis
What are the indications for hemodialysis in CKD?
Fluid and electrolyte disturbances refractory to
medical therapy
Pericarditis
Encephalopathy, seizure, neuropathy
Uremic symptoms: nausea, vomiting, anorexia,
altered food taste, disturbance in sleep wake cycle
Evidence of malnutrition: decreased BUN/Cr,
hypoalbuminemia
What damages does a post renal obstruction cause to the kidney?
intrarenal vasoconstriction, ischemic tubular injury, interstitial fibrosis
What kind of acidosis can indicate post renal obstruction?
Type IV RTA
What is the cardinal feature of pre renal azotemia?
decreased EABV
