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1

Sx of Diabetic Nephropathy

Albuminuria
Occult hematuria
Diabetic symptoms

2

2 key things to monitor w Diabetic Nephropathy

1. Microalbumin (random am sample or 24hr collection) N=0-30mg/d
-microalbuminuria: "high" 30-300mg/d
-macroalbuminuria: "very high" >300mg/d

2. HbA1c levels (>6.5% diagnostic for DM)

3

Risk factors for Diabetic Nephropathy

FMHx, advanced age, HTN, poor glycemic control, minorities, obesity, smoking, OCP

4

Tx for Diabetic Nephropathy

#1 treat diabetes; guidelines recommend drug therapy be initiated immediately

-Gingko (protect glomerulus)
-Flax and pumpkin seeds
-Curcumin (renal protective)
-Guggul
-Chromium
-ALA

5

Causes of Hypertensive Nephropathy

#1: Atherosclerosis (deposition of hyaline-like material on arteriole wall)

-Fibromuscular dysplasias
-Polyarteritis nodosa
-AV fistula
-Aortic aneurism
-Coarctation of aorta
-Embolism

6

Pathogenesis of Hypertensive Nephropathy

Decreased blood flow causes kidney to secrete renin, retain NaCl and H2O --> inc BP

Renin secretion also caused by Na depletion, hemorrhage, shock, CHF, renal artery stenosis

7

Sx of Hypertensive Nephropathy

Mb asx
HA, fatigue, confusion, vision changes, angina, HF, hematuria, epistaxis, irregular heartbeat, ear buzzing, pulmonary edema, uncontrollable HTN, L ventricular hypertrophy, HTN retinopathy, abdominal bruit

8

Labs (ish) for Hypertensive Nephropathy

Diastolic >120, HTN refractory to therapy. CBC, electrolytes, glucose, BUN, creatinine, UA, EKG, PLASMA RENIN, Captopril challenge test

9

Tx for Hypertensive Nephropathy

-Control BP
-Surgical reconstruction of damaged artery or bypass in case of hyperplasia
-Tx atherosclerosis (guggal, garlic, EFA, B vit)
-Vascular protectants (bioflavonoids, vaccinium)

10

Cx of Hypertensive Nephropathy

Early death
Hypertensive heart disease
MI
CHF
Kidney damage
KI failure
Stroke
Loss of vision

11

What population is Nephroptosis most common?

Females, young and thin, more common the right side. 64% of those w fibromuscular dysplasia of renal artery have this

12

What is happening with Nephroptosis?

Kidney drops >5cm upon moving from supine to standing. Theorized o be dt lack of perirenal fat and fascial support and/or longer renal vascular pedicle

13

Risk factors of Nephroptosis

Excessive weight loss
Frequent intense physical activity

14

Sx of Nephroptosis

Severe abdominal, CVA, flank pain and vomitting in upright position dt

1. acute hydronephorosis kinked proximal ureter
2. renal vessel lumen narrowing and ischemia
3. visceral nerve stimulation from traction

15

Nephroptosis Crisis sx

Severe pain, N/V, chills, tachycardia, oliguria, hematuria, proteinuria.

Pain relieved w upward movement of kidney/supine position

16

PE of Nephroptosis

kidney palpable in ipsilateral lower abdomen

17

DDX of Nephroptosis

Urolithiasis, cholecystitis, spastic bowel, PN, ovarian cyst, appendicitis, divertilucitis

18

Workup for Nephroptosis

renal US, IV urography

19

Tx for Nephroptosis

-Surgical nephropexy for symptomatic its w flank pain >1yr

-Laparoscopic nephropexy (newer tx)

20

3 Cystic diseases of the kidney

1. Simple or solitary cyst
2. Autosomal Dominant Polycystic Kidney Disease (ADPKD)
3. Acquired Renal Cystic Disease

21

Presentation of Simple cysts

Flank/back intermittent dull back pain, fever and malaise if infect. Abdominal mass, may be tender if infected

22

Diagnosis of Simple cysts

Labs: Normal UA
US: Sharply demarcated w smooth walls, enhanced back wall
CT: Smooth thin wall, sharply demarcated, should not enhance w contrast media

23

Tx of Simple cysts

Leave alone if simple
Const. hydrotherapy
Drainage or antimicrobial tx if infected
Surgery if obstruction

24

Dx of ADPKD

15-39yo w at least 3 cysts in BOTH kidneys, 40-59yo at least 2 cysts, AND positive FHx

25

Sx of ADPKD

Pain over both kidneys, gross hematuria, HTN, nocturne, palpable nodular kidney

Renal insufficiency: HA, N/V, weight loss

Infected: fever, chills, tender kidneys

26

Labs for ADPKD

-Incr. erythropoietin leads to inc HCB and HCT
-Anemia from blood loss
-Proteinuria, hematuria, pyuria, bacteriuria
-Uremia from renal insufficiency (inc BUN and creatinine)

27

Imaging for ADPKD

KUB: enlarged renal shadows up to 5x size
CT: 95% accurate, can detect from 0.5cm
US: Most cost effective, can detect 1-1.5cm
MRI: Differentiate Renal Cell Carcinoma

28

Cx of ADPKD

1. Gross Hematuria: rupture of cysts, mb CA
2. Nephrolithiasis: Ca oxalate
3. HTN
4. ESRF: 50% leads to renal failure
5. Pain: from enlarging cysts
6. Other: Cerebral aneurysm, MVP, aortic aneurysm, colonic diverticula

29

Tx of ADPKD

1. Low protein diet (0.5-0.75g/kg/d)
2. 3000ml or more fluids
3. Restrict caffeine
4. Flax oil
5. Avoid strenuous activity
6. Treat uremia, stones, infection
7. Tx HTN
8. Constitutional HP
9. Somatostatin, everolius

30

Dx of ADPKD

Kids: poor
35-40 or older: 5-10 year life expectancy