Renal Flashcards
(23 cards)
Renal bicarbonate resorption
mediated by contraction of extracellular fluid, hypokalaemia, hypochloraemia, MCC activity
polyuria
> 3L/day DI normal to high Na use water deprivation test then ADH if does not concentrate to differentiate nephrogenic and cranial DI psychogenic polydipsia normal to low Na
RTA
1 distal, stones, pH > 5.5, scleroderma
2 proximal
4 aldosterone resistant
diuretic use
high HCO3, low Cl-, low Na+, low K+
met alkalosis
cushings, conns, addisons
cushings, conns - too much - met alkalosis
high Na, high K, low K
addisons - too little - non gap met acidosis
low Na, low H, high K
henoch schoenlein
IgA, normal complement
malabsorption renal stone
calcium oxalate
calcium usually binds to oxalate and oxalate is not absorbed
in malabsorption calcium binds to free fatty acids and oxalate is absorbed –> oxaliurea
Bartters
not hypertensive
NKCC2 mutation / ROMK gene mutation
Gitelmans
NaCl cotransporter inactivating mutation
FeNa
< 1% in pre renal AKI
> 1% in renal AKI
urinary casts in interstitial nephritis
white cell casts, non pigmented granular casts, eosinophils
haemostasis in ESRF
decreased activity platelet factor 3
renal loss of anticoagulant factors
GN immunofluorescence - linear IgG
post strep GN lupus (subendothelial) GPA (wegeners) membranous (C3) Goodpastures
subacute bacterial endocarditis
biopsy: necrosis with IgG, IgM, C3 deposits
low complement, high Rh factor, cryo
Alports
congenitally abnormal GBM due to mutation in alpha collagen
a/w sensorineural deafness
GN immunofluorescence membranoproliferative
membranoproliferative type 1
subendothelial Ig deposits with low C3
type 2 C3; no Ig
low C1, C2, C4 (classical complement components)
GN immunofluoresnce membranous
subepithelial immune complexes
Barters
thick ascending limb loop of Henle high urinary PGE2, calcium normotensive met alkalosis hypokalaemia, hypomagnesaemia autosomal recessive
Gitelman’s
distal tubule normal urinary PGE2, low calcium normotensive met alklalosis hypokalaemia, hypomagnesaemie autosomal recessive
urine chloride
< 25 if low volume - past diuretic, vomiting
> 25 otherwise - current diuretic use
aldosterone
increases production of sodium channels in collecting tubules
SAME - increased aldosterone
Liddles - cannot break down sodium channels
cyclosporin dosing
interacts with MMF - reduces MMF by 30%
level 2/24 post dose
drugs that can be cleared by dialysis
BLAST barbiturates lithium alcohol salicylates theophylline
