Renal Flashcards
(36 cards)
1
Q
hemodialysis vs transplant in ESRD
A
transplant is +++ in all parameters
2
Q
HTN + hyokalemia
A
- Decreased renin, increased aldosterone –> primary hyperaldo (tumor, B/L adrenal hyperplasia)
- Increased renin, inc aldo –> 2ndry hyperaldo (renovascular HTN, malignant HTN, renin tumor, diuretics, cirrhosis)
- dec renin, dec aldo –> non-aldo causes (CAH, corticosterone-producing adrenal tumor, Cushing’s, exogenous mineralocorticoids
3
Q
Renal SEs ACEis
A
-decreased GFR –> hyperkalemia, elevated creatinine
4
Q
Renal SEs thiazide diuretics
A
hypokalemia, hyponatremia, hyperuricemia, elevated glucose
can decrease effective arterial volume to kidney and cause secondary hyperaldosteronism
5
Q
SIADH
A
- excess ADH –> water retention and natiuresis –> volume expansion, hyponatremia, w/o edema
- Causes: Neoplasm (esp lung, prostate, bladder), CNS disorder, pneumonia, ventilators, meds, postop
- chronic hyponatremia can be asymptomatic. Acutely –> neuro Sx
- Hypourecemia, low BUN, low/nml Cr
- Tx: fluid restriction, correct underlying cause. Can use hyper tonic saline if refractory, but SLOWLY (myelinolysis)
6
Q
Winter’s formula and implications
A
- Expected PaCO2 for metabolic acidosis = 1.5 * [HCO3] +8 +/- 2
- If not as expected, have another primary resp problem.
- If higher than expected, have a primary respiratory acidosis (i.e. respiratory failure)!! NB: asthmatic whose PaCO2 normalizes w/o treatment = BAD SIGN
7
Q
Salicylate OD
A
-primary resp alkalosis AND primary met acidosis
8
Q
Anion gap
A
Na+ - (Cl + HCO3)
Nml = 5-15
9
Q
Causes of normal AG met acidosis
A
HARD ASS: Hyperalimentation Addison's RTA Diarrhea Acetazolamide Spironolactone Saline Infusion
10
Q
Causes of elevated AG met acidosis
A
MUDPILES: Methanol (formic acid) Uremia DKA Propylene glycol Iron tablet or INH Lactic acid Ethylene glycol Salicylates (late. Also causes resp alkalosis)
11
Q
Effects of alkalosis
A
Decreased cerebral blood flow
Left shift in O2/Hg dissociation decreases O2 delivery
Arrhythmias
Tetany, seizures
12
Q
Effects of alkalosis
A
Decreased cerebral blood flow
Left shift in O2/Hg dissociation decreases O2 delivery
Arrhythmias
Tetany, seizures
13
Q
HTN + hyokalemia
A
- Decreased renin, increased aldosterone –> primary hyperaldo (tumor, B/L adrenal hyperplasia)
- Increased renin, inc aldo –> 2ndry hyperaldo (renovascular HTN, malignant HTN, renin tumor, diuretics, cirrhosis)
- dec renin, dec aldo –> non-aldo causes (CAH, corticosterone-producing adrenal tumor, Cushing’s, exogenous mineralocorticoids
14
Q
Renal SEs ACEis
A
-decreased GFR –> hyperkalemia, elevated creatinine
15
Q
Renal SEs thiazide diuretics
A
hypokalemia, hyponatremia, hyperuricemia, elevated glucose
can decrease effective arterial volume to kidney and cause secondary hyperaldosteronism
16
Q
SIADH
A
- excess ADH –> water retention and natiuresis –> volume expansion, hyponatremia, w/o edema
- Causes: Neoplasm (esp lung, prostate, bladder), CNS disorder, pneumonia, ventilators, meds, postop
- chronic hyponatremia can be asymptomatic. Acutely –> neuro Sx
- Hypourecemia, low BUN, low/nml Cr
- Tx: fluid restriction, correct underlying cause. Can use hyper tonic saline if refractory, but SLOWLY (myelinolysis)
17
Q
Winter’s formula and implications
A
- Expected PaCO2 for metabolic acidosis = 1.5 * [HCO3] +8 +/- 2
- If not as expected, have another primary resp problem.
- If higher than expected, have a primary respiratory acidosis (i.e. respiratory failure)!! NB: asthmatic whose PaCO2 normalizes w/o treatment = BAD SIGN
18
Q
Salicylate OD
A
-primary resp alkalosis AND primary met acidosis
19
Q
Anion gap
A
Na+ - (Cl + HCO3)
Nml = 5-15
20
Q
Causes of normal AG met acidosis
A
HARD ASS: Hyperalimentation Addison's RTA Diarrhea Acetazolamide Spironolactone Saline Infusion
21
Q
Causes of elevated AG met acidosis
A
MUDPILES: Methanol (formic acid) Uremia DKA Propylene glycol Iron tablet or INH Lactic acid Ethylene glycol Salicylates (late. Also causes resp alkalosis)
22
Q
Effects of acidosis
A
Right shift in O2/Hg dissociation increases O2 delivery CNS depression Dec pulmonary blood flow Arrhythmias Decreased CO Hyperkalemia Kussmaul's breathing (acute)
23
Q
Effects of alkalosis
A
Decreased cerebral blood flow
Left shift in O2/Hg dissociation decreases O2 delivery
Arrhythmias
Tetany, seizures
24
Q
Metabolic alkalosis
A
- Two events: initial alkalosis (loss of H+ or increased HCO3 (e.g. volume contraction) + maintenance of alkalosis (kidney problem)
- Two types: saline sensitive (urine chloride 20) has ECF expansion
- Tx: Saline + K if ECF contracted. Address cause/give spironolactone if ECF expanded.
25
ECF contracted (saline sensitive) Met alkalosis
- (Urine Cl <10)
- Vomiting, NG suction
- Diuretics (decreased volume increases bicarb concentration)
- Villous adenoma of colon, diarrhea with high Cl content
- Tx: Saline + K
26
ECF expanded (Saline-resistant) met alkalosis
- (Urine Cl >20)
- 2/2 adrenal d/os (primary hyperaldo). mineralocorticoids cause volume expansion and Cl wasting
- Others: Cushings, severe K deficiency, Bartters, Diuretic abuse
- Tx: underlying cause/give spironolactone
27
Compensation formula Respiratory Acidosis
- Acute (takes 12-24 hrs): HCO3 inc by 1 per 10 inc in PCO2
| - Chronic (takes days): HCO3 up 4 for every 10 inc in PCO2
28
Respiratory Acidosis (Clinical, Causes, Tx)
- Somnolence, confusion, myoclonus, asterixis. Acute: Headaches, confusion, papilledema (increased ICP)
- Causes: pulmonary disease, NM diseases (e.g. MG), CNS malfunction, drug-induced hypoventilation, resp muscle fatigue
- Tx: Airway!, CO2 (caution in "CO2 retainers," Tx resp disease, clear toxins, bronchodilators, intubate if necessary
29
Compensation formula Respiratory Alkalosis
- Acutely, for each 10 dec in PCO2, HCO3 dec by 2
| - Chronically, for each 10 dec in PCO2, HCO3 dec by 5
30
Respiratory Alkalosis (Clinical, Causes, Tx)
- Decreased Cerebral blood flow: lightheadedness, dizziness, anxiety, paresthesias, perioral numbness, Tetany (can be confused with hypocalcemia), arrhytmias (severe)
- Causes: Anxiety, PE, pneumonia, asthma, sepsis, hypoxia, mechanical ventilation, pregnancy, cirrhosis, salicylate toxicity, hyperventilation
- Tx: treat underlying cause, inhale CO2
31
Type 1 RTA
- Distal
- Defect in CT H+ excretion
- Urine pH >5.5 --> inc risk of kidney stones, nephrocalcinosis
- hypokalemia, normal AG met acidosis
- Causes: autoimmune (sjogrens, SLE), transporter defects, cirrhosis, nephrocalcinosis, renal transplant, sickle cell, Toxins (toluene, lithium, ampho B), IV bisphosphonates
32
Type 2 RTA
- Proximal
- Urine pH can be s syndrome, amyloidosis, multiple myeloma, Paroxysmal noceturnal hemoglobinuria, Toxins (HAART, Ifosfamide, lead, cadmium)
33
Angioedema
- Edema in face, mouth, lips, tongue, glottis, larynx (can compromise airway)
- Most common acquired: ACEis. Lead to buildup of bradykinin --> edema
- Management: check for airway obstruction, use epinephrine if necessary, trach if necessary
34
Uremic Pericarditis
- Occurs in 6-10% of renal failure pts
- BUN > 60
- Does not usually present with EKG changes of pericarditis (diffuse ST elevation)
- Tx: hemodialysis
35
AKI (definition, urine output, etiology classes)
- rapid decline in kidney function w increase in Cr (twofold) and 50% decreased GFR
- Can be oliguric, nonoliguric, anuric
- Prerenal: Volume loss/sequestration, decreased CO, hypotension. NSAIDS, ACEi, cyclosporins
- Postrenal: intra (crystals, proteins), extra (pelvis/ureter, bladder/urethra)
- Renal: Glomerulonephritis, vascular (large, small), interstitial, ATN
36
Prerenal failure
- always oliguric
- BUN/Cr >20:1
- Urine >500 mOsm
- FENA < 1%, UNa <20
- Reversible, but can progress to ischemic AKI if hypoperfusion lasts
