renal shiz Flashcards by C D

nephrotic syndrome associated with:

African American or Hispanic
obesity
HIV
heroin use

Focal segmental glomerulosclerosis

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nephrotic syndrome associated with:

adenocarcinoma (solid tumors of breast, lung)
NSAIDS
Hep B
SLE

Membranous nephropathy

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nephrotic syndrome associated with:

Hep B and C
lipdystrophy

Membranoproliferative glomerulonephritis

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nephrotic syndrome associated with

NSAIDs
lymphoma
children

Minimal change disease

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nephrotic syndrome associated with

-URI

IgA nephropathy

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dysmorphic red cells

glomerulonephritis

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red cell casts

glomerulonephritis

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white cell casts

pyleonephritis

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eosinophil casts

Acute (allergic) interstitial nephritis (except won’t show up with NSAIDs)

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hyaline casts

dehydration (normal Tamm-horsfall protein)

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broad waxy casts

chronic renal disease

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granular “muddy brown” casts

ATN (collections of dead tubular cells)

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sudden rise in Cr and BUN

Acute Kidney Injury
usually symptomatic but may have N+V, malaise
shortness of breath, edema, and fluid overload
very severe: confusion, arrhythmia from hyperkalemia, pleurtic chest pain from PERICARDITIS

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hypoperfusion of kidney
BUN rises more than Cr
BUN:Cr >20:1
urine Na 500mOsm

Pre-renal

hypotension systolic

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obstruction of urinary system

BUN: Cr >20:1

Post-renal
must block BOTH ureters for Cr rise
prostate hypertrophy, stone in ureter, cervica cancer, urethral sricture, neurogenic/atonic bladder, retroperitoneal fibrosis (bleomycin)
usually reversible

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BUN:Cr ~10:1
high amount of sodium in urine >20 mEq
high FeNA >1%
low urine osmol

Intrinsic renal disease
acute interstiail nephritis (ofte penicillin)
USUALLY Acute Tubular Necrosis (ATN) due to toxins or ischemia
rhabdomyalsis/hemoglobinuria
contrast and NSAIDs
crystals like hyperuricemia, hypercalcemia, hyperoxaluria
Bence-jones proteins from multiple myeloma
post strep infection
Tumor lysis syndrome–>hyperuricemia

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urine osmol of >500mOsm

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high osmol=more concentrated
usually in hypovolemic state
more ADH–>concentrates
(but still expect low urine Na+ becuase aldosterone is preserving to keep up intravasc volume)

urine osmol 300mOsm

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relatively dilute

often in intrinsic renal damage because damage causes loss of ability to concentrate

Acute Tubular Necrosis

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toxins cause sloughing of tubular cells-->lose Na+ into urine and have dilute urine because cannot concentrate
Tx: reverse underlying cause
-HYDRATE and correct electrolyte abnormalities
-dialysis when:
1. fluid overload
2.encephalopathy
3.pericarditis
4. metabolic acidosis
5. hyperkalemia

prevention of contrast induced nephropathy

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1-2 L normal saline before and during angiography

prevent renal failure from tumor lysis syndrome

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allopurinol, hydration, rasburicase

cardiac cath after chest pain–> AKI!, purple lesions on fingers/toes, ocular problems, livedo reticularis
PLUS eosinophils in urine and high in blood

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atheroemboli all over including to kidney causing AKI

can biopsy skin purple lesions and find cholesterol

no treatment

drug causes of acute interstitial nephritis

also cause drug rashes, Stevens-Johnson, TEN, hemolysis!

DO Hansel and Wright stain for eosinophils!!!!!!!!!!!!!!!!!!

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eosinophils attack tubular cells
penicillins/cephalosporins
sulfa drugs and diuretics
phenytoin
rifampin
quinolones
allopurinol
proton pump inhibitors

other: SLE, Sjogren, sarcoidosis

papillary necrosis

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sudden onset of flank pain
fever
hamturia
in patient with sickle cell, DM, obstruction, or chronic pyelo AND taking NSAIDs

will look like pyelo

best test= CT showing loss of papillae

no treatment

lung and kidney (hematuria, red cell casts, protienuria) problems only NO upper respiratory

Goodpasture dx: antiglomerular basement membrane antibodies biopsy kidney or lung (kidney-linear deposits) tx: plasmapheresis, steroids

Asian with gross hematuria 1-2 days after URI

``` IgA nephropathy/Berger disease increased IgA in 50% kidney biopsy no tx some resolve, some progress to ESRD ```

``` glomerulonephritis 1-2 WEEKS after strep throat r impetigo cola colored urine LOW COMPLEMENT levels periorbital edema HTN oluguria ```

post-strep golmerulonephritis dx: antistreptolysin O titers (ASO titers) antiDNAse antibody LOW COMPLEMENT LEVELs tx: antibiotics as needed, diuretic if fluid overload

hearing loss visual disturbances PLUS glomerulonephritis

Alport syndrome type IV collagen defect no tx

glomerulonephritis fever malaise myalgias all organs BUT NOT LUNGS, skin-GI pain, stroke in young person, gangrene, livedo reticularis Hep B

``` Polyarteritis Nodosa anemia ESR and CRP elevated angiography of area with suspected problem-renal, mesenteric check for Hep B tx: prednisone ```

Lupus and the kidney

most likely to have membranous glomerulonephritis or glomerulosclerosis biopsy!!!!! tx: glucorticoids

large kidneys on sonogram | history of rheumatoid arthritis, cancer, Crohns, chronic infection

Amyloidosis biopsy fat pad green birefringence wit Congo red stain treat underlying disease

nephrotic sydnrome

protienuria >3.5 g/24 hours edema hyperlipidemia thrombosis (URINARY LOSS OF PROTEIN C

metabolic acidosis with normal anion gap (between 6-12)

Renal Tubular Acidosis diarrhea Na+ - (Cl- + HCO3-)= anion gap due to hyperchloremic in each

high urine pH above 5.5 plus hyperchloremic and nonanion gap metabolic acidosis hypokalemic nephrolithiasis

Type I-distal tubule damaged and therefore bicarb not made and acd not excreted-->alkaline urine test by giving ammonium chloride-->should cause decrease in urine pH as able to excrete acid again (BUT will not happen in distal RTA damage secondary to SLE, Sjogren, amphotericin Tx; give more bicarb high urine pH could also be due to infection with proteus and staghorn calculus

intially high urine pH then gradually becomes acidic nonanion gap metabolic acidosis, hyperchloremic hypokalemic

``` bicarb reabsorbed at proximal tubule normally proximal RTA (type II) damage due to amyloid, myeloma, Fanconi, acetazolamide, heavy metals ``` deplete bicarb until urine acidic (osteomalacia test: give bicarb and see if able to resabsorb-->type II if urine becomes alkaline tx: deplete volume with thiazide diuretic to increase bicarb reabsorption

persistently high urine sodium in spite of sodium depleted diet hyPERkalemic urine pH

Type IV RTA-hyporeninemia, hypoaldo decreased amount or effect of aldosterone-->hyperkalemia, hyponatremia, retain hydrogen ions tx: fludrocortisone to replace aldosterone

urine anion gap

urine sodium minus urine chloride distinguish between diarrhea and RTA as cause of NONANION GAP METABOLIC ACIDOSIS RTA= positive urine anion gap diarrhea=negative urine anion gap

Elevated anion gap metabolic acidosis | Na+ - (Cl- + HCO3-) = greater than 12

``` lactate in hypotension/hypoperfusion ketoacids in DKA/starvation oxalic acid in ethylene glycol OD formic acid in methanol OD uremia in renal failure salicylates in aspirin OD ```

increased serum pH slight increase in pCO2 increased bicarb

metabolic alkalosis-always with resp compensation increasing pCO2

stones with gout or tumor lysis

uric acid stones- require CT due to not visualized on x-ray

hypertensive crisis!!

htn w/ end organ damage tx: labetalol or nitroprusside

renal shiz Flashcards

(41 cards)