Rx_2.3 (Renal) Flashcards Preview

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Flashcards in Rx_2.3 (Renal) Deck (16)
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1

Furosemide: MOA, uses, SE

  • MOA: inhibits sodium-potasium-chloride co-transporter @ ascending LOH
  • uses:
    • CHF
    • acute pulmonary edema
    • hyeprcalcemia
  • SE:
    • hypokalemia
    • hypocalcemia
    • alkalosis
    • ototoxicity
    • volume depletion
    • nephritis

2

Presentation of Adult Polycystic Kidney Disease

  • growth of renal cysts ==> renal failure by copressing adjacent normal parenchyma
  • presents @ 30-40yo
  • sx/signs
    • abdominal discomfort
    • frequent UTIs
    • hematuria, polyuria, nocturia
    • mild proteinuria
  • associated w/berry aneurysms and mitral valve prolapse

3

Cause of Adult Polycystic Kidney Disease (APKD)

  • mutation @ polycystin 1 gene
  • located @ chromosome 16

4

Presentation of post-strep kidney disease

  • 1-3 weeks after streptococcal pharyngitis ==>
  • poststrep glomerulonephritis (nephritic syndrome)
    • hematuria
    • hypertension
    • azotemia
    • oliguria
  • positive antistreptolysin O antibodies

5

Complication in chronic renal disease (e.g. @ noncompliant diabetic patients)

  • osteomalacia <== kidney's inability to maintain normal vitamin D production

6

Sx of chronic renal failure

  • edema, HTN, pulmonary edema, CHF
  • hyperkalemia, hyperphosphatemia
  • hypocalcemia
  • renal osteodystrophy
  • uremia
  • anemia
  • N/V
  • peripheral neuropathy
  • pruritis

7

Steps for understanding acid-base status

  1. check arterial pH
    1. pH < 7.4 = acidemia
    2. pH > 7.4 = alkalemia
  2. check PCO2
    1. acidemia
      1. PCO2 > 40 mmHG = respiratory acidosis
      2. PCO2 < 40 mmHG = metabolic acidosis w/compensation
    2. alkalemia
      1. PCO2 < 40 mmHG = respiratory alkalosis
        PCO2 > 40 mmHG = metabolic alkalosis w/compensation

  3. In metabolic acidosis: check anion gap 

    1. AG = Na+ - (Cl- + HCO3-)

8

Causes of respiratory acidosis

  • respiratory acidosis = due to hypoventilation ==> increased acid production
  • possible causes:
    • airway obstruction
    • acute lung dz
    • chronic lung dz
    • opiods, sedatives
    • weakening of respiratory muscles

9

Causes of anion gap metabolic acidosis

  • AG > 12 meQ/L
  • MUDPILES:
    • Methanol (formic acid)
    • Uremia
    • Diabetic ketoacidosis
    • Propylene glycol
    • Iron tablets or INH
    • Lactic acidosis
    • Ethylene glycol (oxalic acid)
    • Salicytates (aspirin) (late)

10

Causes of non-anion gap metabolic acidosis

  • AG = 8-12 mEq/L
  • HARD-ASS:
    • Hyperalimentation
    • Addison disease
    • Renal tubular acidosis
    • Diarrhea
    • Spironolactone
    • Saline infusion

11

Causes of respiratory alkalosis

  • PCO2 < 40 mmHG
  • due to hyperventilation:
    • hysteria
    • hypoxemia (e.g. high altitude)
    • salicylates (early)
    • tumor
    • pulmonary embolism

12

Causes of metabolic alkalosis

  • PCO2 > 40 mmHg
  • loop diuretics
  • vomiting
  • antacid use
  • hyperaldosteronism

13

Drugs associated w/crystal-induced nephropathy

  • protease inhibitor; e.g. indinavir
  • drug crystallizes in urine ==>
    • hematuria
    • crystals in urine

14

Minimal change disease impact on glomerular capillary oncotic pressure and GFR

  • MCD = nephrotic syndrome ==> proteinuria
  • epithelial cell foot process effacement ==> protein w/in bowman's space ==>
    • increased oncotic pressure @ BS
    • decreased oncotic pressure @ GC
  • ==> increased GFR

15

Starling equation

Normal GFR

GFR lab estimate (general)

  • GFR = Kf [(PGC - PBS) - (ΠGC - ΠBS)]
  • Normal GFR = ~100 mL/min
  • Cr clearance = approximate measure

16

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