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20 Cards in this Set
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Proteinuria only in the upright position |
Orthostatic proteinuria. Nephrotic rate of protein excretion is 3g/24 hours.
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Dx. AKI, sterile pyuria, and leukocyte casts. Fevers. Rash.
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Acute Interstitial nephritis
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Tx: Persistent hematuria, non glomerular in nature
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Cytoscopy. If the blood cells were abnormal in appearance, if tehre were casts or protein would point towards glomerular in nature. at that pt you would biopsy.
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Dx. dark urine, elevated serum creatine kinase, positive urine dipstick for blood, no erythrocytes.
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Rhabdomyolysis. Common in crash injuries, alcohol, hyphosphatemia, drug use. Treat w fluids, to keep urine output.
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Tx step for suspected obstructed nephropathy
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Kidney ultrasound.
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Dx. AKI w thrombocytopenia and MAHA, fever.
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HUS. Key is seeing the elevated LDH which shows vascular damage, and if there are schistocytes indicating MAHA. Predisposing conditions include Ecoli which produced the Shiga toxin. Also def. in Factor H.
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Dx. elevated creatning, proteinuria, and muddy brown casts
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ATN. Can be due to ischemia, nephrotoxic, cisplatin, IV aminoglycosides, radiocontrast.
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Dx. Hypotension, hyponatremia, and a low FENA
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think of prerenal azotemia
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Tx of hepatorenal syndrome
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Midodrine and octreotide
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Dx. hyperkalemia, hyperphosphatemia, and hyperuricemia.
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Tumor lysis syndrome. Rapidly progressive lymphoid neoplams. You can use rasburicase.
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Features of prerenal azotemia
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Other than the basics (20:1 etc), also see a normal urinalysis, oliguria, and rel. low blood pressure.
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Tx for GFR <15 wo hypervolemia, hyperkalemia, uremic, or acidotic
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nothing. This is stage 5 CKD, and may need dialysis. Early initiationof dialysis does not improve patient outcomes.
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Tx. proteinuria,hematuria HTN, and decline in GFR in a diabetic patient.
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Biopsy. AKI in the setting of Diabetic nephropathy, you need to biopsy to ascertain etiology. Diabetic nephropathy only leads to albuminuria, NOT hematuria. If there is hematuria, you cant just chalk it off as DM nephropathy.
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Dx. Pt w CKD presenting with hyperphosphatemia, elevated PTH, and hypocalcemia
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Secondary Hyperparathyroidism. Patients w CKD cant excrete phosphate and cant produce 1,25 dihydroxy Vit D. The hyperphosphatemia leads to increase PTH. This leads to an osteopenia, and subsequent fractures. Low Vit D also prevents absorption of calcium, leading to hypocalcemia. You will also see alk phos level.
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Dx. Osmolar gap, AKI, and calcium oxalate crystals
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Ethylene glycol poisoning.
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Effectiveness of Thiazide diuretics w GFR<30
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Not effective, need to use things like loops (lasix)
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Hypokalemia in the setting of metabolic alkalosis
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Think Diuretic abuse.
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Patient w RUQ pain piercing to the back and hypocalcemia
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Acute Pancreatitis can cause hypocalcemia by the chelation of calcium by free fatty acids liberated by pancreatic enzymes.
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Hypercalcemia in patient with hilarlymphadenopathy |
Sarcoid can cause hypercalcemia by increasing the production of 1alpha hydroxylase by macrophages. this can be reduced by steroids.
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Dx. Hypercalcemia and Elevated parathyroid hormone related protein
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Usually found in malignancy. Neoplastic cells make PTHrP, commone in scc. Hypercalcemia
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