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24 Cards in this Set

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What is RTA?
Renal Tubular Acidosis
What are the 4 Types of Acidosis, the later 3 being types of RTA , list what is wrong
i. High/Anion gap metabolic acidosis---metabolic acidosis
ii. Proximal (type II) RTA--bicarb reabsorption defect
iii. Distal (type I) --acidification of urine defect
iv. Type IV RTA -- ammonium excretion defect
---RTAs are Non-Anion Gaps, ie the R in Hardups is RTA (1,2,4)
What is Fe-na (Na subscript)?
What does it indicate if above 1?
Fractional Excretion of Sodium
--Fe-Na >1 suggests:
-INtrinsic Renal Failure
---Or
possibly prolonged post-renal failure--could be caused by progressive BPH (check prostate)
What is formula for Fe-Na
U of Na * P of Cr /
P of Na * U of Cr
X 100 = Fe-Na

P is plasma

(you pee over pee yew)
What do BUN and Cr do in renal failure/ do to suggest renal failure?
Both BUN and Cr RISE
--in proportion
--ie their ration wont change--such that as they both rise, the BUN:Cre Ratio will stay "normal" but with higher levels for each
--I THINK____ and normal is 10:1-----I Think
SIDE NOTE on BUN:Cr ration
is ratio is the fact that both urea (BUN) and creatinine are freely filtered by the glomerulus, however urea reabsorbed by the tubules can be regulated (increased or decreased) whereas creatinine reabsorption remains the same (minimal reabsorption).
>20:1 = PreRenal
10-20:1 = NORMAL to Post-Renal
<10:1 = INTRA-Renal
What sort of micro specimens in U/A w/ micro are indicative of Intertubular Necrosis/ Tubulointerstitial Disease?
Brown-Muddy Casts
--sloughed off dead cells
Moving to ATN, which is an Intrinsic Renal Failure that Stands for?
Most common.....?
Acute Tubular Necrosis (ATN)
--MOst common cause of Acute Renal Failure in the hospitalized pt.
--
What is ATN usually due to
Note: it's an Intrinsic Renal Failure Dz
--Due to Ischemia, Drugs, Toxins
----look for muddy brown casts
What are some non-intrinsic causes of ATN? (3)
Sickle Cell nephropathy
Hypercoagulable States
Arteriolar nephrosclerosis
Case:
Admitted for Pneumonia. fever
BUN and Cr increases,
CBC: increased WBCs, Bandemia and Eosinophilia
-Hematuria and Pyuria on U/A micro

What is Dz?
AIN
--eosinos is helpful

Bandemia--band of immature WBCs from marrow
What is AIN
-has 2 names
Acute Interstitial Nephritis
--or
Allergic Interstitial Nephritis
What do the following drugs have in common:
Pens, Cephs, Sulfonomides, Quinolones,
Rifampin
Allopurinol
H2 blockers
NSAIDs
Typical precipitaters of AIN
--note: high does Acetaminophen can also be nef toxic, not just NSAIDs

-Others include Lead, cyclosporine, contrast, heavy metals
What do the following have in common:
Acute Uric Acid Elevation
HyperCalcemia
HYpoKalemia
Misc: HyperOxaluria, Cystinosis, Fabry's Dz
Potential Endogenous Nephrotoxins
What is Tx for AIN?
Specific Rx?
Tx is w/d of underlying offending agent (ie drugs or endo toxins)

Rx: Steroids--Glucorts may benefit, but pros/cons
10-12% of Pts with ESRD (end stage renal dz) have this genetic prob?
ADPKD
-may have flank pain
-hematuria--often gross
-HTN
-UTI prone
-Sx in 3rd-4th decade

--can also get liver cysts --no biggy
What other system must be checked/imaged in ADPKD?

Eventualy Tx for ADPKD?
Brain---can get berry aneurysms

--Usually Pts need dialysis
What do these 3 have in common:
-Alport's Syndrome (aka)
-Medullary Cystic Dz
-Medullary Sponge Kidney
Hereditary Renal Dzz
--Alports is known as Hereditary Nephritis
What is acronym for causes of Non-anion gap Acidosis?
HARDUPS
What does HARDUPS stand for?
H-Hyperalimentation
A-(addisons), Acetazolamide
R-RTA
D-Diarrhea
U-Ureteral/sigmoidal/ileal diversion
P-Pancreateic Fistula
S-Spironolactone
Type II RTA--Proximal:
can be inherited or acquired, what are the acquired causes?
Myeloma
Renal Transplant
Ifosfamide, L-lysine
---get defect in bicarb reabsorption which normally occurs in PCT
Type I RTA--Distal
can be inherited or acquired, what are the acquired causes?
-Sjoergen's Syndrome
-Sarcoidosis
-UT Obstruction
-Amphotericin B (amphoterrible to kidneys)
-Lithium

=Defect in in Acidification of Urine
Type IV RTA--Ammonium Excretion Deficit
--what are causes?

Low RAAS molecules
HyperKalemia !!
--note other types of RTA have HYPOKalemia
Low Renin and Aldosterone (&minimal response to exo mineralcorticoids)

NOTE: really the Cause is Low RAAS molecules, such that low Aldosterone = Hyper K, and Low AT-II = reduced stim of Na/H Antiport = H+ builds up in body, instead of being excreted as NH4+
What conditions are associated with RTA?
DM
Glomerulosclerosis
Many forms of chronic Kidney Dz with Tubulointerstitial Involvement