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24 Cards in this Set
- Front
- Back
What is RTA?
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Renal Tubular Acidosis
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What are the 4 Types of Acidosis, the later 3 being types of RTA , list what is wrong
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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) |
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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) |
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What is formula for Fe-Na
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U of Na * P of Cr /
P of Na * U of Cr X 100 = Fe-Na P is plasma (you pee over pee yew) |
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What do BUN and Cr do in renal failure/ do to suggest renal failure?
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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 |
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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 |
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What sort of micro specimens in U/A w/ micro are indicative of Intertubular Necrosis/ Tubulointerstitial Disease?
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Brown-Muddy Casts
--sloughed off dead cells |
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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. -- |
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What is ATN usually due to
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Note: it's an Intrinsic Renal Failure Dz
--Due to Ischemia, Drugs, Toxins ----look for muddy brown casts |
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What are some non-intrinsic causes of ATN? (3)
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Sickle Cell nephropathy
Hypercoagulable States Arteriolar nephrosclerosis |
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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 |
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What is AIN
-has 2 names |
Acute Interstitial Nephritis
--or Allergic Interstitial Nephritis |
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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 |
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What do the following have in common:
Acute Uric Acid Elevation HyperCalcemia HYpoKalemia Misc: HyperOxaluria, Cystinosis, Fabry's Dz |
Potential Endogenous Nephrotoxins
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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 |
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10-12% of Pts with ESRD (end stage renal dz) have this genetic prob?
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ADPKD
-may have flank pain -hematuria--often gross -HTN -UTI prone -Sx in 3rd-4th decade --can also get liver cysts --no biggy |
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What other system must be checked/imaged in ADPKD?
Eventualy Tx for ADPKD? |
Brain---can get berry aneurysms
--Usually Pts need dialysis |
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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 |
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What is acronym for causes of Non-anion gap Acidosis?
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HARDUPS
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What does HARDUPS stand for?
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H-Hyperalimentation
A-(addisons), Acetazolamide R-RTA D-Diarrhea U-Ureteral/sigmoidal/ileal diversion P-Pancreateic Fistula S-Spironolactone |
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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 |
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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 |
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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+ |
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What conditions are associated with RTA?
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DM
Glomerulosclerosis Many forms of chronic Kidney Dz with Tubulointerstitial Involvement |