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65 Cards in this Set

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Hypernatremia Tx
replace water-free deficit w/ hypotonic saline, D4W or water depending on volume satus
Hypovolemic hyponatremia
renal failure
nephrotic syndrome
cirrhosis
CHF
hypothyroidism
2nd or 3rd adrenal insufficiency
Euvolemic hyponatremia
SIADH - most common and extravascular
Drugs
Psychogenic polydipsia
Oxytocin use
Hypovolemic hyponatremia
Diuretics
vomiting
diarrhea
bleeding
third spacing
Treatment of Hyperkalemia
C BIG K
Calcium gluconate - cardioprotective
Bicarbonate
Insulin
Glucose
Kayexalate
Hypokalemia Tx
Treat underlying disorder
Oral and/or IV potassium repletion
Replace Magnesium
Monitor ECG and potassium levels frequently
Hypercalcemia Signs
> 10.2 mg/dL
Stones, bones, groans, moans
osteopenia, fractures
kidney stones
anorexia, constipation
psychiatric overtones
Hypercalcemia Tx
IV hydration
Furosemide
Calcitonin and biphosphonates for severe
AVOID THIAZIDES (increases calcium)
Hypocalcemia
< 8.5 mg/dL
Abdominal cramps, tetany
facial spasm from tapping facial nerve (Chvostek's sign)
carpal spasm after arterial occlusion by a BP cuff (Trousseau's sign)
prolonged QT interval
Hypocalcemia
Treat underlying disorder
Magnesium repletion
Oral calcium (IV calcium for severe)
Type IV Renal Tubular Acidosis
Most common
Aldosterone deficiency or resistance, leading to defects in sodium reabsorption and H and K excretion

Serum potassium High
Serum pH low
urine pH low
Type IV Renal Tubular Acidosis Tx
1. Furosemide
2. Mineralocorticoid and glucocorticoid replacement
3. low potassium diet
Type II Renal Tubular Acidosis
Defect in bicarb reabsorption

Serum potassium low
Serum pH low
Urine pH low

Can be caused by carbonic anyhydrace inhibitors
Type II Renal Tubular Acidosis Tx
Potassium citrate
Type I Renal Tubular Acidosis
Defect in distal H+ secretion

Serum potassium low
Urine pH high
Caused by cirrhosis, SLE, Sjogren's sickle cell, lithium, amphotericin
Type I Renal Tubular Acidosis Tx
Potassium Citrate
Indications for urgent dialysis
AEIOU
Acidosis
Electrolyte abnormalities (hyperkalemia)
Ingestions (salicylates, theophylline, methanol, barbiturates, lithium, ethylene glycol)
Overload (fluid)
Uremic symptoms (pericarditis, encephalopathy, bleeding, nausea, pruritus, myoclonus)
Carbonic Anhydrase Inhibitors
Acetazolamide

Acts on proximal convuluted tubule

Inhibits carbonic anhydrase, increasing hydrogen reabsorption

May lead to metabolic acidosis
Loop diuretics
Furosemide, ethacrynic acid, bumetanide, torsemide

Inhibit Na/K/2Cl transporter at ascending loop ofhenle

Leads to hypokalemia and hypocalcemia
Which loop diuretic is best for patients w/ sulfur allergies?
Ethacrynic acid
Thiazide Diuretics
Hydrochlorothiazide, chlorothiazide

Inhibit Na/Cl transporter at distal convuluted tubule

Decrease sodium, decrease potassium

Hyperglycemia, hypercalcemia, hyerlipidemia, hyperuricemia
Potassium Sparing Diuretics
Spironolactone - aldosterone receptor antagonist

Triamterine, amiloride - block sodium channel

Use in situations of hypokalemia

Leads to gyneco
Postinfectious glomerulonephritis
Can be seen 2-6 weeks after strep infection
Postinfectious glomerulonephritis Hx
oliguria, edema, htn, tea colored urine
Postinfectious glomerulonephritis labs
Low serum C3, Increased ASO titer
Lump-bumpy immunofluorescence
Postinfectious glomerulonephritis tx
Tx: most resolve on own
IgA nephropathy
Berger's disease

Associated w/ upper respiratory or GI infections

Commonly seen in young males
IgA nephropathy hx
episodic gross hematuria or persistent microscopic hematuria
IgA nephropathy labs
normal C3
IgA nephropathy treatment
Glucocorticoids for some patients
ACEI for patients w/ proteinuria
Wegener's granulomatosis
graunlomatous inflammation of respiratory tract and kidney
Wegener's granulomatosis hx
cavitary pulmonary lesions
hemoptysis
hematuria
respiratory and sinus symptoms
Wegener's labs
c-ANCA
segmental necrotizing glomerulonephritis few immunoglobulin deposits on immunofluorescence
Wegener's Tx
steroids and cytotoxic agents
Goodpasture's syndrome
rapidly progressing glomerulonephritis w/ pulmonary hemorrhage
Goodpasture's syndrome hx
male in mid 20's w/ hemoptysis, dyspnea
Goodpasture's syndrome Labs
linear anti-GBM
iron deficiency anemai
pulmonary infiltrates on cxr
Goodpasture's syndrome tx
plasma exchange
pulsed steroids
Alport's syndrome
Hereditary glomerulonephritis in boys 5-20 years old
Alport's syndrome hx
hematuria, nerve deafness, eye disorders Progresses to renal failure
Alport's syndrome labs
GBM splitting on electron microscopy
Minimal change disease
most common cause of nephrotic syndrome in children
Minimal change disease hx
tendency towards infections and thrombotic events
Minimal change disease labs
normal on light microscopy
electron microscopy: fusion of epithelial foot processes
Minimal change disease tx
steroids
good prognosis
Focal segmental glomerulosclerosis
Associated w/ HIV, obesity, IV drug abuse
Focal segmental glomerulosclerosis Hx
Typically a young AA male w/ uncontrolled hypertension
Focal segmental glomerulosclerosis Labs
Microscopic hematuria, biopsy w/ sclerosis in capillary tufts
Focal segmental glomerulosclerosis Tx
Prednisone, cytoxic therapy
ACEI to decrease proteinuria
Membranous nephropathy
most common nephropathy in Caucasian adults

2ndary to tumor malignancies
Membranous nephropathy Hx
Associated w/ HBV, symphilis, malaria, and gold
Membranous nephropathy labs
spike and dome appearance
IgG and C3 deposits at basement membrane
Membranous nephropathy tx
Prednisone and cytotoxic therapy for severe disease
Diabetic nephropathy
Thickened GBM, thickened mesangial matrix
Diabetic nephropathy tx
tighten blood sugar
ACEI for type I DM and ARBs for type 2 DM
Lupus nephritis
Both nephrotic and nephritic
Lupus nephritis hx
proteinuria or RBC's on UA may be found during evaluation of SLE patients
Lupus nephritis labs
Mesangiel proliferation
Subendothelial and subepithelial immune complex deposition
Lupus nephritis Tx
Prednisone and cytoxic therapy
Renal Amyloidosis Hx
patients w/ multiple myeloma or chronic inflammatory disease (rheumatoid arthritis or TB)
Renal Amyloidosis Labs
Nodular sclerosis, apple-green birefringence on Congo red stain
Renal Amyloidosis Tx
Prednisone and melphalan
Membranoproliferative nephropathy
Type I associated w/ HCV, cryoglobulinemia, SLE, subacute endotherlial endocarditis

Seen in patients 8-30 years old
Membranoproliferative nephropathy Labs
Tram-tracked basement membrane

Low C3
Membranoproliferative nephropathy Tx
Corticosteroids and cytoxic agents