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36 Cards in this Set

  • Front
  • Back
gold standard for quantifying the glomerular filtration rate and renal plasma flow
radionuclide kidney clearance scanning
when to order MRI of kidneys
mass lesions and cysts
test of choice for the evaluation of urologic bleeding in patients at high risk for bladder cancer with an estimated GFR above 60 mL/min/1.73 m2
CT urography
can identify non-uric acid–containing kidney stones
KUB xray
Indications for kidney biopsy
suspected glomerular pathology such as glomerulonephritis and the nephrotic syndrome, acute kidney injury of unclear cause, and kidney transplant dysfunction
Contraindications to kidney biopsy
bleeding diatheses, active infection of the genitourinary system, hydronephrosis, atrophic kidneys, and uncontrolled hypertension; relative C/I: solitary kidney, severe anemia, and chronic anticoagulation
abnormal serum osmolal gap
>10 mosm/kg H20; reflects the presence of unmeasured solutes
Formula: plasma Osmolality (mosm/kg H2O)
2 × Sodium (meq/L) + Glucose (mg/dL)/18 + BUN (mg/dL)/2.8
normal effective osmolality
275-295 mosm/kg H204 to 6 meq/L (4-6 mmol/L) over the first 24 hours is sufficient
goal rise in sodium in patients with symptomatic hyponatremia
4-6 meq/L over 1st 24 hours
conditions causing pseudohyponatremia
yperglobulinemia or severe hyperlipidemia
most common form of hyponatremia
hypotonic hyponatrmeia
causes of hypertonic hyponatremia
marked hyperglycemia or exogenously administered solutes such as mannitol or sucrose
first step in the evaluation of hyponatremia
check plasma osmolality - normal in pseudohyponatremia (check chol, TG, serum total Pr)
how is cause of hypotonic hyponatremia established
history, vol status, urine osmolality, urine sodium level
Uosm for primary polydipsia and hyponatremia
<100
mechanism of hyponatremia in beer potomania
water excretion is in part solute dependent, chronic ETOH + low solute intake = decrease free water excretion; hyponatremia develops in setting of modest increases in fluid intake
when does reset osmostat occur?
quadriplegia, TB, advanced age, pregnancy, psych disorders
how to distinguish reset osmostat from SIADH
document excretion of dilute urine following a water load
What is cerebral salt wasting?
syndrome of hypotonic hyponatremia that may complicate subarachnoid hemorrhage or neurosurgery
risk factors for acute hyponatremia
pos-op hypotonic fluids; use of thiazides, use of ecstacy, overhydration with extreme exercise, primary polydipsia
treatment of symptomatic hyponatremia
hypertonic saline in symptomatic SIADH; NS for hypovolemic hyponatremia; seizure or coma - 100ml or 2ml/kg bolus infusions of 3% NS, repeated up to 2x as needed
maximum rate of correction of hyponatremia
not >10 meq/l within 24 hours or 18 within 48 hours
clinical features of osmotic demyelination syndrome
progressive quadriparesis, speech and swallowing disorders, coma, locked-in syndrome (IRREVERSIBLE)
treatment of asymptomatic hyponatremia
fluid restriction in SIADH or hypervolemic hyponatremia
causes of diabetes insipidus
decreased release of ADH (central diabetes insipidus); ADH resistance (nephrogenic diabetes insipidus); and metabolism of ADH by circulating vasopressinase (gestational diabetes insipidus)
define polyuria
urine volume >3L/24h
diff Dx of polyuria
DI, primary polydipsia, osmotic diuresis
urine osmolality in osmotic diuresis, primary polydipsia and DI
>300 in osmotic diuresis; <200 in Di and primary polydipsia
effect of water deprivation testing in primary polydipsia and DI
increases urine osmolality to ~600mosm/kg H20; <200 in DI
effect of desmopressin in central DI / gestational DI / nephrogenic DI
rise to 600 mosm/kg H20 except in nephrogenic DI
treatment of hypernatremia
in shock, NS - avoid boluses; estimate water deficit, D5 water
rate of correction of hypernatremia
no more than 10 meq/L to avoid cerebral edema
estimated water deficit formula
Total Body Water [0.6 in Men and 0.5 in Women × Body Weight (kg)] × [(Serum Sodium/140 [or target serum sodium]) – 1]
treatment of central of gestational DI
intranasal desmopressin
treatment of nephrogenic DI
thiazide diuretics (increase prox Na and water reabsorption); d/c lithium if possible or add amiloride