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Nephrology
RTA
Renal Tubular Acidosis Type 1 (Distal) Distal tubule can not generated Bicarb under aldosterone influence ⇒ ↓ H secretion Etiology Amphotericin SLE Sjogren Presentation Normal AG metabolic acidosis ↓K Diagnosis Best initial → UA → pH >5.5 Most accurate → Ammonium Cl (acid) infusion → Urine remains alkaline ↓K Complications Alkaline...
Read moreGenetic Syndromes
Bartter Syndrome → Genetic salt loss in loop of Henle Metabolic alkalosis Not volume-responsive NOT hypertensive ↓K ↑ Urine Cl Gitelman Syndrome → Problem with thiazide-sensitive Na/Cl symporter in the distal convoluted tubule Metabolic alkalosis Not volume-responsive NOT hypertensive ↓K ↓Mg ↑ Urine Cl Conn’s Syndrome → Primary hyperaldosteronism Metabolic alkalosis...
Read moreNephrotic Syndrome
Measure of severity of proteinuria Definition Proteinuria → >3.5 gr/24h Hypoproteinemia Hyperlipidemia Edema Etiology Diabetes Hypertension Any type of GN Associations Cancer → Membranous Children → Minimal change disease IVDU/AIDS → Focal-segmental NSAID → Minimal change disease, Membranous SLE → Any of them C3 nephritic factor → Membranoproliferative II/III Transient proteinuria → Common in boys →...
Read moreUrinary incontinence
Stress Incontinence Presentation Old woman Painless leakage with ↑ abdominal pressure Coughing Laughing Lifting heavy objects Diagnosis Patient stand and cough → Leakage Treatment Kegel Estrogen cream Surgical tightening Urge Incontinence Presentation Sudden pain in bladder Immediate urge to urinate Diagnosis Pressure measurement in half-full bladder Manometry Treatment Bladder training...
Read morePotassium Disorders (K)
Hyperkalemia K >5 Etiology Pseudo ↑K Hemolysis Tourniquet Thrombocytosis Leykocytosis ↓ Excretion Renal failure ↓ Aldosterone RTA type 4 Addison disease Drugs ACEi ARB Aldosterone inhibitors Spironolactone Eplerenone K-sparing diuretics Triamterene Amiloride Tissue release Tissue destruction Hemolysis Rhabdomyolysis Tumor lysis ↓ Insulin → Insulin drives K into cells Acidosis → H...
Read moreSoduim Disorders (Na)
Hypernatremia Na >145 Etiology Free water loss (6 Ds) Diuresis Dehydration Sweating Burns Fever Diarrhea Doctors (Iatrogenic) Disease Pneumonia → Hyperventilation Sickle cell Diabetes Insipidus Central DI → ↓ADH CNS disorder Very high Na → No thirst Nephrogenic DI → ↑ but ineffective ADH Na not very high → Patient is...
Read moreNephrolithiasis
Etiology Ca oxalate Alkaline urine Ca overexcretion ↓Ca intake → Ca in gut will not bind oxalate ⇒ ↑Oxalate absorption Crohn disease → ↑ Oxalate absorption Fat malabsorption Metabolic acidosis/RTA 2 → Remove Ca from bone ↓Citrate → Citrate will not bind to Ca in urine and Ca will deposit ↑Oxalate Struvite...
Read morePCKD
Cyst Complexity Simple cyst → Do NOT aspirate Echo free Smooth, thin wall Sharp demarcation No debris inside Complex cyst → Potential cancer → Aspirate Mixed echogenicity Irregular, thick walls Lower density on back wall Debris in cyst Polycystic Kidney Disease ADPKD Etiology Familial ADPKD1, ADPKD2 gene Presents >30y Presentation Pain Hematuria...
Read moreTTP/HUS
TTP/HUS Etiology ↓ Metalloproteinase ADAMTS 13 ADAMTS 13 is vWF-cleaving enzyme ⇒ Large vWF multimers PLT mictothrombi → Block off small vessels → End-organ damage TTP → Adults Hereditary HIV Cancer SLE Drugs Cyclosporine Ticlopidine Clopidogrel HUS → Children E. coli 157:H7 Shigella Presentation ↓PLT Intravascular hemolysis → Most important, Always present Microangiopathic hemolytic anemia...
Read moreCKD/ESRD
CKD = GFR <60 for >3m Kidney damage DM Hypertension Glomerulonephritis PCKD ESRD = Uremia (GFR <30) Etiology Leading cause → DM → Basement membrane thickened, Mesengial expansion, fibrosis HTN → Nephrosclerosis, Glomerulosclerosis Tubular damage Glomerular damage RPGN Presentation Uremia Anorexia N/V Uremic frost → Urea crystals on face Indications for Dialysis...
Read moreAnalgesic Nephropathy
Etiology NSAIDs Presentation ATN AIN Membranous glomerulopathy Vascular insufficiency NSAIDs inhibit prostaglandins → Constrict afferent artriole Papillary necrosis Papillary Necrosis Etiology Sloughing off renal papillae NSAIDs Sudden vascular insufficiency Presentation Sudden flank pain Fever Hematuria Extra NSAIDs in the setting of Sickle cell Diabetes Urinary obstruction Chronic pyelonephritis Diagnosis Best...
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