Pearls from Dr. Anjali Ganda
NSAID-related renal dysfunction: AIN, ATN, papillary necrosis, nephrotic syndrome (minimal change disease and membranous nephropathy)
Posted 05/29/16 03:25:44 PM by Matthew Cummings
CKD vs AKI?
- CKD: Anemia, 2⁰ hyperparathyroidism, small, echogenic kidneys on US, acidosis (↑AG from impaired anion excretion/fewer functioning nephrons, normal AG related to impaired H+ excretion/tubular damage)
Posted 05/29/16 03:26:18 PM by Matthew Cummings
AMS and ↑osmolar gap (measured – calculated osms)? Think ME DIE: Methandol, Ethylene glycol, Diuretics (mannitol), Isopropyl alcohol, Ethanol (and ketones)
- Ethylene glycol: can result in spuriously high lactate (lactate structurally similar to glycolic acid so look for other clues --> hypocalcemia and Ca oxalate crystals in urine)
- Indications for fomepizole (ADH inhibitor)? Suspected toxic alcohol ingestion and 2/4: Osm gap >10, pH<7.3, HCO3<20, Urinary Ca oxalate crystals
Posted 05/29/16 03:26:54 PM by Matthew Cummings
Metformin often one among many potential causes of lactic acidosis, but is more likely in patients with: Hx of taking metformin, lactate>15, AG>20, severe metabolic acidosis (pH<7.10, HCO3<10), renal insufficiency (Cr>2), and more common in patients with underlying CHF, cirrhosis, CKD
- Add metformin toxicity to differential of sepsis, mesenteric ischemic, respiratory failure
- Early dialysis in these patients – remove the drug and correct severe acidosis
Posted 05/29/16 03:27:31 PM by Matthew Cummings
For further reading...
Posted 05/29/16 03:31:19 PM by Matthew Cummings
NSAIDs Inhibit prostaglandin release (prostaglandins dilate the Afferent arteriole). Can cause:
- ATN (especially with volume depletion)
- Papillary Necrosis
- Membranous/Minimal Change
Posted 10/06/16 10:56:13 AM by Adam Faye
Nephritic: Injury/Inflammation of glomeruli which allows proteins, erythrocytes and leukocytes to pass through. Typical triad:
- Hypertension (abnormal bp regulation)
- Red Cell Casts
Posted 10/06/16 10:59:22 AM by Adam Faye
Glomerulonephritis Low Complement:
If normal complement GN
- Systemic - HSP, ANCA, Goodpasture's, vasculitis
- Renal only- Post-infectious GN, MPGN
Posted 10/06/16 11:05:44 AM by Adam Faye
Acidosis in Renal Failure:
- Non-Gap: Ammoniagenesis is impaired
- Gap: Result of sulfate/phosphate buildup
Posted 10/06/16 11:06:43 AM by Adam Faye
- Major cause of death is increased CV risk
- BP control is protective
- Data shows BP at HD is poor predictor of prognosis. Better to use home BP recordings
- Lipid data has been conflicting - this cochrane review showed little to no benefit in CV events
Posted 10/06/16 11:27:32 AM by Adam Faye
To help determine if someone has CKD vs. AKI look at comorbidities, prior history of anemia and Phos/Ca for signs of renal osteodystrophy
Posted 05/18/17 12:48:32 PM by Emily Miller
When looking at a Renal Ultrasound: Small, shrunken kidneys are often seen in CKD. In CKD can find large kidneys with amyloid, DM, PCKD and HIVAN. Can see large kidneys acutely with AIN.
Posted 05/18/17 12:49:48 PM by Emily Miller
For patients with decompensated heart failure w/ RV dysfunction and possible cardiorenal syndrome, be cautious with Lasix dose as these patients tend to be very preload dependent. Too much lasix can lead to a dangerous drop in blood pressure.
Posted 05/18/17 12:50:52 PM by Emily Miller
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