NEPHROLOGY

CKD

AMYLOIDOSIS

ACID BASE BALANCE

 post ictal MA: observe and rpt labs
after 2hrs. if still present, look for other causes.

Tx with HCO3 if pH <7.1

INCONTINENCE
Post void residual urine: normal in females (<150ml), normal in males (<50ml)

URGENCY INCONTINENCE (OVERACTIVE BLADDER): tx with antimuscarinics (oxybutynin), timed voiding

OVERFLOW INCONTINENCE (NEUROGENIC BLADDER): dribbling of urine, cholinergic tx: betanechol

High post void residual volume >50mL

LUPUS Nephritis:

HPN nephrosclerosis
ENURESIS

Nonmedical enuresis: first line: desmopressin, bed wetting alarm. If refractory : TCA imipramine
UROLOGY

Commonly idiopathic:

ABNORMAL DETRUSOR OVERACTIVITY: +frequency, urgency, nocturia, incontinence (storage type of

symptom)
URETHRAL diverticulum: usually in females, painful mass in the anterior vaginal wall. + hematuria,
recurrent uti, incontinence

TUMOR LYSIS SYNDROME

RHABDO
RENAL ARTERY STENOSIS  RENOVASCULAR HPN

TX: ACEi/ARBs

– decreases intraglomerular pressure, dilates efferent arterioles

– less likely to develop MI, stroke, ESRD but can cause AKI.
DIABETIC KIDNEY DISEASE

 Hyperfiltration due to dilation of AFFERENT arteriole from chronic hyperglycemia. So,

microalbuminuria develops due to functional and structural changes in the GBM and podocytes.
 KIDNEY INJURY

GLOMERULAR DISEASE is suspected if:

RBC CAST- pathognomonic, proteinuria, HPN, edema, brown tea colored urine

Initial evaluation: C3/C4 LEVELS, CBC, serum albumin. PSAGN (LOW C3)
Tx for this: SUPPORTIVE

MCD: in <10yr old, fatigue, edema, nephrotic change proteinuria, no rbc cast or hematuria

FSGS: form of nephrotic syndrome, no RBC casts. Presentation: hematuria, edema

HUS: +AKI, low C3, hematuria (no RBC cast on urine) + MICROANGIOPATHIC HEMOLYTIC ANEMIA

Urinalysis findings
Acute tubular necrosis/RTA
 TYPE IV RTA: aldosterone controls H and K excretion.  K is high with mild MA, in a setting of
normal kidney function. Usuallly seen in the setting of patients with poorly controlled DM.

NEPHROTIC SYNDROME (RVT CX)

RENAL CYST
SYNDROME
STONES: noncontrast ct scan/UTZ
STRUVITE

UTI:

Leukocyte esterases = pyuria.

Nitrites = E. coli, nitrates to nitrite

In pregnancy, increased progesterone levels causes smooth muscle relaxation and ureteral dilation. 
increased risk for acute pyelonephritis, PTL.

VCUG performed after UTZ to r/o abscess

DRUG INDUCED INTERSTITIAL NEPHRITIS

KIDNEY TRANSPLANT

Acute rejection occurs within the 1st 6 mos, T cell mediated, px is usually asx but may have fever,
decrease UO, or graft tenderness.

 Labs: proteinuria, increased serum creatinine

 Biopsy: lymphocytic infiltration of the intima with inflammatory tubular disruption
 + intimal arteritis
  Tx: reversible, glucocorticoids and increase in dosage of immunosuppression regimen
(tacrolimus, mycophenolate)

BK virus (polyoma) reactivation – similar presentation with acute rejection but biopsy reveals:
intranuclear inclusions. Mixed lympho and neutrophilic infiltrate

Acute toxicity to tacrolimus (calcineurin inhibitor): prerenal AKI (constricted afferent and efferent
arterioles), HPN, u/r biopsy, urinalysis is usually u/r (bland) NO PROTEINURIA

ETHYLENE GLYCOL TOXICITIY : envelope shaped crystals

High osmolal gap (measured – serum osmo; normal <10)

High anion gap (na – (Cl + HCo3) ; normal 10-14

AMITRYPTILINE: causes urinary retention – anticholinergic properties, less detrusor muscle

contraction and less urethral sphincter relaxation

ASPIRIN TOX: causes mixed acid base disturbance. Presentation: fever, tinnitus, tachypnea, GI
s/sx

FIRST GEN ANTIHISTAMINE: anticholinergic property  urinary retention in elderly with mild
BPH
=pre renal injury
 BLADDER CANCER

 CONCLUSION IN BLADDER CA, WALANG KWENTA ANG SCREENING

RENAL CELL CA

 PAINLESS HEMATURIA, FLANK PAIN, ABD MASS, VOIDING SYMPTOMS AND SUPRAPUBIC PAIN IS
UNCOMMON

EXERCISE ASSOCIATED HYPONATREMIA

 Excess water drinking during exercise

UNILATERAL URETERAL LACERATION

 May have normal voiding, normal UA and crea due to normal function of contralateral kidney.
 Large volume of intraperitoneal fluid – causing abd distention and pain.
 Leaks out through the sutured but not healed vagina  watery vaginal discharge
 Dx: CT urography. Tx with surgical repair
BLUNT TRAUMA

 if suspicious for kidney injury, do CT scan of abdomen and pelvis with contrast. Hematuria (gross
or microscopic can be present but can be absent), flank ecchymosis/flank pain
 retrograde urethrogram is for urethral/ureteral. - USUALLY GROSS NOT MICROSCOPIC,
dysuria, and blood at meatus, flank pain (ureteral), high riding prostateami
 Bladder injury: suprapubic pain, gross hematuria
o Dome vs anterior bladder injury: + FAST with Dome (intraperitoneal) vs Ant bladder
(extra), confirm with retrograde cystography
 Do CT scan of the abdomen FIRST then if u/r do retrograde cysto.
 Anterior urethral injuries: IMMEDIATE SURGERY
 Posterior urethral injuries: temporary urinary diversion via suprapubic catheter ff by delayed
repair.
 AN ABSENCE OF HEMATURIA DOES NOT MEAN THERE IS NO INJURY.

PEDIA
4 AND 5: ANTIBIOTIC PROPHYLAXIS

Newborn jaundice with elevated creatinine from a mother with ESRD and SLE.

 Elevated creatinine is part of the sepsis workup, if kidneys are normal but with elevated crea, it
is probably reflective of the mother’s creatinine level from kidney failure. (crea readily crosses
placenta)
 FIRST STEP in evaluation is look for oliguria, edema, HPN. – if present, do renal utz

HUS

 Form of thrombotic microangiopathy

 Causes intrinsic kidney injury
 + urinalysis: blood and protein