Wednesday Lectures, 2/11/2015

TTHM 9.1 (2/11/15) Kidney Day (Tint. Ch. 91~98, 128)

10a ~ AKI & Renal Dysfunction (Prince)

Prerenal, Intrinsic, PostRenal

Community Acquired (mostly prerenal, dehydration, sepsis)

Hospital Acquired (mostly intrinsic, AKI, meds)

Know the pt’s Potassium, BUN/Cr Ratio (>15 or 20 suggests prerenal), fluid status, Toxic drug levels, consider GFR (esp for contrast studies); Urine Na (FeNa) may be useful for hypovolemia mechanism… EKG!

Digoxin Toxicity: DigiBind & Dialysis…

Foley in? Nephrology Consult?

Rhabdo: IVF.

Emergent Dialysis: Lithium, ASA, Methanol, EtGlycol, Theophylline, Uremic Pericarditis, Refractory Hyperkalemia.

Contrast Induced Nephropathy ~ often have significant comorbid Dsx… (MRI GFR needs >30) (CT recommendation GFR > 60 & IVF bolus)

Don’t give Demerol to CKD, stays around forever!

ESRD pts have 6x higher CVA, 10x higher SDH, 10to30x higher CAD!

 

1030a ~ Urolithiasis & Renal Colic (LaVoie)

Pain Control (Toradol, Opioids), Nausea Control (Zofran), Single dose NSAIDS are safe despite AKI, US to r/o hydronephrosis, UA to r/o concurrent infxn!

IVF ~ help or harm? …Cochrane 2009 says nbd either way.  Manage pt’s volume status.

Keep in mind DDx: Infection/Pyelo/Divertic/Appy, Ao Dissection, Mesenteric/Renal Ischemia, Ectopic/Gyn!

*AAA commonly misdiagnosed as renal colic! (Nearly 20%!) Most will have hematuria!

STONE score 2014: attempting to exclude 2* diagnosis via clinical decision rule, misses 0.3 to 3%…

Hematuria absent in up to 25% of Urolithiasis.

Is imaging standard of care?  “1st time stone” guideline useful c Dx uncertainty…

& useful c suspicion for proximal infection (r/o hydronephrosis)

CT most sensitive, possibly consider

 

11a ~ Small Groups (Prasad & Paolo)

12p ~ Holy Cow (Rossettie, Schenker, Joslin)

1230 ~ Jr/Sr (Cantor, Lavoie)

130p ~ Nephrotic Syndrome (Cantor)

2p ~ UTI (MacConaghy)

230p ~ Dialysis (Prasad)

3p ~ Male GU (Mann)

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