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?
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)