Condition
A 72-year-old man is admitted with confusion and decreased urine output. He was recently treated for pneumonia and has had poor oral intake for the past 4 days. His medications include lisinopril and furosemide.
On exam, he appears dry and hypotensive (BP 88/56 mmHg) with tachycardia. Mucous membranes are dry, and skin turgor is poor. There is no peripheral edema.
Laboratory results:
BUN: 72 mg/dL
Creatinine: 2.8 mg/dL (baseline 1.0)
BUN:Cr ratio >20:1
Urine sodium: <20 mEq/L
FeNa <1%
Pre-renal AKI
What is the general hallmark of an AKI?
Drop in GFR and rise in SCr
MC type of AKI
Pre-renal
UA findings in nephrotic syndrome?
proteinuria >3.5g/24h, oval fat bodies
Tx for acute interstitial nephritis?
stop offending agent, supportive measures (1/3 need dialysis)
consider roids and renal bx if pts refractory after 3-7 days
A 68-year-old man comes to the emergency department with abdominal pain, difficulty urinating, and decreased urine output for the past 2 days. He has a history of benign prostatic hyperplasia (BPH).
On exam, he is hypertensive (BP 162/94 mmHg) and uncomfortable. His bladder is palpable and distended.
Laboratory results:
BUN: 54 mg/dL
Creatinine: 2.9 mg/dL (baseline 1.1)
BUN:Cr ratio ~15:1
FeNa: variable
Urinalysis: bland (no casts)
Post-renal AKI
AKI/ESRD + pericardial friction rub
uremic pericarditis - NEEDS DIALYSIS
MCC of intrinsic AKI
ATN
Lab findings in Goodpasture's syndrome?
anti-GBM antibodies
Tx for ATN?
Tincture of time - treat any underlying electrolyte or volume issues
A 66-year-old man is admitted to the ICU with septic shock from pneumonia. He required aggressive IV fluid resuscitation and broad-spectrum antibiotics. Despite stabilization, he develops progressive oliguria over the next 48 hours.
On exam, his blood pressure is 92/60 mmHg, and he has mild peripheral edema.
Laboratory results:
BUN: 65 mg/dL
Creatinine: 3.5 mg/dL (baseline 1.2)
BUN:Cr ratio ~10–15:1
FeNa: >2%
Urine sodium: >40 mEq/L
Urine osmolality: <350 mOsm/kg
Urinalysis: muddy brown granular casts
ATN - intrinsic AKI
Granular/muddy brown casts on UA
ATN
Drugs - PCN (BL), NSAIDs, PPIs
Lab findings in postinfectious glomerulonephritis?
+ASO titer (if strep)
Tx for Goodpasture's syndrome?
Dialysis common
Plasma exchange
steroids and immunosuppressants
A 45-year-old woman is hospitalized for a urinary tract infection and started on trimethoprim-sulfamethoxazole 10 days ago. She now presents with fever, rash, and new-onset hematuria.
On exam, she has diffuse maculopapular rash and mild flank tenderness.
Laboratory results:
BUN: 46 mg/dL
Creatinine: 2.8 mg/dL (baseline 1.0)
Eosinophilia on CBC
Urinalysis: white blood cell casts, hematuria, eosinophiluria
BUN:Cr ratio ~10–15:1
Acute interstitial nephritis
necrotizing granulomatous lesions in upper respiratory tract, lungs, and kidneys
MCC of post-infectious glomerulonephritis
Strep A - Impetigo
Lab findings for pre-renal AKI
BUN:Cr >20:1
Urine sodium <20 meq/k
FeNa <1%
Indications for dialysis?
AEIOU
Acidosis, electrolyte imbalance, ingestion, overload (volume), uremia
A 23-year-old man presents with cola-colored urine that developed 2 days after a sore throat. He reports no fever or rash. He has had similar self-limited episodes of dark urine after upper respiratory infections in the past.
On exam, his blood pressure is mildly elevated (142/88 mmHg), and there is no peripheral edema.
Laboratory results:
Creatinine: 1.6 mg/dL (baseline 0.9)
Urinalysis: hematuria with red blood cell casts and mild proteinuria
Complement levels: normal
Kidney biopsy: IgA deposits in the mesangium on immunofluorescence
IgA Nephropathy - Bergers disease
Fever, rash, eosinophilia
acute interstitial nephritis
MC presenting complaint of IgA nephropathy
Gross hematuria - coca cola urine
1. >.3mg increase SCr in 48 hours
2. 1.5x baseline Scr in 7 days
3. <.5 mg/kg/hr urine volume for 6 hours
Nephrotic syndrome tx:
1. edema
2. proteinuria
3. hyperlipidemia
1. loop diuretics and Na restriction
2. ACEI/ARB, SGLT2, MRA
3. Statins