10 articles Nephrology

Minimal Change Disease

Minimal Change Disease: Causes nephrotic syndrome (non-diabetic): Childhood: 70%-90% Adult: 10-15% Clinical features: Age > 45, sudden onset of symptoms, HTN (some) Explosive-onset (days) of nephrotic syndrome (unlike other forms of nephrotic syndrome that progress over years) Bilateral 3+ edema, 4+ proteinuria, low albumin, elevated cholesterol ***Occurs shortly after URI*** Lack of RBCs or casts…

Rhabdomyolysis

Rhabdomyolysis: Admit to the ICU!!! Tx: ***IV fluid rehydration!!! (give a significant amount of fluid) – start immediately, high volume! After hydration is achieved, then start alkalization of urine (want pH +6): IV Bicarbonate. CPK level: Very elevated! Measurement of myositis (muscle break down) (Ex: +10,000) UA: “very bloody” but NO RBCs (not blood but…

Obstructive uropathy

Obstructive uropathy: stone blocking ureter, N/V, sharp 10/10 intensity abdominal pain (diffuse tenderness but worse on 1 side), CVA tenderness (worse on 1 side) that radiate to groin on same side), dizzy, drowsy, disoriented, weak, fever, chills, diarrhea Admit to ICU Consult Urology (Dr. Rogers, Dr. Todd Olsen, Dr. Beird?) for obstructive uropathy – may…

Renal Failure – ESRD

End-Stage Renal Disease (ESRD): Dialysis (note patient’s regular dialysis schedule, consult Nephrology to set this up in house while inpatient: Dr. Tran, Dr. O’Neil, Dr. Moore). Lidocaine/Prilocaine 2.5%/2.5% (Emla 2.5% cream): apply topically over the A-V Fistula site 1 hr prior to each dialysis round Hibiclens wash night before Ash Cath placement for initiation of…

Kidney Stone

Pain from kidney stone passing: (Nephrolithiasis) Acute onset of flank pain radiating to the groin combined with hematuria is highly indicative of nephrolithiasis. Order UA – look for blood. NSAIDs (Ibuprofen) are more effective and better tolerated than opiates for pain control. Toradol (Ketorolac) 10-30mg IV/IM X 1 dose (acutely in the ER) Morphine 2mg…