腎臟科Nephrology random notes 01

Nephrology random notes 01

1. Blood cells

- Hgb: RBC can remove NO in blood--> RBC infusion can elevate blood pressure

- Platelet decrease: cause-->drug?, infection? DIC? hematologic disease? autoimmune?

2. UTI

Urine analysis

           - pyuria+bacteriuria + symptoms?

           - no need to treat asymptomatic UTI in women except pregnant women 

           - check renal echo if UTI in men

           - Treatment:

                   *quinolone and Baktar not first line--> 

                    drug resistance carried by plasmids, save these drugs for MDR-TB; 

                   *Ceftriaxone has IM form for those who can not stay in the hospital for IV antibiotics

                   * yeast and candida--> can be viewed as normal colonies

                   * Proteus: may be related to stones

3. Proteinuria

- A/C ratio: DM, HTN patients wound check this.

- P/C ratio: generalized protein loss

4. BUN/Cr↑ (pre-renal azotemia) causes

- Breakdown: GI bleeding (RBC), trauma

- Sepsis

- High protein diet

- Steroid use

BUN↓ : may be related to liver function ↓

5. Oliguria----->AKI?

- Pre-renal: try hydration, but beware of heart, kidney, liver function, allergy

- Post-renal: try Foley tube insertion, DDx: stone, malignancy, BPH

- Renal: drug induced? use lasix

6. Skin turgor evaluation spots

- Axillary region

- Inguinal region

7. Diet and CKD in Taiwan

- Avoid: carambole , kiwi fruit, melons, papayas, brown rice, anchovy, salty soup

8.Shortness of breath

- Hypoxia: A/a gradient abnormal, ex. pulmonary edema(CO2 more soluable than O2)

- CO2 retention with muscle fatigue, ex. asthma, COPD

9. ABG/VBG in SOB patients with CKD

- Do not count anion gap because we still cannot differentiate whether metabolic acidosis is caused by infection or renal diseases

- RTA narrowly defined: RTA with normal Cr.

10.  Dialysis

- lung edema: refractory to diuretics

- pericarditis

-K+↑, EKG change(+), fail medical treatment (Cr high-->protect heeart, may not have EKG abnormality; can double-check K+ level if doubting hemolysis) 

- Uremia

- Intoxication: Ca2+, acylovir,aminophylline ,Benzodiazepam(x), with smaller molecular and less protein binding ability

- Elective: acidosis, anemia

- Uremic encephalopathy diagnosed by rule out, DDx: CVA, stroke, sepsis (BP drop after dialysis!)

High Cr without symptoms: This is a strong person ! XD

11. Spider angioma

- Estrogen↑ --> central arteriole, peripheral capillaries--> on liver cirrhosis 

12. Else

-  Imipenem: may induce seizure

-  Cardiac echo: IVS--> septum thickness, LVPW--> left ventricle thickness, concentric hypertrophy--> HTN related