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| Acute Interstitial Nephritis (AIN) | The presence of AKI + Eosinophilia suggests AIN. AIN is typically an allergic reaction to medications such as penicillins, cephalosporins, sulfa-containing antibiotics and diuretics, NSAIDs, PPIs, etc. About 1/3 of patients with AIN may also present with a rash, fever, eosinophilia, and other constitutional symptoms. | TX: First, Stop the offending drug. |
| Rhabdomyolysis | Elevated CK or Myoglobin, a dipstick positive for blood but negative for RBCs, and a history of muscle trauma suggest rhabdo. **Rhabdo causes AKI. |
TX: -Large infusions of NS IVFs to prevent and treat AKI, which occurs in 10-60% of patients. |
| Tumor Lysis syndrome | Elevated uric acid level + hx of rapidly proliferating tumor or recent chemotherapy suggests TLS and malignancy. | |
| Ethylene glycol poisoning or Methanol poisoning | Pt with AKI, AMS, increased AG and Osmolar gap. | |
| Postreptococcal glomerulonephritis | Elevated antistreptolysin O titer plus history of recent pharyngitis. | |
| Indwelling catheter | Don’t place them or leave them in for managing incontinence, for staff convenience, or for monitoring output in patients who are not critically ill. The IDSA recommends using patient weight to monitor diuresis. Acceptable indications for an indwelling catheter include: -Critical illness; obstruction; hospice care; and perioperatively for <2 days for urologic procedures. |
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| Distinguishing between rhabdo vs. hemolysis | Hemolysis will show darkened, pigmented serum while rhabdo is associated with clear serum. Both of them may show a UA with positive dipstick for blood but no RBCs on microscopic examination. | |
| Glomerulonephritis(GN) | ||
| Pyelonephritis | WBCs in urine, if the dipstick is positive for blood, there will be RBCs on the microscopic exam. | |
| Sevelamer is taken by patients with CKD and hypercalcemia to lower their calcium. How does it work? | By blocking intestinal absorption of phosphate, which lowers PTH secretion. Sevelamer is a phosphate binder. Calcium acetate is also a phosphate binder. | |
| Secondary Hyperparathyroidism | ||
| Preferred opioids for use in patients with ESRD are: | Fentanyl and Methadone. | |
| Prerenal, intrinsic renal, and postrenal causes of AKI | Prerenal causes: V/D, overuse of diuretics can lead to prerenal AKI.
Intrinsic renal causes: GN, AIN, ATN. |
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| When should you acidify urine (with cranberry juice or betaine.)? | Is indicated for the basic stones calcium phosphate and struvite (Magnesium ammonium phosphate). Why? These basic stones tend to form in alkaline urine. Acidifying urine prevents them from forming.
On the other hand, uric acid stones, cystine, and calcium oxalate stones tend to form in acidic urine. So acidifying urine is not indicated. |
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| Microscopic Hematuria workup | -First, assess for benign causes like: UTI, vigorous exercise, menstruation, and recent urologic procedures. If no answers are found, then -Get UA with microscopy to look for casts or dysmorphic blood cells. Also, check for renal function. If no answers, -Do CT urography and cystoscopy. CT evaluates the upper urinary tract for nephrolithiasis and renal cancer, urethral strictures, and prostatic problems. Urine cytology is less sensitive than cystoscopy for bladder cancer. |
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| Asymptomatic Microscopic hematuria (AMH) | AMH is defined as ≥ 3 RBC/HPF on a properly collected urine specimen in the absence of an obvious benign cause. A positive dipstick isn’t diagnostic of AMH but rather means you should get a microscopic examination to confirm or refute AMH. |
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| Urge urinary incontinence | Defined as loss of urine accompanied or preceded by a strong impulse to urinate. May also be accompanied by frequency and nocturia. Common in older adults. | -First line treatment is conservative therapies such as behavioral therapy, including bladder training and lifestyle modification. Drugs should be used as an adjunct to behavioral therapies for refractory urge incontinence. |
| Stress incontinence | May use vaginal inserts such as pessaries to treat. | |
| Metformin in patients with renal impairment | Before, Metformin was contraindicated in patients with Cr > 1.5. In 2016, the FDA came up with new guidelines for using Metformin in patients with renal failure. | |
| Renal artery stenosis | For patients with renal artery stenosis who have good BP control, no testing is necessary other than monitoring renal function, particularly if an ACE inhibitor or ARB is part of the regimen. | |
| Acute uncomplicated Cystitis | Treat based on a patient’s reported symptoms, rather than documented evidence of infection. | |
| Primary monosymptomatic enuresis, the most common type of nocturnal enuresis or Bed Wetting | Use of a bed alarm has the best evidence for long-term success in that they train the child via classical conditioning to awaken at the onset of urination and get to finish voiding in the toilet. If bed-alarms don’t’ work or can’t be used, meds like desmopressin, imipramine, and oxybutynin can be used. Meds may work well when the patient is using them but when they stop, it may recur. Using a reward system for dry nights may help but we are not sure if it’s success surpasses the normal 15% annual resolution rate when nothing is done. |
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