IgANephropathy:MCCofGNinadults 13daysafteranUPTI Recurrentepisodesofgrosshematuria Serumcompliment:NORMAL

PoststreptococcalGN: 13wksafterpharyngitis(10days)andImpetigo(21days)

CRF:(knowallthefactorsthatdelaytheprogressionofdisease) Factorsimprovingprognosis: Aceinhibitors(canworsenRFifCr>33.5mg/dl) Proteinrestriction(readcloselyESRDinKaplan)

Endstagerenaldisease: Normochromicnormocyticanemiad/tEPdeficiency. Allpts.withCRFandHct<30%(Hb<10g/dl)RecombinantEPtherapyAFTERIrondeficiency hasbeenruledout.

S/EofEPtherapy: WorsensHTN(Intravenous:2050%ptswillhavea10mmhgriseinDBP,S/Croute:lessrisein BP)MayevenleadtoHTNencephalopathyd/trapidincreaseinBP

Tx: Fluidremoval(Dialysis) AntiHTNdrugs(bblockersandVasodilators)

Prevention: SlowlyraisetheHctwithagoalhctof3035% Headaches(15%pts.) Flulikesyndrome:(5%pts)LesscommonwithS/CEP,TxwithNSAIDs Redcellaplasia:rare

Options: 1.Transplant: Bettersurvivalandqualityoflife RelateddonorlivingnonrelatedlivingDead 5yrsurvival:88%

Postopcx: PresentsasOliguria,HTN,azotemia Acuterejection(grafttenderness,biopsyheavylymphocyticinfiltrateandvascular involvementTx:IVsteroids) Cyclosporinetoxicity Ureteralobstruction Vascularobstruction ATN

Dx:Inordertoconductad/d RenalUSG MRI Biopsy Radioisotopescanning

2.Dialysis: Aut.Neuropathypersistsorworsensindiabetics Anemia,bonediseaseandHTNpersist. 5yrsurvival:DM20%,NonDM3040%

Renalarterystenosis: Headache HTN Renalbruit

Fibromusculardysplasiayoungadults Atherosclerosiselderly TxforbothAngioplastywithstenting LOWERURINARYSYSTEM: Irritativevoidingsymptoms: Frequency Urgency Dysuria Suprapubicorperinealdiscomfort

Obstructivesymptoms:

Hesitancy Weakstream Nocturia Dribbling Postvoidresidual>50cc Senseofincompleteemptying

Hematuria: Initial(streambeginsred) urethraldamage Terminal(streamendsred) BladderorProstaticdamage Totalhematuria Kidneyorureterdamage Prostatodynia:NohxofUTIbutvoidingabnormalitiespresent s/s: Dx: UANormal ExpressedprostaticsecretionsNormalnumberofWBCs. Cultureive Afebrile Irritativevoidingsymptoms

Nonbacterialprostatitis:(Maybecausedbymycoplasmaorureaplasma) Dx: UANormal Expressedprostaticsecretions>10wbcs/HPF Cultureive Afebrile Irritativevoidings/s

D/D:RuleoutbladderCAinanelderlypt.presentingwiththispicture. Tx:Oralerythromycin(Macrolideformycoandureaplasma) Acutebacterialprostatitis: Causativeorganisms: YoungChlamydia,Gonorrhea

 S/S:

ElderlyE.coli

Febrile Irritativevoidings/s DREVerytenderprostate

Dx:(obtainmidstreamurinesample) Cx: Abscess Septicemia UANormal Expressedprostaticsecretions>10wbcs/HPF(pyuria) DogramstainandCulture(+ive)

Tx:I/Vantibiotics(hospitalizationrequiredb/coffearedCx) Chronicbacterialprostatitis: Dx: UANormal Expressedprostaticsecretions>10wbcs/HPF Culture+ive Afebrile Irritativevoidings/s DRENormalorinduratedprostate

BPH:(Startsinthecenter,ProstateCAstartsintheperiphery) Dx: Mostpts.areASYMPTOMATICwithanenlargedprostateonDRE Irritativeandobstructivevoidingsymptoms Usuallynohematuria,suprapubicpainandsystemicfeatures. Elderlypt.withARFandobstructivevoidingsymptomsFIRSTstepinMxFoleycatheter. InchronicsevereBPH,foleycathwontpassd/thypertrophyLASTresort:suprapubiccath. Pt.mayneedtovalsalvainordertopee(generatingenoughintraabdominalpressure)Maynot beabletodoitifinseverepain. Allpts.withirritativeandobstructivesymptomsDoUA(rulesoutUTI)andCrIfCrraised DoUSGofKUB MildBPHwillnotcauserenalinsuffiencyunlesscompletebladderoutletobstructionispresent.

 Mx:

DREenlarged,firmprostate PostvoidurinesampleIncreasedvol. AlwaysdoUAandSerumcreatininefirsttoruleoutothercauses. CystoscopyVisualizesthebladderobstructiondonewheninvasivetxbeingconsidered(before surgery) Cystometrogramseebelow USGandIVPwhenCxBPHORcoexistentUTI SerumPSAisonlyoptional(PSAplusDREincreasestheprob.TodetectprostateCA)

Mildsymptomswatchfulwaiting Moderatesymptoms:

Finasteride(actsonepithelialcomponents)or Alphablockers(initialTOC,actsonthesmoothmusclesofprostateandbladderbase) SeveresymptomsTURPIffailsdoCYSTOMETROGRAM(alsodonewhenneurologiccauseis beingconsidered)

BladderCA: Riskfactors: S/S: Hematuria Irritativeandobstructives/s Suprapubicpain(advancedCAPerivesicalnervesinvolvedorincreasedoutletobstruction) SystemicfeaturesMets Chronicanalgesicuse Cigarettesmoking

Acutecystitis:(MCroute:ascendinginfection) Mech:UTisgenerallysterileexceptfordistalendofurethraandmeatus.Still,nocolonizationwith gramivebacilliunless: Poorhygiene Contraceptives Genitalinfections Alterationofthenormalflorawithantibiotics

Oncethishascolonized,anyfactorcancausetheascentofbacteriaupintotheUTsuchasurethral massageduringintercourse.

UncomplicatedcystitiscanbeMxwithfindingsonlyonUAnoneedforculturestartoralTMP SMXIfpt.allergicOralciproorNitrofurantoin Urineculturecolonies>1000/ml(Pyelonephritis>10,000/ml)

Urethritis: ChlamydiaMUCOpurulentdischarge,culture<100colonies/mlmeaningcultureNEGATIVE GonorrheaPurulentdischarge,Gram+ive Detrusorinstability: Causesurgeincontinence(Spontaneouscontractionsofbladderunresponsivetocorticalinhibition) Hypertonicbladder: Constanturinedribbling(Bladderhypertonic,urethralsphincterhypotonic) Postvoidurinevol.?

Atonic/acontractilebladder: Causes: s/s: Tx: Intermittentcath. Cholinergicsbethanecol Avoidalcoholanddotightglycemiccontrol(onlyifDM) OverflowincontinenceConstanturinedribbling Postvoidurinehighvol. Diabeticautonomicneuropathy MS Anestheticblocks Anticholinergics Caudaequinesyndrome Antipsychotics H1antihistaminics(doxepin,hydroxyzine,diphen.,chlor.) TCAs Sedatives

Stressincontinence: Pelvicfloorweaknessinwomen

Afterradicalortransurethralprostatectomyinmen PostvoidurineNORMAL

Detrusorsphicterdyssynergia: Occursd/tneurologicalproblem. Bothdetrusorandsphinctercontractcausingdifficultyininitiatingurinationandinterruptionof thestream.

Urinaryfistula: Hxofpelvicsurgeryorirradiation Constanturineleakingthroughfistula DxIVP

Acuteepididymitis: s/s: Fever Painfulenlargementoftestes Irritativevoidingsymptoms

*Sexuallytransmitted(chlamydiaandgonorrhea)Adultsepididymitis+urethritis(painatthetipof penisandurethraldischarge) *Nonsexuallytransmitted(E.coli,pseudomonas)Elderlyepididymitis+UTI ObstructiveUropathy:(postrenalazotemia)mightbed/tstonescausingunilateralobstruction, s/s: Flankpain Lowvol.voids(oliguria)withorwithoutoccasionalhighvol.voids(obstructionisbeingovercome byalargevol.ofretainedurine) Azotemia(pressureatrophyanddecreasedGFR)

*Voidingcystourethrogram donewhenpthasrecoveredfrominfectionandyouneedtolookfor somestructuralabnormalitiesintheurinarytract(morecommoninchildren) DRUGS: NSAIDs,ACE,diureticsblunttherenalresponsetolowintravascularvol.(wouldpredisposetopre renalazotemiainasusceptibleelderlyperson) Rifampin:

DiscolorsALLbodilysecretions Discolorssoftcontactlenses

Acycloviranacuteriseincreatinine I/Vdrugcausescrystallinenephropathy(tubularobstructionanddamage)in510%pts.usually indehydration Txandprevention:Hydrationanddoseadjustment(slowingI/Vinfusion)

Vancomycin:Nephrotoxicinhighdoses Azithromycin:Givenin Comm.acquiredpneumonia Sinusinfections Strep.pharyngitis Chlamydia

Cyclosporine:(InhibitstranscriptionofIL2andothercytokinesmainlythehelperTcells) S/E:HyperMING Hypertension: seenin1stfewwksoftherapy DOCCCBs

Malignancy:increasedriskof SCCifskin Lymphoproliferativediseases

Infections Neurotoxicity:Oftenreversible Headache Visaualdisturbances Tremors Seizure Mutismetc

Nephrotoxicity:MCandseriousS/E Reversible:Acuteazotemia Irreversible:progressiverenaldisease Hyperuricemia,hyperkalimia,hypophosphatemia,hypomagnesemia

HUSmayoccurrarely

Gingivalhypertrophyandhirsuitism Glucoseintolerance:Concommitantuseofpresdnisonesignificanthyperglycemia GImanifestations: Anorexia NVD

TACROLIMUS: SameMOAandS/Eascyclosporine NOgingivalhypertrophyandhirsuitism MOREneurotoxicity,GIs/s,glu.Intolerance

AZATHIOPRINE:metabolizedto6MP(inhibitorofpurinepathway) Doserelateddiarrhea Leukopenia Hepatotoxicity

MYCOPHENOLATE:InhibitorofIMPDHinhibitingpurinepathway Myelosuppression

KAYEXALATESodiumpolystyrenesulfonate METFORMINcase:Pt.withprerenalazotemianeedstostopmetforminifhesalreadytakingitb/c lacticacidosisispotentiatedbyrenalfailure.Pt.hadhighHb(17g/dld/trelativepolycythemiain dehydration) LONGACTINGHYPOGLYCEMICSe.gGLYBURIDEusedwithcautioninRFptsb/ctheycanaccumulate andcausehypoglycemia(shorteractinglikeglipizidecanbeusedsafelyastheyareprimarilymet.By liver) MCCofnephroticsyndromeinhodgkinslymphomaisMinimalchangedisease. Ingeneral:Membranousnephropathyisassoc.withothermalignancies(lung,breast,stomach, colon,nonhodgkins) Uremiccoagulopathy: MajoruremictoxicinvolvedGuanidinosuccinicacid(Defectinplateletvesselandplateletplatelet adhesion) Nowadays,onlypresentsasepistaxisandecchymosesb/cofdialysis.

Majorbleedingoccursinthosenotondialysis.

Labs:aPTT,PTT,TTgenerallynormal BTisusuallyprolonged. Plateletcountnormal(TheresplateletDYSFUNCTIONnotthrombocytopenia,thatswhyaplatelet transfusionwontdob/ctheyquicklywillbecomeinactivatedbythetoxins) Tx: DDVP(TOC) CanalsogiveCryopptandestrogenconjugates.

Dialysis: MCCofdeathinapt.withdialysisCardiac(60%dieofsuddencardiacdeath,20%acuteMI) ApartfrommanyriskfactorsforcardiacdiseaseIncreasedhomocysteinelevelsinESRDand DialysisandInhibitionofNOcausesvasoconstrictionsandHTN Withdrawalfromdialysisaccountsforonly20%deathsinadialysispt.

Youngblackmalewithisolatedpainlesshematuriathatresolvesrapidly.(d/tpapillaryischemia sickledcellsd/thypoxia) RenalcellCA: s/s: Mostlyasymptomatic Hematuria40%pts. Fever,nightsweats,anorexia,wt.lss20%pts. Classictriad:Flankpain,hematuria,palpableabd.Massstronglysuggests metastatic/advanceddisease)Onlyin10%pts. Scrotalvaricocele(majorityonleft)<10%ptsDontemptywhenptrecumbent.

Lab:Polycythemiaandthrombocytosis Dx:CTabdomen(TOC) Cystinuria: s/s: Recurrentstonessincechildhood PositivefamilyHx. Defectivetransportofcystine,lysine,arginine,ornithinebytherenaltubularbrushborder. Cysteineformshard,radioopaquestones

Dx: UAtypicalhexagonalcrystals Urinarycyanidenitroprussidetest(candetectelevatedcysteinelevels)+ive.Itisalsoawidely usedscreeningtest.

Hyperkalimia: Amongothercauses,canbeapseudohyperkalimialabsamplecanbecomehemolysedduring venipuncture. Drugscausing:NSAIDs,ACE,K+sparingdiuretics(spirono,amiloride,triamtrene) EKGchanges:PeakedtwavesProlongedPRintervalandQRSdurationEventuallossofP wavesprogressivewideningoftheQRSandmergingwiththeTwaveproducesaSINEWAVE patternprogressestoV.fiborasystole.

Extensiveevidenceofhyperkalemia,notelossofPwavevoltage,anddramaticincreaseinwidthof QRScomplex Tx:Dependsonthedegreeofhyperkalimia ImmediateTxif:

 Give:

EKGchanges Muscleparalysis K+>6.5

10%Calciumgluconateforheart(stabilizinfmyocardialmemb.) IVdextrose+Insulinand/orB2agonists/NaHCO3fortranscellularshift Givediuretics(loopandthiazides)andcationexchangeresins(kayexalate)onlyifrenalfunction ok. DialysisRenalfailurept.orlifethreateninghyperkalimia.

Pt.withrenalcolic: Xrayabdomenpelvisifnostonesseenconsiderfollowingpossibilities: Uricacidstones(radiolucent) Calciumstones<13mm Nonstonecause(e.g.Obstructionbyabloodclotortumor)

Generalguidelinesforstones: Recurrentrenalstones:Do24hrurinecollectionforcalcium,citrate,urate,oxalate,sodiumand pHlevels) Hydration>2L/day PainMx:Narcotics(mayexacerbatenausea,vomiting)andNSAIDs(onlypreferredinthosewith normalrenalfunction)

Uricacidstones: Dx:USGorCTwithoutcontrast(TOC) Tx: Hydration(>2L/day) Alkalinizationofurine(sodiumbicarborsodiumcitrate) Lowpurinedietwith/withoutallopurinol

Calciumoxalatestones: Mx:(Inorderofrelativeimportance) 1 2 3 4 5 Hydration>3L/day Normalorincreasedcalciumdiet(RDA1000mg/dL) Na+restriction(<100mEq/dL) Oxalaterestriction(chocolate,vitC) Decreasedproteinintake

*IfapersononHCTZdevelopsrecurrentcalciumstonesCheckurinesodiumlevels(toseeifpt. iscompliantwiththesodiumrestricteddietb/csaodiumincreasescalciumexcretionandhence increasingstoneformation) UTI: Evenifdipstickcomesoutnegative(Negativeleukocyteesteraseandnitrites),dourinecultureifpt. presentswiths/slikeUTI Acutepericarditis: MCCviralinfection EKGchanges: DiffuseSTelevationthatistypicallyconcaveup(asopposedtoinacuteMIwherewehaveST elevationinonlyspecificleads) ElevationofPRsegmentinleadaVR DepressionofthePRsegmentinotherlimbleads

MajorityofGNareImmunecomplexmediatedexceptafew: 1 MPGN: TypeII:Densedepositdisease M/S: DenseINTRAmembranousdepositsthatsatinforC3(IgGAbcalledC3nephriticfactordirected againstC3convertaseofthealternativecomplementpathwayleadingtopersistentactivation andkidneydamage 2 CresentericGN: M/S: CellmediatedinjuryTypeIVHSreaction 3 DiffuseproliferativeGN SLE 4 Memb.Nephropathy Hep.Cassociationandpt.increasedforrenalveinthrombosis,pul. Edema 5 Alportssyndrome: M/S: AlternateareasofthickandthincapillaryloopswithGBMsplitting 6 Thinbasementmembranedisease:M/ShematuriaandNOproteinuria M/S:

Markedlythinnedbasementmemb.

Contrastinducednephropathy: MCpresentation:Creatininespikewithin24hrsofcontrastadministrationwithreturntonormal renalfunctionwithin57days. Mechanism:Renalvasoconstrictionandtubulardamage Moreatrisk:DiabeticandChronicrenalinsufficiency(Lookatcreatinine)Trytodo alternativestudysuchasUSGbutifCTisamust,usenonioniccontrastagents.

PREVENTION(allofthefollowingarepreCTi.e.precontrasttreatments) 1 2 3 4 I/VHydration(ISOTONICBICARBONATEistheIVfluidofchoice) Nonioniccontrastagents(lowosmolality) Limittheamountofcontrast NAcetylcysteine(preventsdamaged/titsvasodilatoryandantioxidantproperties)inpts.with borderlineRF. 5 FenoldopamForuseinpts.withborderlineRF 6 DiscontinueNSAIDs(Causerenalvasoconstriction) 7 Prednsione:Onlyinthosewithknownallergytocontrastmaterial(doesntpreventcontrast inducednephropathyONLYtakescareoftheallergicaspect) Priapism:Anypt.presentingwithpriapismcheckhismedications Commoncauses: SicklecelldiseaseandleukemiaChildrenandadolescents Perinealorgenitaltraumaresultsinlacerationofcavernousartery NeurogeniclesionsSCinjury,Caudaequinesynd. DrugsTrazodoneandPrazocin(MCcausativedrug)

AcuteinterstitialNephritis: Commoncausativedrugs: MnemonicCATNAP 1 2 3 4 5 6 Phenytoin Allopurinol Antibiotics(MethicillinMC)cephs,sulfa,rifampicin NSAIDs Thiazides Captopril

s/s: Rash(maculopapular) Arthralgias ARF UA:

*Eosinophiluria *WBCcastsmademostlyofeosinophils *Hematuria *Sterilepyuria TxDiscontinuecausativedrug Medullarycystickidney: s/s: Dx: Mx: Notherapytopreventdiseaseprogression(usuallynoharmfuleffects) Periodicscreeningforstones,UTIandhematuria. Pts.withmedullarycystickidney+hemihypertrophySCREENFORCANCER Renalfailure+systemiceosinophilia: AIN PAN AtheroembolicDisease KUB:Nephrocalcinosis USG:NORMAL(asopposedtoAPKD) IVP:Radiallyarrangedcontrastfilledcysts InitiallyasymptomaticlaterdevelopUTIandstonespresentwithflankpainandhematuria NOrenalfailure NOHTN(asopposedtoAPKD) AdultformAut.Dominant JuvenileformAut.Recessive(Callednephronophthisis)

Hydration:

CrystalloidsNormalsaline,Ringerslactateetc ColloidsAlbuminetcGiveninburnsorhypoproteinemicstates

*Rehydrationtherapyinelderlyptsshouldbeundertakenwithcautionb/cNa+loadingcanunmask Subclinicalheartfailure Atheroembolicdisease:(Cholesterolembolization) Elderlypts.withatheroscleroticdisease Causes: Arterialintervention Anticoagulantsorthrombolytics

S/S:Anyorganexceptlungscanbeinvolved SkinLivedoreticularis,petechiae,gangrene,ulcersandmottlingoftoes. RenalfailureRiseinCr.overseveralwks GIandCNSs/s

Labs: UAeosinophiluria,mildproteinuria,hematuria Normocyticnormochromicanemia Increasedleukocytes IncreasedESR IncreasedCRP Decreasedcomplement

DxTissuebiosyisdefinitive TxConservative(anticoagulationshouldbestoppedasitmaypreventhealingofruptured plaques) Diabeticnephropathy:ACEeffectiveastheyreduceintraglomerularHTN,decreasingglomerular damage. 1 Within1styrofDMGlomerularhyperperfusionandrenalhypertrophywithincreasein GFR(hyperfiltration) 2 First5yrsGBMthickening,Glomerularhypertrophy,mesangialvol.expansionwithGFR returningtonormal. 3 Within510yrsMicroalbuminuriaprogressiontoovernephropathy 4 Seequestion15block2INaadiabeticpt.Diabeticnephropathyfindingspresentafter successfultxofUTI(glomerularbasementmemb.Changes) Hypertensivenephropathy: 1 Nephrosclerosishypertrophyanintimalmedialfibrosisofrenalarterioles

2 GlomerulosclerosisLossofglomerularcap.Surfaceareawithglomerularandperitubular fibrosisM/Shematuriaandproteinuriaoccur Hepatorenalsyndrome: CxofESLDoccurringin10%ptswithcirrhosis. DecreasedGFRintheabsenceofshock,proteinuriaorothercauseofrenaldysfunctiond/trenal vasoconstriction.Resultingd/tdecreasedvasodil.Substances. MCCofdeathInfectionandHemorrhage

TypeIHRSRapidlyprogressive.Pts.diewithin10wkswithouttx. TypeIIHRSSlowlyprogressive.Averagesurvival36months. KidneyBiopsyNORMAL

Tx:LIVERtransplantationistheonlytherapy(mortalitywithdialysisishigh) Acutepyelonephritis: MultiresistantorganismlikegramiverodGiveAminoglycosides(e.g.amikacin) Aminoglycosidesusedlessinelderlyandthosewithrenaldysfunctiond/tneedforconstant monitoring. Chronicallyill,institutionalizedorindwellingbladdercathetersMRSAcancausepylointhese.

CxsepsishencegetbloodandurineculturesBEFOREstartingantibioticsinanyptappearing septic. HypotensiveptaggressivetxwithIVcrystalloids,IVantibiotics,Sxvasopressors. CTandUSGwhenpt.doesntrespondtoantibiotics(within3days)ORwhenDxisindoubt Painlessgrosshematuria: Inadultsconsidermalignancyunlessprovenotherwise Initialpresentingsignin80%ofsuchtumors(kidney,ureterorbladdermalignancy) Assessment: ContrastCTorIVP Cystoscopy(Bladderandurethra)

Falsehematuria: AlwaysconfirmerythrocytesM/Sb/coffaslepositivedipsticktestinginthecaseof: Myoglobinuria Hemoglobinuriaporphyria Aftereatingbeets

RifampinS/E

Isolatedproteinuria:Canoccurd/tanystress Theevaluationofpt.shouldbeginbytestingtheurineonatleast2otheroccasions.

Papillarynecrosis: Causes: Analgesicoveruse(MC) DM Infections UTobstruction Hemoglobinopathies Cirrhosis CHF Shock Hemophilia

Nephriticsyndrome: Apartfromthetypicals/s,alsocauses: Rash Lowgradefevers Proteinuriamaybemildorprofounddependingontheunderlyingetiology

Nephroticsyndrome:(evenifitsa12yroldwithNephrotic,thinkacceleratedatherogenesisb/cof hyperlipidemia) MCD MGN MPGN MesangialproliferativeGN FocalsegmentalGS(NEPHRITICrangeproteinuriawithrapiddevofRF,azotemiaandnormal sizedkidneysoccursevenwhenCD4countsareNORMALinanHIVpatient)

Cxofnephroticsyndrome: *Hypercoagulationd/t: LossofATIII,prCandS Plateletaggregation

Hyperfibrinogenemia(d/tincreasedhepaticsynthesis) Impairedfibrinolysis

Manifestsas: RVT Renalarterythrombosis Pul.embolism

Renalveinthrombosis: s/s: Suddenonsetofabdominalpain Fever Grosshematuria

*proteinmalnutritiom *Ironresistantmicrocyticanemia(transferrinloss) *VitDdef.(Cholecalciferolbindingproteinloss) *Thyroxindecrease(TBGloss) *Increasedinfections Multiplemyeloma:(plasmacellmyeloma,myelomatosis,kahlersdisease) Fatigue Bonepain(esp.backandchest) Normochromicnormocyticanemia(HB<12) Electrophoresis:Monoclonalparaproteinspeak(clonalproliferationoftheplasmacells producingexcessproductionofasingleimmunoglobulintype) Bencejonesproteinurialeadingtorenalinsufficiencyd/tobstructionwithlargelaminated castscontainingparaproteins(mainlyBJP) Hyperuricemia,amyloiddepositionandpyelonephritisMAYoccur

InsolublecrystaldepositionresultinginARF: Hyperuricemia Indinavir Acyclovir Sulfonamide

Rhambdomyolysis: DipstickpositiveforhematuriabutMicroscopynegative Riskfactorsshouldbepresentlikealcoholism(MC),cocaineabuse(directlytoxicto myocytes),crushinjuries,statinuse,metabolicabnormalities,prolongedimmobilization) DisproportionateriseofCREATININEascomparedtoBUN(like3.4to36) Txaggressivehydration.Mannitolandalkalinizationofurinemaybeused

REMEMBER: NormalurineRBCs4orless/HPF NormalurineWBCs10orless/HPF Analgesicnephropathy: MCformofdruginducedCRF Presentation:womanwithchronicheadacheswithpainlesshematuria MCpathologies: Papillarynecrosisd/tpap.Ischemiacausedbyintensevasoc.Ofmedullaryvasarecta Chronictubulointerstitialnephritis(chronicpyelonephritiscanalsocausethis)

Earlymanifestations: Later: Hematuria Renalcolicmayoccurifhematuria(grosswithunchangedRBCs)isprominentandclotsare forming Polyuria Sterilepyuria(WBCcastsmayalsobeseen)

Advanceddisease: HTN Proteinuria(nephroticrangeseeninseverecases

ATN:ProlongedhypotensionfromanycausecanleadtoATN Urineosmolality 300350mosm/L(never<300) UrineNa+ >20mEq/L

FeNa+ >2%(fractionalexcretion)

WBCcasts AINandpyelonephritis Crystals: Uricacidclassicstellateorstarshaped Caoxalateenvelopeshaped Cysteinehexagonal IdiopathicantiGBMantibodymediatedGN: Involveskidneyalone nopul.InvolvementlikeGoodpastures

MicroscopicPolyangiitis: Feverandmalaise Abd.Painandhematuria purpura Glomerulonephritis Pul.Hemorrhage SerologyNormalcomplementbutpositiveANCA

Mixedcryoglobulinemia: PresentsjustlikeHSPexceptfor:

*lowcomplements *NOGIbleedetc *HCVassociation Solitaryrenalcyst:pt.maypresentwiths/sofatotallydifferentdiseasebutwhenulookattheCT KNOWhowthecystlookslikeverycommon.Firstcheckifithas: Thickenedirregularwalls Multilocularmass Thickseptaewithinmass

Contrastenhancement

IfitdoesntreassurepatientandNOfurthertestingwithrepeatCTsetc.