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Renal Tx


Metabolic alkalosis: Tx: Chloride-responsive: correct ECF volume deficit with isotonic saline; d/c diuretics; add H2 blocker or PPI; IV acetazolamide if CV or pulmo dz
Metabolic alkalosis: Tx: Chloride-resistant: surgical resection of mineralcorticoid-producing tumor (?adrenal adenoma); ACEI or spironolactone to block aldosterone effect
Metab acidosis Tx IV bicarb if pH<7.1 and hemo unstable; tx underlying disorder
Glomerulonephritis Tx cyclophosphamide & prednisone for inflammatory response (less nec in PSGN); salt/fluid restriction; HD if azotemia; ACEI
CKD tx ACEI, ARB; ctrl comorbids (LDL <100, A1c <7.5, BP <130/80); EPO/Fe prn
nephrotic syndrome tx ACEI, judicious diuretics, Na/fluid restriction; aggressive infxn tx; anticoag prn
renal stone tx: <5 mm: fluids; strain urine for stone; analgesics prn; poss alpha or CCB
renal stone tx: 5-10 mm: fluids, analgesics; ESWL or ureteroscopy w/basket extraction
renal stone tx: >10 mm: inpt mgmt if unable to maintain oral intake; hydration; Gold Std: perc nephrostomy; or ureteral stent; ESWL or (>2 cm) perc lithotomy
hypernatremia tx Na >145; tx as inpt; Tx hypovolemia first (isotonic saline), hyponatremia second (oral free water or IV D5W)
hypernatremia: if Na >200: HD
Hyponatremia tx Tx hypovolemia as inpt; tx underlying cause (euvolemic/ hypervolemic: fluid restriction)
Too rapid correction of hyponatremia can cause central pontine myelinolysis => neuro damage
severe hypovolemic hyponatremia (<120) tx cautious use of hypertonic saline
hyperkalemia tx severe high K+ then underlying dz; dc K-sparing meds; IV Ca gluconate; bicarb, D50, Ca CO3, IV insulin; kayexalate
hyperphosphatemia tx if 2/2 CKD: PO4 restriction + oral PO4 binders; oral CaCO3
hypermagnesemia tx 10-20 mL IV Ca gluconate in 10 min; furosemide
bladder ca: tx: superficial lesion: endoscopic resection & fulguration, f/u cystoscopy q3 mo; poss adjuvant thiotepa, mitomycin-C, or BCG
bladder ca: tx: recurrent dz or diffuse TCC: radical cystectomy
Renal cell ca tx radical nephrectomy for local dz; palliative XRT for dissem dz (brain, bone, lungs); poss alpha interferon & interleukin
Renal cell ca: ineffective treatments neoadjuvant xrt for early dz; radical nephrectomy in advanced dz; hormonal/CT
Wilms tumor tx multimodal: surgery (radical nephrectomy), CT (dactinomycin, vincristine, doxorubicin), poss xrt
HUS tx Abx after sx onset may decrease duration; Cipro or rifaximin
loop diuretics: site of action loop of henle
Thiazide diuretics: site of action Proximal distal renal tubule
K-sparing diuretics / Aldosterone antagonists: site of action Distal renal tubule & collecting duct
Carbonic anhydrase inhibitors: site of action Proximal renal tubule
Created by: Adam Barnard Adam Barnard