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