70 yr old male admitted with hx of recurrent heart failure and metabolic deraangements, has peripheral edema and metabolic alkalosis
- what drug?
- carbonic anhydrase inhibitor
50 yr old buisnessman with hx of frequent episodes of renal colic w/ Ca containing stones. Work up shows high concentration of calcium salts in urine.
What diuretuc would be used?
- thiazide
6o yr old businessman with advanced prostate cancer is admitted to the ED with mental obtundation. Electrolyte panel shows high serum calcium.
What diuretic?
- Loop and thiazide
Describe method of reducing urine vol in pt with nephrogenic diabetes.
desmopressin- ADH agonist
Describe a method for increasing water excretion in syndrome of inappropriate antiduretic hormone secretion
vasopressin/ADH inhibitor
70 y/o female in the ICU for renal failure following recent hospitalization for MI. She has a past medical hx of type 2 DM and mild HTN> On examination shhe is lethargic, confused and with mild lower extremity edema.
- what are potential mechanisms of acute renal failure?
- Prerenal: due to decreased blood flow to kidneys (hypoperfusion) from heart failure
- Intrarenal: shift/progression from prerenal etiology
- Postrenal: due to obstruction of urinary tract downstream from kidney
Explain the significance of protein and glucose in the urine.
- 2 different mechanisms
- underlying damage –> increase glucose in urine from oversaturated transporters
- most likely due to DM (underlying diabetic nephropathy)
proteinuria = glomerular damage, possibly podocytes
What is the cause of epithelial and pigmented casts in the urine?
- myoglobin or hemoglobin; blood from nearby vessels
- most of the time we will see casts from the epithelial cells sloughing from tubules into urine, especially from acute tubular necrosis
How do you calculate FENa
((urine Na x plasma Cr) / (plasma Na x urine Cr)) x 100
What is the difference in pH and HCO3 in acute vs chronic respiratory acidosis
- pH and HCO3 is lower in acute
- HCO3 is higher in chronic acidosis because there has been time for compensation
two roles of the sacrum
support and reproduction
what part of sacrum carries greatest load during normal walking
base
How does SI joint change during pregnancy, especially when near full term?
looses, widens laterally, sacrum rotates slightly so that the coccyx clears the vault
