SAQ 5: Nephrology

45 year old male is brought is with pain abdomen. His urine dipstick suggests 3+ RBCs. His vitals at triage are BP 110/80 mm Hg, pulse = 98/min, SpO2 of 97% on room air.

11)      What are the causes of hematuria other than renal calculi or tumor? (2 points)

22)      N2O:O2 mixture is contraindicated in what conditions? (2 Points)

33)      What are the indications of admission for renal colic? (2 Points)

44)      Define AKI? Give possible causes? (4 points)

HYPERKALEMIA (HARD) & INDICATIONS OF DIALYSIS (AEIOU)

Causes: (HARD)

H     Hemolysis
A     Addisson's Diseases
R     Renal Failure/Rhabdomyolysis
D     Drugs: ARBs/Spironolactone and nephrotoxic agents

In an OSCE, first place the patient on monitored bed, cannulate, and get repeat samples for U & E, Creatinine, Calcium, and venous blood gases. Ask for an EKG to look for tall T waves.

Ask history of any Infections, injuries or renal disease, cardiac symptoms like chest pain/palpitations.

Background medical diseases like HTN, CHF, DM, Multiple myeloma, SLE
Drugs like ACEI, ARBS, Spironolactone, NSAIDS, Aminoglycosides, Amphotericin, recent contrast media imaging.

Treatment:

1. 10 ml of 10% Calcium Gluconate slow IV push
2. 50 ml of 50% Dextrose with 10 Units HAI over 10 minutes
3. Nebulized Salbutamol
4. Kayexalate PO or Enema
5. NaHCO3 can also be used
6. Lastly, HD and ICU care should be recommended for refractory hyperkalemia.

Treat Underlying cause:

Hydrate with IV Fluids

Stop all nephrotoxic drugs

Treat infections with antibiotics

Monitor UO

Note the Indications for Dialysis in Acute Renal Failure: AEIOU

• Acidosis (Metabolic Acidosis with pH < 7.2)
• Electrolyte disturbances: Refractory hyperkalemia
• Ingestions
• Overload (Fluid Overload: CHF)
• Uremia: Pericarditis/Encephalopathy

(Source: Trivedi, 2011)