Nephritic syndrome

Presentation- Oliguria, hematuria,  HTN, AKI *PSGN, lupus, croglobulinemia, HSP C3↓, Ig A C3 normal 1.Post-streptoccal glomerulonephritis (PSGN) Prevalence- 2~6 y/o Etiology- 14 days after Group A streptococcus infection Lab 1.Normal C4, C3↓ & C50↓(first 2 wks), 1~2 months recover 2.ASO, anti-DNase B, anti-NAD, and AHase elevated→ after pharyngeal infection(1~3 wks) 3.Anti-DNase B and AHase elevated→ […]

Nephrotic syndrome

Criteria- Serum albumin<2.5, Proteinuria>3.5g, cholesterol>200, edema Primary MCD, FSGS, MGN, MPGN Secondary Diabetic, amyloidosis, cryoglobulinemia, Lupus Treatment- ACEi, ARB, Na restriction, diuresis Complication- Thrombosis, infection 1.Minimal change disease (MCD) Forward- Children most common Etiology- Insect bites, NSAID, Rifampin, Hodgkin disease, Interferon, HIV Pathology- Podocyte disappear, epithelial cells foot process effacement, heparan sulfate proteoglycan 喪失 Treatment- […]

Acute kidney injury, AKI

RIFLE classification KDIGO 2012 AKI guideline Diagnostic criteria(required only one) 1.SCr ↑>0.3 within 48hrs 2.SCr ↑1.5 fold within 7 days 3.Urine volume< 0.5 ml/kg/hr for 6 hrs AKI type Prerenal Etiology- Sepsis, hypotension, diarrhea, vomiting, hemorrhage, burn, 3rd space, renal stenosis, heart failure, cyclosporin, ACEi, NSAID, hepatorenal syndrome Renal 1.Glomerular Etiology- RPGN Presentation- Edema Lab-  […]

Hypercalcemia

Presentation- Renal stone, bone, abdominal moans, psychiatric overtones ECG→ Shortened QT, prolong PR, prolong QRS, high QRS, T wave flat Etiology Treatment 1.Asymptomatic- IV fluid, mobilization 2.Symptomatic- IV fluid, lasix, calcitonin 3.Malignancy- Adding bisphosphonate 4.Vit D intoxication, granuloma- glucocorticoid 5.Recurrence- EDTA(10~50mg/kg IVD 4hrs), dialysis

Hypocalcemia

Forward- PH ↑ free calcium ↓ , albumin ↑ 1g/dL→ total calcium ↑ 0.8mg/dL(free calcium ↓ ) Corrected Ca = [0.8 x (normal albumin – patient’s albumin)] + serum Ca level Presentation- Carpopedal spasm, tetanus, Chvostek’s sign, Trousseau sign, bradycardia ECG→ QT prolong, T wave inversion , QT prolong Etiology Treatment 1.If seizure→ 10% calcium […]