0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

TREATMENT

■ Antibiotics if poststreptococcal etiology

■ Supportive care, control BP

■ Steroids and other immunosuppressives are used to treat underlying sys-

temic disease (when present), but are not indicated in poststreptococcal GN.

ACUTEINTERSTITIALNEPHRITIS

Acute interstitial nephritis results from interstitial inflammation, most com-

monly in response to medication, but is also associated with infections and

autoimmune disease. The most commonly implicated medications include:

■ Penicillins

■ Diuretics

■ Anticoagulants

■ NSAIDs

SYMPTOMS/EXAM

■ Fever and rash may be present.

DIAGNOSIS

■ Elevated BUN/Cr

■ Presence of eosinophils, WBCs, and WBC casts on UA

■ Renal biopsy is definitive.

TREATMENT

■ Discontinue offending agent.

■ Steroids if significant renal impairment

■ Renal function generally returns to baseline over weeks.

ACUTETUBULARNECROSIS

The most common cause of hospital-acquired ARF, this is (generally)

reversible injury to the renal tubule due to:

■ Renal ischemia: Surgery, trauma, sepsis

■ Nephrotoxic agents: Aminoglycosides and radiocontrast agents are most

common offenders.

■ Risk factors for contrast-induced ATN include renal insufficiency,

diabetes, intravascular volume depletion, and higher dose of contrast

material.

■ Pigments:Myoglobin, hemoglobin

DIAGNOSIS

■ Characterized by the loss of urinary concentrating ability

■ UNa>20

■ FENa>2%

■ Urine osmolality = serum osmolality.

■ Urinalysis is positive for granular (muddy brown) casts and renal tubular

casts.