ATN vs. AIN

ATN: Acute tubular necrosis leads to ARF. Causes: 1) ischemic: globar ischemia, shock, hemorrhage, sepsis, DIC 2) nephrotoxic: aminoglycosides, radiocontrast, NSAIDs (especially in the setting of CHF), poisons, myoglobinuria, hemoglubinuria, cisplastin, multiple myeloma (kappa and gamma light chains). Dx: elevation of BUN and Cr and decrease in UOP consistant with ARF

AIN: Acute interestitial nephritis inflammation of the glomerular and tubular interestitium. 10% risk of ARF. Causes: acute allergic reaction to medications (e.g. penicillins, NSAIDs, anticoagulants, thiazides, furosemide, phenytoin, sulfa drugs), infection (streptococcus and legionella pneumophilia), CVD (e.g. sarcoidosis). Dx: increased BUN, Cr, eosinophiluria

ESR

Elevated ESR: severe infection, multiple myeloma, Waldenstrom macroglobulinemia, temporal arthritis, polymyalgia rheumatica

Depressed ESR: polycythemia, extreme leukocytosis, sickle cell anemia

Pseudogout

Risk factors: age, osteoarthiritis, hemochromatosis, hyperparathyroidism, hypothyroidism, Bartter's syndrome

Gout Meds

CHRONIC GOUT:
Xanthine oxidase inhibitors (decrease production): allopurinol, oxypurinol, tisopurine, febuxostat, and inositols

Uricosurics (increase secretion): probenecid, benzbromarone and sulfinpyrazone, EDTA

Urate oxidase (breaks down uric acid deposits): pegloticase
ACUTE GOUT:
NSAIDs (antiinflammatory):diclofenac, etoricoxib, indomethacin, ketoprofen, naproxen
Corticosteroids (antiinflammatory): prednisone
Cholchicine (inhibits neutrophils and uric acid deposition)

Acid Base Problems:

pH=bicarb/PCO2
Metabolic Acidosis: Low bicarb, Low pCO2 (compensation)
Metabolic Alkalosis: High bicarb, High pCO2 (compensation)
Respiratory Acidosis: High pCO2, High bicarb (compensation)
Respiratory Alkalosis: Low pCO2, Low bicarb

Cancers with Bone Metastasis:

BLT w/ Kosher Pickle, Mustard, Myo: Breast, Lung, Thyroid, Kidney (renal), Prostate, Multiple Myeloma

Causes of Hyponatremia

Urine Na >10: Diuretics, ACEI, Renal Salt Wasting, Cerebral Salt Wasting, Addison's
Urine Na <10:>Dehydration, Vomiting, Sweating, Diarrhea