Nephrology Board Review培训讲义.pptVIP

Nephrology Board Review Sidharth Shah, MD. June 2007 Make sure you know…. Hyponatremia Hypernatremia (H20 deficit) ETOH ketoacidosis RF 2/2 atheroembolic disease (cholesterol emboli) Obstructive uropathy Indinavir -- crystal nephropathy Stage 2 HTN Question 1 42 yo male brings in his 10yr old son as he’s concerned that the child is happy all the time and appears to be “like a puppet”. What syndrome does the child likely have? Nephrology MKSAP: Q87 64 yo male admitted with a 5 day history of lethargy and mild confusion. He is known to have alcoholic cirrhosis, nonbleeding esophageal varicies, ascites. There is no history of recent ETOH consumption, melena, or hematemesis. No co abdominal pain has not fallen. He’s on a 2gm Na diet and takes a MVI qday. Exam: VS: BP 110/70, HR 87bpm, Temp 36. Icteric sclerae, and spider angiomata present. No JVD. Lungs are clear, with decreased breath sounds as both bases. Cardiac: HRRR. No gallop, rub. Abdomen is protruberent but not tender, with a shifting dullness. Liver is not palpable. Extremities show 1+ ankle edema. Asterixis is present, but the patient has not focal neurologic signs. Nephrology MKSAP: Q87 Labs: Hgb: 11.5g/dl HCT: 32 PLT: 84,000/uL WBC: 5400/uL Serum BUN: 20mg/dl Serum Cr: 1.2mg/dl Serum Na:114meq/dl Serum K: 4.1meq/L Serum Cl: 80meq/L Serum HC03: 28meq/K Serum total protein: 6.9g/dl Serum Alb: 2.5g/dl Cholesterol 186mg/dl Serum Osm:241 mosmol/kg H20 Urine Osm: 200mosmol/kg H20 Spot Urine Na: 10meq/L Nephrology MKSAP: Q87 What is the cause of this patient’s hyponatremia? Nonosmotic stimulation of ADH Hepatorenal syndrome Low-Na diet Reset osmostat Pseudohyponatremia Nephrology MKSAP: Q87 What is the cause of this patient’s hyponatremia? Nonosmotic stimulation of ADH Hepatorenal syndrome: Hyponatremia can be seen in HRS, but does not cause it. Low-Na diet: Never associated with hyponatremia Reset osmostat: Would have appropriate dilute urine Pseudohyponatremia: Occurs in high serum levels