Pre-Renal Intrinsic Renal Post-Renal

Glomerular Interstitial Tubular Misc/Meds

ETIOLOGY Volume depletion RPGN: Meds (75%) Sepsis/Hypotension Myoglobin BPH

Cardiorenal Post-infectious GN ABX: PCN/Cephal. Peri-Operative Bilirubin Bladder mass
Hepatorenal ANCA-assoc PPI, NSAIDs Meds/Toxins Uric Acid Nephrolithiasis
(Nephrotic syndrome) Lupus nephritis Allopurinol TLS, acute gout,
IgA Autoimmune d/o Lesch-Nyhan
Anti-GBM SLE, Sjogren’s Medications
MPGN/cryo Sarcoidosis
ATN: MCD, MN TINU syndrome
Work-Up Hx/PE
BUN/Cr > 20:1 Nephritic: hematuria Dx of exclusion, FENa > 2% Myoglobin: Hx
sub-nephrotic proteinuria clinical suspicion FEUN > 50% CK, UA Renal U/S
Urine Micro: dysmorphic Hx: Rash, fever, FEUA > 20% “Type IV RTA”
RBC, RBC cast (rare) eosinophilia (~10%) Bilirubin:
7-10 days after drug Urine Micro: RTE cells, > 30, UA
Nephrotic: proteinuria (+) urine eos casts
often > 10g/day Hansel: ~80% sens. Uric Acid:
UNa < 20 mEq/L Hypoalbuminemia Wright: ~60% sens. > 15mg/dl
FENa < 1% Hyperlipidemia NSAIDs, sarcoidosis Spot urine UA/Cr>1
In pts on diuretics? Urine Micro: lipid droplet NOT eosinophilic UA: often normal
FEUN < 35% ATN casts FENa > 1% due to
FEUA < 10% tubular damage
Serologies Isosthenuria
Urine SG, UOsm
Large kidneys on U/S
Urine Micro: Bland/ Urine Micro: WBCs,
Squam. Epith. Cells WBC casts

Treatment Volume expansion GN specific treatment Supportive Care All: IVF to increase Relieve
Diuresis, improve CO HD renal perfusion and obstruction
HRS: STOP DRUG Lasix PRN UOP
Midodrine 7.5 – 12.5mg TID Steroids 1mg/kg/d No forced diuresis ?Bicarb: may promote
Octreotide (100-200 mcg SC TID) max 60mg for 1-2wks Ca-Phos stones
Norepi Rasburicase/allopurinol
Goal: inc MAP 10 mmHg