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Chief
complaint:
Edema
Edema: one or more alterations in the Starling forces ergo increased
flow of fluid from the vascular system into the interstitium or
into a body cavity
Increased (capillary) hydrostatic pressure
hypoalbuminemia in nephrotic syndrome;
venous and lymphatic obstruction
Decreased (capillary) oncotic pressure
proteinuria in nephrotic syndrome
Increased capillary permeability
drug induced, inflammation, viral/bacterial
infection
Sodium and water retention
congestive heart failure, acute
glomerulonephritis , other forms of renal
failure
1) Capillary leak
2) Reduction of effective arterial volume
3) Renal factors and the RAAS
4) Arginine Vasopressin
5) Endothelin
6) Natriuretic peptides
Usual causes, check for:
Cardiac – pulses, BP, cold/clammy, DOB
Liver – jaundice, bleeding problems
Renal – type of edema, BP
Nutrition - Kwashiorkor, flag sign
• conscious, irritable, coherent,
NICRD
• BP 150/90 HR 90 RR 24
History
Physical Exam
edema, abdominal • HEART: AP, NRRR, (-) murmurS
distension, decreased UO, • ABDOMEN: NABS, soft, no
tea-colored urine organomegaly, tenderness, or
- consulted private MD, u/r masses.
diagnosis & medications given, no • EXTREMITIES: FEP, grade II
relief of Sx bipedal edema.
Elaborate on URTI
Chronology of edema development
Dyspnea upon exertion, orthopnea, PND
Abdominal pain, flank pain?
Decreased appetite, altered taste, altered
sleeping pattern, difficulty concentrating,
restless legs or myoclonus?
Frequency, dysuria
Family history of hereditary nephritis?
Pigmenturia Hematuria
Red urine withour at least 5 RBCs/HPF
RBCs in urine, with
Hemoglobinuria coarse granular
Myoglobinuria casts
Upper UT vs. Lower
Drugs/food
UT bleed
Glormerular
Isolated Renal Disease
Non-glomerular
IgA nephropathy (Berger disease)
Postinfectious GN
Upper
(poststreptococcal GN)
Membranoproliferative GN
Tubulointerstitial
Focal segmental glomerulosclerosis
Vascular
Multisystem Disease Crystalluria
Systemic lupus erythematosus
nephritis Hemoglobinopathy
Henoch-Schönlein purpura nephritis
Anatomic
Goodpasture syndrome
Hemolytic-uremic syndrome Lower
HIV nephropathy
Inflammation
Urolithiasis
Trauma
Coagulopathy
Heavy exercise
Munchausen syndrome
Edema secondary to a RENAL CAUSE
But what type?
AKI CHUA
AKI: Acute Kidney Injury/ ARF (urine monitoring)
C: Congestions (x-ray)
H: Hyperkalemia (peak T-waves in ECG)
U: Uremia (Neuro: drowsy)
A: Metabolic Acidosis (ABG)
Urinalysis: to check if Nephrotic or nephritic
ABG: for acidosis
CBC: dilutional anemia?
Symptomatic
1) Edema – Diuretics
2) Hypertension - ACE inhibitors, Calcium Channel
Antagonists
Furosemide? Antibiotics?