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1. Nephrology Review February 19, 2010

4. Milutinovic et al. Kidney Int. 1975:8;185-190 inulin iothalamate (CCr+Curea)/2

5. Na + K + Cl -

7. การที่มี BUN และ serum creatinine สูงเกินค่าปกติ (Normal Cr ชาย ≤ 1.5, หญิง ≤ 1.3 mg/dl) Azotemia

8. Uremia กลุ่มอาการที่เกิดจากความผิดปกติของการคั่งของของเสีย สารน้ำและเกลือแร่ที่เกิดคู่กับการเสื่อมหน้าที่ของไต - nausea, vomiting - anorexia - weight loss - dyspnea - fatigue - pruritus

9. Azotemia GFR ปกติ GFR ต่ำ Acute KI Chronic KD Intrinsic RF Post RF Pre RF Chronic GN Chronic TIN BUN Cr

13. Definition of Acute kidney injury OR 2004 Level of dysfunciton Outcome

15. Acute Kidney Injury Within 48 hours  serum Cr > 0.3 mg/dL  serum Cr > 50% (1.5 fold) More than 6 hours  urine output < 0.5 ml/kg/hr Adequate fluid resuscitation

16. AKIN classification Baseline serum Cr (48 hr) urine output Stage 1 (R)  >0.3 mg/dL or  1.5-2 fold <0.5 mL/kg/hr >6 hr Stage 2 (I)  2-3 fold <0.5 mL/kg/hr >12 hr Stage 3 (F)  >3 fold or <0.3 mL/kg/hr >24 hr  >0.5 mg/dL if Cr > 4 mg/dL) anuria for 12 hr RRT No GFR criteria

18. Decreased circulatory volume Activation of central baroreceptors Norepinephrine Vasopressin Angiotensin II PGE2 / PGI2 Nitric oxide Autoregulation (MAP > 70) Vasoconstriction Mesangial contraction Reduced renal blood flow & GFR Prerenal

20. Functional & Physiologic change Loss of cell polarity Loss Cell-cell, cell matrix interaction Tight junction defect ↑ Distal Na delivery Tubular obstruction Back leak Renal vasoconstriction ↓ GFR Tubuloglomerular feedback Brush border detachment

22. Na + K + Cl - Medullary ischemia Intermediate syndrome Urine Na low Urine spgr low

35. RENAL Na + REABSORPTION HCO 3 - HCO 3 - + H 2 O+CO 2 CA H + +HCO 3 - CA Na + glucose PO 4 AA Carbonic anhydrase inhibitor H + Na + 3 HCO 3 - Na + 3Na + 2K + 3Na + 2K + 3HCO 3 - Na +

36. TAL of Henle Loop diuretics

37. DISTAL TUBULE Thiazide

38. CORTICAL COLLECTING TUBULE Na + K + H + spironolactone Amiloride

39. POLYURIA

42.  GFR  salt excretion  H 2 O excretion

46. Water reabsorption V2 Medullary Hypertonicity

55. ADH stimulation Central Nephrogenic Partial Complete

60. Fluid therapy

61. hypotonic isotonic colloid ICF 2/3 ECF 1/3 II 3/4 IV 1/4 TBW - male : 60%BW, Female 50%BW Elder - male : 50%BW, Female 45%BW Children : 60%BW

63. Bunn F, Trivedi D, Ashraf S. Colloid solutions for fluid resuscitation. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD001319. DOI: 10.1002/14651858.CD001319.pub2. There is no evidence that one colloid solution is more effective or safe than any others (albumin, PPF, dextran, HES, gelatin) There is no evidence from RCTs that resuscitation with colloids reduces the risk of death, compared to resuscitation with crystalloids,in patients with trauma, burns or following surgery. Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000567. DOI: 10.1002/14651858.CD000567.pub3.

66. Water balance

72. Potassium

74. 50 – 55 mEq/kg 3,000 – 4,000 mEq 65 mEq (2%) Red cell 250 mEq Muscle 2,635 mEq Liver 250 mEq Bone 300 mEq ICF ECF II IV K 160mEq/l K 4mEq/l 5-10 mEq 5-10 mEq 50-100 mEq 90-95 mEq

77. HYPOKALEMIA

81. ST depress, Peak P, PR prolong Widening QRS

89. HYPERKALEMIA

91. Flat P Prolong PR AV block Widening QRS Sine-wave

100. TREATMENT mechanism onset peak Ca antagonist 1-5 min HD remove 15 min PD remove 2 h Kay exalate remove 1-6 h NaHCO 3 shift unreliable Insulin shift 1 0 - 2 0 min 1-2 h B2 agonist shift 1 0 - 20 min 1-2 h

102. Acid-Base Disorders

104. PCO 2 H + , HCO 3 - HCO 3 - /CO 2 Albumin Bone Proteins PO 4 Buffers

113. Hypoventilation

114. Hyperventilation

115. Causes of metabolic acidosis

123. Renal HCO 3 - reabsorption Serum HCO 3 - (mEq/l) HCO 3 - reabsorption 25 50 Volume depletion K + depletion

128. Approach to Patients with Glomerular Diseases Suchai Sritippayawan Division of Nephrology , Internal Medicine, Siriraj Hospital, Mahidol University

129. Structure

130. pore fenestration charge Slit pore

131. Pathogenesis

132. JOURNAL OF NEPHROLOGY Vol . 11 No . 4 - 1998 / 177-182

134. Structure Proliferation Expansion Endocap-proliferation Thinkening : spike, double contour Necrosis Leucocytic infiltration Extracap-proliferation (crescent) vasculitis

135. Mesangial : IgMN, IgAN, lupus Subepithelial : membranous Subendothelial : lupus Intra GBM : lupus, MPGN I

136. Brenner : Brenner and Rector's The Kidney, 8th ed. Copyright © 2007 Saunders, An Imprint of Elsevier

140. >70% of RC are glomerular RC Proteinuria > 1 g/day or 2+ Indetermine 30–70% Nonglom. <30% acanthocyte ring

151. Telescopic urine sediment

152. How to approach?

154. Secondary glomerular diseases

167. Primary glomerular diseases

172. Managements

180. PREGNANCY & KIDNEY DISEASE

188. HELLP acute fatty live HUS,TTP Onset > 20 wk  < 20 wk < 48 hr PPT  > 48 hr PPT Plt    Coag DIC DIC normal Liver dysfn    normal hypoglycemia Renal failure mild    