醫學筆記匯整 ED Notes

 Prerenal  : hyaline cast

• Effective volume depletion 
• Drug : ACEI, ARB, NSAIDs 
• Renal artery stenosis, thrombus 
   

 Intrinsic  

• GN : Dysmorphic RBC, RBC cast, WBC cast
   
• ATN : Granular muddy brown cast
  - Ischemia : 續發於 prerenal, 最常見
  - Nephrotoxin :
     NSAIDs, contrast, Aminoglycoside, Cisplatin, Genta 
     Rhabdomyolysis, Heolysis, Multiple myeloma
   
• AIN : WBC cast
  - Allergy : Sulfa, NSAIDs, 馬兜鈴酸, Penicilin
  - Infection : APN
  - Infiltration : lymphoma, sarcoidosis
  
  ( 皮膚紅疹, Eosinophilia, Eosinophiluria )
   
• HUS
• Tumor infiltration
• Renal vein thrombosis
   

 Postrenal :  RBC 但沒有 dysmorphic

• Obstruction : stone, BPH, tumor, blood clot, Neurogenic bladder

看來這算法是 區分 Prerenal & ATN
Acute GN 雖然也是屬於 Intinsic 但算出來會像是 prerenal 
 ( ref. 小兒腎臟 FC p.124 -4  & 125 -7 ) 

 AKI 定義 : RIFLE, AKIN, KDIGO 

基本上就是 creatinie 上升 > 0.5 mg/dL/d
UOP < 0.5mg/kg/h

 

KDIGO 先定義, 再分嚴重度