Nephrology

A

• Acute Kidney Injury — Diagnosis and Management

  Identify prerenal, intrinsic, or postrenal causes; review nephrotoxins; manage volume status, electrolytes, and acid–base; start dialysis for standard indications.
• Acute Kidney Injury — Evaluation & Management

  Define AKI by KDIGO criteria; assess volume, meds, obstruction; manage with fluids or diuresis as appropriate; avoid nephrotoxins; consider dialysis for AEIOU indications.
• Acute Kidney Injury — KDIGO Staging, Volume Optimization, and RRT Indications

  AKI is defined by creatinine rise or oliguria. Apply KDIGO staging, optimize hemodynamics and volume, avoid nephrotoxins, and initiate renal replacement therapy for standard emergent indications or persistent severe AKI after optimization.
• Acute Symptomatic Hyponatremia — 3% Saline Bolus, Desmopressin Clamp, and Relowering Safety

  Severe symptoms (seizures, coma) require immediate 3% saline boluses to raise Na+ by 4–6 mEq/L quickly; then maintain controlled correction using a desmopressin clamp and tailored fluids to avoid overcorrection and osmotic demyelination. Aggressively treat the underlying cause.
• Acute Symptomatic Hyponatremia — Rapid Correction Protocol

  Severe symptomatic hyponatremia requires hypertonic saline boluses and tight correction limits to avoid osmotic demyelination; use DDAVP clamp strategies to prevent overcorrection.
• Anemia of CKD — Iron, ESA, and HIF‑PH Inhibitors

  Correct iron deficiency first; use ESAs for persistent anemia with careful Hb targets; consider HIF‑PH inhibitors per labeling; individualize based on symptoms and risk.

C

• Calciphylaxis in ESRD — Painful Necrotic Lesions and Multimodal Therapy

  Dialysis patient with exquisitely painful violaceous plaques progressing to necrosis—consider calcific uremic arteriolopathy (calciphylaxis).

H

• Hemodialysis — Vascular Access Issues & Infection Prevention

  AV fistula preferred over graft over catheter; meticulous infection prevention and prompt management of access complications are critical.
• Hyperkalemia — ECG Risks & Treatment Algorithm

  Immediate threat when ECG changes or K+ ≥6.0. Stabilize membrane, shift K+ intracellularly, and remove K+; address causes and prevent recurrence.
• Hypermagnesemia — Toxicity and Treatment

  Hypotension, bradycardia, and hyporeflexia suggest toxicity; stop magnesium sources, give IV calcium for cardiac stabilization, provide fluids and diuretics, and dialyze when needed.
• Hypernatremia — Diagnosis and Management

  Differentiate water deficit from sodium gain; correct gradually (generally ≤10–12 mEq/L per 24 h) using hypotonic fluids; address the underlying cause.
• Hypernatremia — Free Water Correction

  Treat dehydration and hyperosmolality by calculating free water deficit and replacing slowly; correct underlying cause and monitor sodium closely.
• Hypokalemia — Diagnosis & Potassium Repletion

  Evaluate urinary K+ loss and acid–base status to identify renal vs extrarenal causes; replete potassium and correct magnesium; monitor for arrhythmias.
• Hyponatremia — Diagnosis & Management

  Classify by serum osmolality and volume; check urine osmolality and urine Na; treat severe symptoms with hypertonic saline; limit correction to ≤8–10 mEq/L in 24 h to avoid ODS.

I

• IgA Nephropathy — Diagnosis & Treatment

  Risk‑stratify by proteinuria, eGFR, and MEST‑C pathology; maximize supportive care (RAASi, SGLT2i); consider immunosuppression in high‑risk cases.

L

• Life-Threatening Hyperkalemia — Stabilize, Shift, and Remove Potassium

  Treat hyperkalemia with a three-step sequence: stabilize cardiac membrane (IV calcium), shift K+ intracellularly (insulin/dextrose, β-agonists, bicarbonate if acidotic), and remove K+ (diuretics, potassium binders, or dialysis). Continuous ECG monitoring is essential.
• Life‑Threatening Hyperkalemia — Membrane Stabilization, K+ Shift, and Removal

  ECG changes or K+ ≥6.0 mEq/L require immediate IV calcium for membrane stabilization, insulin/dextrose and beta‑agonist for intracellular shift, and measures to remove potassium (loop diuretics, binders, or dialysis). Identify and treat precipitating causes.
• Lithium Toxicity — Fluids and Dialysis

  Acute or chronic toxicity presents with GI upset, tremor, ataxia, and confusion; give isotonic fluids to enhance clearance and arrange hemodialysis for standard indications.

M

• Membranous Nephropathy — Risk Stratification & Treatment

  Use anti‑PLA2R/THSD7A antibodies and risk stratification (proteinuria, eGFR) to guide therapy; ACEi/ARB and SGLT2i for all; immunosuppression for high‑risk or progressive disease.
• Minimal Change Disease (Adult) — Diagnosis & Steroid Therapy

  Adult MCD presents with nephrotic syndrome; high corticosteroid responsiveness; evaluate for secondary causes; manage complications of nephrosis.

P

• Peritoneal Dialysis — Modality Selection & Complications

  Peritoneal dialysis modality selection considers lifestyle and residual renal function; prevent and treat peritonitis; manage catheter and exit‑site care meticulously.

R

• Rhabdomyolysis — Diagnosis and Management

  Muscle breakdown with elevated CK causing AKI risk; aggressive isotonic fluids, treat hyperkalemia, address cause; consider urine alkalinization selectively.
• Rhabdomyolysis — Fluids and Complication Prevention

  Identify muscle injury with elevated CK and myoglobinuria; give early isotonic fluids, monitor electrolytes and urine output, and manage complications such as hyperkalemia and AKI.

S

• Secondary Hyperparathyroidism in CKD — Management

  Manage with phosphate control, vitamin D repletion/analogs, and calcimimetic therapy; avoid hypercalcemia and oversuppression; align with dialysis protocols.
• Severe Hyperkalemia — ECG Changes, Membrane Stabilization, and Dialysis Triggers

  Hyperkalemia with ECG changes or K+ ≥6.5 mEq/L is a medical emergency. Stabilize the myocardium with IV calcium, shift potassium intracellularly with insulin/dextrose (± beta-agonists, bicarbonate if acidosis), and remove potassium via diuretics, binders, or hemodialysis. Identify and correct precipitants.
• Severe Hypokalemia — Urgent Repletion

  Recognize muscle weakness and arrhythmia risk; correct magnesium, give potassium cautiously IV or PO, and monitor ECG and levels.
• Severe Symptomatic Hyponatremia — Hypertonic Saline

  Neurologic symptoms from low sodium require prompt 3 percent saline boluses with careful monitoring to avoid overcorrection; consider desmopressin clamp strategy.