Summary
Samenvatting alle aandoeningen onderdeel nefrologie
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alle aandoeningen onderdeel nefrologie
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Ziekte Oorzaak Klinisch beeld Urinesediment bloedOZ Nierbiopt therapie+ dipstick
Prerenaal 1. Daling weefselperfusie - - Oligurie leeg - Serumureum >> URGENT
nierlijden 2. Geisoleerde renale perfusie - - Geconcentreerde - - Serumcreatinine > - vocht: IV
urine kristalloiden
- - laag natrium - stoppen toxo sotffen
- - lage fractionele GEEN DIURETICA
natrium
-
Acute 1. Prerenaal nierlijden die - - GFR daalt Epitheelcilinder - serumureum > SUPPORTIEF
tubulusnecrose slecht behandelt werd - - oligurie of s, tubulaire - serumcreatinine > - stoppen toxo
2. Nefrotoxo producten bewaarde diurese cellen of leeg stoffen
gedaalde GFR, back leak, - - geen - bijvullen of vocht
tubulaire obstructie hematurie/pyurie beperken
- - isothenurie (nt - hemodialyse/
geconcentreerd) hemofiltratie
- - hoge fractionele GEEN LISDIURETICA
natrium (tenzij overvulling en
- - hoge natrium oligurie)
-
Contrast 1. Jodium houdende stoffen - diurese bewaard Leeg - serumcreatinine > SUPPORTIEF +
geassocieerde (dosisafh) Vals verhoogde preventief
nierschade proteinurie - contrast vermijden
- volume beperken
- hydratatie pre en
post procedure
Rhabdomyolyse = 1. Val lange tijd op grond - myalgie + op bloed - verhoogde CK PREVENTIEF +
spierafbraak 2. Crush syndroom - nausea Gepigmenteerd - verhoogde LDH URGENT
3. Hevige spierinspanning - braken e cilinders - serumcreatinine > - hydrateren
4. Intox - anorexia - hyperkaliemie - urine alkaliniseren
, 5. Virale infectie - onwel - hyperfosfatemie
Myoglobuline in bloed en - roodbruine urine - hypocalcemie
door GFR
Aminoglycosiden 1. AB langer dan 1w - diurese bewaard - serumcreatinine > - vermijden
- hypokaliemie
- hypomagnesiemie
Hepatorenaal 1. Renale hypoperfusie bij - oligurie - serumcreatinine > GEEN VULLING
syndroom leverlijden en portale - natrium laag - serumureum >
hypertensie - FENa laag
- oedeem
- ascites
Acute tubulo- 1. Medicatie: allergie - geen klachten Leukocyten - serumcreatinine > - Allergisch
interstitiele 2. Infectie - nausea WBCcilinders - serumureum > interstitieel - stoppen medicatie
nefritis 3. Auto- immuun - anorexia Soms RBC - eosinofilie bij oedeem - cortico
4. Sarcoidose - braken Milde allergie - Infectie
- algemene malaise proteinurie interstitiele - infectie aanpakken
- flankpijn infiltraten
- koorts/rash bij Negatieve met WBC
allergie kweek
GEEN POLLAKISURIE
EN DYSURIE
Acute opstijgende 1. Bacterie - koorts Leukocyturie Inflammatie NOOIT - AB
pyelonefritis - pijn nierstreek WBCcilinders - leukocytose - Vocht
- malaise Bacterien - CRP> - NSAID
- braken Soms RBC - verhoogde
- dysurie Proteinurie bloedbezinkingssnel
- pollakisurie heid
Kristalgeinduceer 1. Urinezuurkristallen - deterioratie Kristallen - serumcreatinine> Intratubulai - IV hydratatie
de 2. Medicatie nierfunctie Hematurie - serumureum> re kristallen - rasburicase
- flankpijn Leukocyturie - allopurinol
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