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diagnosis differential nephrology algorithm causes renal management clinical pocus pharmacology ultrasound endocrinology pathophysiology kidney table treatment signs rheumatology symptoms workup
Limbic system Medial/rostral hypothalamus Lateral hypothalamus Hypothalamic neurosecretion ADH Autonomic centers Signal generator CRH Negative feedback Sympathetic nervous system Anterior pituitary ACTH Adrenal medulla Adrenal cortex #Cortisol #Epinephrine (norepinephrine) Response to signal
CRH Negative feedback ... pituitary ACTH Adrenal ... medulla Adrenal
Primary Adrenal Insufficiency: • ACTH stimulation test - Synthetic ACTH does not stimulate cortisol secretion because
Primary Adrenal ... dysfunctional adrenal ... Elevated, because feedback ... inhibition by adrenal ... injury to the adrenal
Regulation of GFR Physiologically, GFR is auto-regulated very precisely with changes in the mean arterial pressure (MAP)
neuro-hormonal feedback ... Tubuloglomerular feedback ... Neuro-hormonal feedback
Hyperkalemia: Diagnostic algorithm Decreased renal potassium excretion • Acute renal failure • Chronic renal failure • Drugs Increased
algorithm Decreased renal ... excretion • Acute renal ... • Congenital adrenal ... Addison's/congenital adrenal ... high: • Post-renal
Menstrual Cycle Physiology: Ovarian Cycle – Ovulation Explained Around Day 14, estrogen exerts sudden +++ positive feedback
sudden +++ positive feedback ... negative to positive feedback
Primary Adrenal Insufficiency Addison's Disease - Damage of the adrenal glands with lack of cortisol, androgens and
Primary Adrenal ... Damage of the adrenal ... aldosterone Causes of Adrenal ... Metastatic Disease -> Adrenals ... melanoma Bilateral Adrenal
Adrenal Crisis Do not confuse acute adrenal crisis with Addison disease. In 1855, Thomas Addison described a
Adrenal Crisis ... confuse acute adrenal ... syndrome of long-term adrenal ... contrast, an acute adrenal ... be a cause of adrenal
Hyponatremia - Differential Diagnosis Algorithm ADH Independent: • Tea and Toast Syndrome, Beer Potomania - Low solute
• Renal Failure ... Hypovolemic - GI losses, renal ... Hypothyroidism, adrenal
Hypernatremia Diagnosis and Workup Step 1 . Repeat the sodium concentration. Step 2. Check plasma osmolality. NORMAL PLASMA
HYPOVOLEMIC • extra-renal ... - fevers • renal ... hypothyroidism • adrenal ... nephrotic syndrome • renal
Hypochloremia - Differential Diagnosis Algorithm Cause - Decreased Intake: • Low salt in diet • Exclusive D5W
- Diarrhea • RENAL ... gas transport, renal ... tubulo-glomerular feedback
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