ADMS 3502 Lecture Notes - Lecture 17: Heme, Heart Failure, Hypotension
21 May 2020
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72 year old man, slowing expanding abdominal aortic aneurysm. Problems with srugery hypotension, bleeding, prolonged aortic clamping time. 24 hours later, urea = 20mmol/l, creatinine = 304 mol/l. Brightly pigmented ( heme ) granular casts in urine. Interpretation of case 1 casts are sediments of glycoprotein lining cells. A heme cast is a red blood cell cast. In renal dysfunction, sediments may be present in urine due to injury of tubules or capillaries. An aneurysm, which is a dilated segment of an artery can impede blood flow (just like blood vessel narrowing or plaque formations). Oliguria and volume overload is due to water retention. ), acetaminophen: x-ray contrast dye, cyclosporin, paraquat, hemoglobin, myoglobin. 80 year old woman develops fever, confusion. Admitted to hospital, dx pyelonephritis (ascending infection of the kidney) Urine: iso-osmotic, [na+] = 62 mmol/l, many brightly pigmented (heme) granular casts. Interpretation of case 2: amg nephrotoxicity may not be reversible. Dramatic rise in creatinine is expected in atn.
