amboss 7/1 renal Flashcards
what type of cast is found in nephrotic syndrome
fatty casts
pregnant women with pyelonephritis should be what
admitted and given IV cefotaxime
what is the treatment of choice for complicated pyelonephritis
IV ciprofloxacin 10-14 days`
what is the likely culprit organism for a UTI with an indwelling catheter and + LE. patient has a history of stones
proteus mirabilis
what else will you find with a proteus infection
alkalized urine pH >7
what is the most common cause of UTI
ascending infection
what is a contraindication for foley
suspected urethral injury
what is the preferred method for evaluating urethral injury
retrograde urethrogram
what is a characteristic finding of uric acid crystals
low urine pH (which is characteristic of calcium oxalate, cystine as well), radiolucent stones on Xray (cannot be seen),
what are bipyramidal crystals
calcium oxalate
what are hexagon shaped crystals in the urine
cystinuria
what stones form in alkaline pH
calcium phosphate and struvite stones
which stones are found on x ray
calcium phosphate and struvite stones
what is the treatment of choice for unilateral fibromuscular dysplasia
ramipril and percutaneous angioplasty without stent
what is the treatment of choice for a real stone larger than 10mm
lithotripsy
what is a relative contraindication to lithotripsy
obesity
what is the alternative to lithotripsy
ureterenoscopy
what is the proper treatment for a large stone obstructing the ureter causing hydroneophrosis with concomitant infection (UTI/pyelo)
nephrostomy tube to decompress the ureter
what is the cause of analgesic nephropathy
Prostacyclins enhance renal blood flow by dilating renal capillaries, most prominently in the medulla of the kidney. By inhibiting prostacyclin production, nonsteroidal anti-inflammatory drugs (NSAIDs) decrease renal blood flow. After prolonged exposure to analgesics, especially analgesics used in combination, as is the case here, patients develop renal papillary necrosis and subsequent analgesic nephropathy (chronic kidney disease).
what is the presentation of analgesic nephropahty
features of kidney dysfunction: fatigue, anemia, uremia, and elevated creatinine. He also has sterile pyuria (WBCs in the urine with negative cultures) and ultrasonography shows changes associated with chronic kidney disease. Along with these findings, his long-term use of naproxen and the aspirin-caffeine combination
what are the characterstics to watch out for in renal cell carcinoma vs bladder cancer
signs of increased renin production –facial plethora, hypertension, blurry vision, signs of polycythemia
Patients with hematuria should generally be evaluated for
urinary tract infections (urinalysis, urine culture), kidney function (creatinine, BUN), and glomerular disease (urine microscopy). Furthermore, patients > 35 years or with risk factors for urothelial malignancy regardless of age should undergo cystoscopy to evaluate the lower urinary tract and CT urography to evaluate the upper urinary tract.
where does blood that presents initially in the stream of urine and then becomes normal before the stream ends typically originate from
the urethra
where does blood that presents throughout the stream or terminal blood come from in the urinary system
the bladder or above
what is the presentation of prerenal AKI
BUN/Cr > 20, oliguria, azotemia, decreased urine sodium (in response to the prerenal AKI)
what causes an increased risk of ascending bacterial infections during pregnancy
Increased levels of progesterone result in ureteral smooth muscle relaxation and ureteral dilation. Pressure exerted by the expanding uterus contributes to ureteral dilation. Ureteral dilation can increase urinary stasis and ureterovesical reflux, leading to higher rates of ascending bacterial infections.
One of the most commonly used polychemotherapy regimens for high-grade non-Hodgkin lymphoma is…
CHOP (a combination of cyclophosphamide, doxorubicin, vincristine, and prednisolone).
what is a SE of CHOP (a combination of cyclophosphamide, doxorubicin, vincristine, and prednisolone).
Hemorrhagic cystitis, which presents with lower urinary tract symptoms and hematuria, is a common complication of cyclophosphamide therapy.
what is the treatment for CHOP induced hemorrhagic cystitis
mercaptoethane sulfonate –by deactivating acrolein and by increasing the urinary excretion of cysteine, a free radical scavenger. Adequate hydration and frequent voiding are further important measures to prevent hemorrhagic cystitis.
what is the work up for a child with recurrent UTI
voiding cystourethrography
what test is suggestive of cysteinuria
urine nitroprusside test
what are the findings for minimal change disease on light microscopy
No changes
what are the findings for minimal change disease on electron microscopy
effacement of foot processes of the podocytes
what are the findings for minimal change disease
proteinuria, edema, hypoalbuminuria, (nephrotic syndrome).
what does linear deposition of antiGBM antibiodies indicate
good pastures
what does deposits of IgG and C3 at the glomerular basement membrane indicate
membranoproliferative glomerulonephropathy
what does subepithelial dense deposits indicate on EM
spike and dome appearance; membranous
membranous nephropathy looks like thicken glomerular basement membrane.
is membranous nephropathy found in children
no.
what does mesangial proliferation indicate
IgA nephropathy
what else, other than deposits of IgG and C3 at the glomerular basement membrane can indicate membranoproliferative glomerulonephropathy
Splitting of the glomerular basement membrane (which results in a tram-track appearance)
what is associated with membranous nephropathy
caused by immune complex deposition (associated with systemic lupus erythematosus, hepatitis B, or hepatitis C) or by overactivation of the alternative complement pathway.
more likely to occur in asian or Korean people
what are the imaging findings for post strep glomerulonephritis
Light microscopy: glomeruli appear enlarged and hypercellular (infiltration of monocytes and polymorphonuclear cells)
Immunofluorescent microscopy: granular deposits (IgG, IgM, C3 complement), which create a “lumpy-bumpy” appearance (starry sky pattern)
sub epithelial complex deposition
what is the presentation of IgA nephropathy
second to third decade of life with recurrent episodes of gross hematuria usually during or immediately following infection
what is the mechanism of IgA nephropathy
Between episodes of flares, patients typically have asymptomatic urinary abnormalities such as microhematuria. The most likely explanation for these findings is an increased number of defective circulating IgA antibodies, the synthesis of which is triggered by mucosal infections (e.g., pharyngitis).
does hypertension occur with minimal change disease
no.
what are complement levels in minimal change
normal
what does nephrotic syndrome with hypertension, reduced complement associated with Hep B infection
membraneous nephropathy.
who gets minimal change
children less than 5
what is the presentation of renal tubular acidosis type I
Type 1 renal tubular acidosis is associated with decreased activity of the H+/K+ ATPase antiporter on the apical surface of intercalated cell, which reabsorbs K+ and secretes H+ into the lumen of the tubule. This subsequently results in hypokalemia and hyperchloremic metabolic acidosis with urine that cannot be acidified to a pH < 5.5.
how do patients with RTA1 present
in a hyperchloremic, hypokalemic, metabolic acidosis with a urine pH of > 5.5
what is potter sequence
craniofacial abnormalities, clubbed feet, and pulmonary hypoplasia.
what is a good prophylactic agent for postcoital UTI
Bactrim or nitrofurantoin, cephalexin, a fluoroquinolone,
postcoital treatment for UTI agent
amoxicillin clavulanate
what is urge incontinence
from increased detrusor muscle activity, which causes involuntary detrusor muscle contraction and urinary tenesmus that lead to a sudden release of urine.
what is the treatment for urge incontinence
Anticholinergic agents (e.g., oxybutynin) can help treat this condition by decreasing detrusor muscle tone.
what is overflow incontinence
Overflow incontinence (due to detrusor under-activity or bladder outlet obstruction) results in increased urine bladder volumes. Patients with overflow incontinence usually have continuous urinary leakage or dribbling (not sudden episodes of urinary loss), and post-void residual urine volumes would be increased.
Stress incontinence
can result from decreased pelvic floor muscle tone in which the urethra and bladder neck cannot completely close against the anterior vaginal wall. As a result, increases in intra-abdominal pressure (e.g., coughing, sneezing, lifting) force urine through an incompletely closed urethra.
what is the cause of stress incontanence
urethral hyper mobility
what is the first line surgical intervention for stress incontinence and when is it used
A urethral sling is the first-line surgical procedure for stress incontinence if conservative therapy, consisting of pelvic floor muscle exercises (Kegel exercises), lifestyle changes (e.g., weight loss, alcohol cessation), and use of continence pessaries have failed. The sling is inserted via vaginal approach and supports and partially compresses the urethral lumen, thereby decreasing or stopping urinary leakage when intraabdominal pressure increases
rapidly progressive glomerulonephritis presents how
with crescent formation and hematuria with proteinuria
what is the treatment for RPGN
methylprednisolone
what is the cause of incontinence in NPH
inability to suppress voiding caused by underlying compression of the periventricular white matter tract
what is the presentation of nephrogenic DI
hypernatremia, high ADH, with low urine osmolarity
presents with polyuria, polydipsia, nocturia, dehydration
what is nephritic syndrome
this is glomerular capillary change that causes proteinuria, hmaturia, oliguria, azotemia and salt retention. this results in swelling of the periphery, hypertension and intravascular volume expansion
what is allergic interstitial nephritis
rash and kidney pain. there will be eosinophilia on urinalysis
what can cause allergic interstitial nephritis
PPIs, such as pantropazole rifampin
cephalosporins, NSAIDs,
what kidney diseases/disorders does lupus cause
causes membranous nephropathy. thickening of the capillary loops through immune complex deposition.
subepithelial spike and dome appearance
lupus also can cause membranoproliferative glomerulonephritis which causes microhematuria and elevated creatinine
what are the immune complexes in membranous nephropahty caused by lupus
IgG and C3
what is hypercellular glomeruli associated with
PSGN
what is another cause of membraneous nephropathy
lung cancer/solid malignancy
Deposition of antibodies between podocytes and the basal membrane causes thickening of glomerular capillary loops and basal membrane, which in turn leads to nephrotic syndrome.
who gets focal segmental glomerulosclerosis
heroin abuse, obesity, sickle cell disease, and HIV infection
what is the course of FSGS
ESRD
what is the presentation of acute interstitial nephritis
fever, rash, bloody urine, eosinophils in urine
what are the characteristics of diabetic kidney
Nodular glomerulosclerosis with Kimmelstiel-Wilson nodules is pathognomonic of diabetic nephropathy, even though diffuse glomerulosclerosis is the most common finding. Early antihypertensive treatment, e.g., with ACE inhibitors, can delay the progression of diabetic nephropathy.
what is common in people with sickle cell trait
renal papillary ischemia/necrosis
what is scleroderma renal crisis
severe hypertension and features of acute renal failure, such as increased creatinine, oliguria/anuria, vomiting, and fluid overload (as evident from pedal edema, dyspnea, jugular venous distention, an S3 gallop, pulmonary edema, and pleural effusion).
what is the pathophysiology of myeloma kidney
immunoglobulin light chains or Bence Jones protein
what is required for the diagnosis of multiple myeloma
bone marrow biopsy
what are hepatic cysts characteristic for
polycystic kidney disease
what should autosomal dominant polycystic kidney disease really be called
polycystic renal-hepatic-ACOM disease.
what are other findings in ADPKD
mitral valve prolapse, kidney, hepatic, testicular, spleen, ovary, and pancreatic cysts
what is IgA neprhopathy
renal glomerular damage caused by IgA deposition in the mesangium of the renal glomeruli
what is the treatment for bladder cancer with muscle wall involvement but no local invasion or lymph node
radical cystectomy with ileoconduit and cisplatin
what is the treatment for uncomplicated pyelonephritis
7 days of fluoroquininolone outpatient
Detrusor sphincter dyssynergia is
commonly seen in patients with multiple sclerosis or spinal cord injury. In patients with detrusor sphincter dyssynergia, involuntary contractions of the detrusor muscle press small amounts of urine against the contracted sphincter muscle.
what is a devstating consequence of pyelonephritis
renal papillary necrosis
what amyloid is produced from RA or inflammatory processes
amyloid A
what are 5 alpha reductase inhibitors used for
BPH.
what is consequence of using 5 alpha reductase inhibitors for BPH
reduces symptoms and PSA levels
what are the recommendations for PSA screening
should be discussed if there is mild symmetrical enlargement and the person is 50
what is the effect of losartan on vessel tone, renin actiivty, sodium excretion, levels of aldosterone
blocking of angiotensin II receptors leads to an increase in urinary sodium excretion, decreased vessel tone, and lower levels of aldosterone. The combination of these effects lowers blood pressure. Due to a loss of negative feedback regulation, treatment with sartans typically leads to increased renin levels and increased renin activity, which in turn leads to increased levels of angiotensin II.
what is a complication of crohns disease
Malabsorption of fatty acids due to deficiency in bile acids is common in patients with Crohn disease (and/or short bowel syndrome) and likely explains this patient’s nephrolithiasis. In the intestinal lumen, undigested fatty acids chelate calcium, which would normally bind oxalate and lead to its excretion in the feces. Patients with Crohn disease often have pathologically increased luminal oxalate and increased oxalate absorption. After entering the serum, oxalate is excreted in the urine (hyperoxaluria), where it binds calcium and forms calcium oxalate stones.
what are uric acid stones treated with
potassium citrate
what can exacerbate uric acid stones
probenecid
how does posterior urethral tear present
high riding prostate, blood at the meatus, urge to void but cant,
lymphogranuloma venereum is what and presents how
Chlamydia trachomatis are responsible for this STI, which has an increasing incidence among men who have sex with men. Further manifestations are systemic symptoms such as fever, malaise, chills, and/or myalgia. notorious for pustules and granuloma with painless lesion/ulcer
what is the treatment for HPV condylomata acuminata
curettage or laser surgery or electrocoagulation
painless vascular lesions and the absence of inguinal lymphadenopathy are suggestive of
granuloma inguinale, which is caused by Klebsiella granulomatis.
what is the treatment for Klebsiella granulomatis.
azithromycin
what is the test to confirm the diagnosis of primary syphilis
dark field microscopy
treatment for C. trachomatis epididymitis
involves ceftriaxone and doxycycline.
what is the most common cause of epidimititis from 15-35
Neisseria gonorrhoeae and Chlamydia trachomatis.
common cause of epididymitis in prepubertal boys, males > 35 years,
Escherichia coli
and men who are the insertive partner during anal intercourse.
what is an alternative treatment for chlamydia
doxycycline
what is the first thing to do with testicular pain
ultrasound to rule out torsion
is the standard of care for treating non-seminomas in all stages.
Adjuvant chemotherapy with cisplatin, etoposide, and bleomycin (BEP regimen) The patient has signs of advanced non-seminoma with metastases to his liver and increased tumor markers (stage IIIC). In addition to the radical inguinal orchiectomy, he would likely require 4 cycles of this regimen due to the advanced nature of his cancer.
increased serum β-hCG concentration, and often produce large amounts of α-fetoprotein.
A yolk sac tumor
mild increase in serum β-hCG (typically < 100 mIU/mL) but no alpha fetal protein
seminoma
large amounts of beta-HCG
choriocarcinoma
when does spontaneous testicular descent occur
by 4-6 months it is unlikely to happen
does a varicocele increase the risk of testicular torsion
no.
Risk factors for testicular torsion include
testicular tumors, testicles with a horizontal lie, undescended testes, a spermatic cord with a long intrascrotal portion, and extension of the tunica vaginalis over the proximal spermatic cord (bell-clapper anatomical variant).
what can leydig tumors do?
produce sex hormones
