Day 9 - GU1 Flashcards
Diuretic(s) most useful: acute pulmonary edema
Loop diuretic (recall: LMNOP)
Diuretic(s) most useful: Hypercalciuria causing kidney stone
Thiazides
Diuretic(s) most useful: Glaucoma
Acetazolamide or Mannitol
Diuretic(s) most useful: Mild to moderate CHF & expanded extracellular volume
Loop diuretic (~double dose to get fluid off, then assess for UOP for adjustments); Note: All CHF pts should be on low-dose, potassium-sparing diuretic (e.g., spironolactone or eplerenone), which reduces long-term mortality
Metolazone: drug class & use
Thiazide diuretic used in cases of cirrhosis (mixed w/ loop diuretic)
Diuretic(s) most useful: in conjunction w/ loop diuretics to retain potassium
Potassium-sparing diuretics
Diuretic(s) most useful: Edema assoc. w/ nephrotic syndrome
Loop diuretic, Metolazone (one of strongest thiazides)
Diuretic(s) most useful: Increased ICP
Mannitol
Diuretic(s) most useful: Mild to moderate HTN
Thiazides
Diuretic(s) most useful: Hypercalcemia
Loop diuretic
Diuretic(s) most useful: Altitude sickness
Acetazolamide
Diuretic(s) most useful: Hyperaldosteronism
Potassium sparing diuretics
Nephrolithiasis Expectant mgt
Strain urine w/ strainer - analyze stone after passing; Most pass spontaneously in 1-2 wk, especially if
Surgical tx for kidney stones: indications & options
Surgical tx - 10-20% required in cases; Indications: unable to pass after 1 mo, complete urinary obstrx, impariment renal infx, peristent infx; Surgical options: Extracorporeal shock wave lithotripsy for stones in renal pelvis or ureter; Ureterorenalscopy for ureteral stones for possible lithotripsy and stent placment; Percutaneous nephrostolithotomy Staghorn calculi need possible
Hematuria w/u
H & P, UA w/ cell ct, CBC, Chemistry w/ electrolytes, PSA (men > 40, elevated w/ any prostate pathology); Note: tampon placement to prevent menstrual bleeding into UA OR do straight cath; Imaging - (1) CT scan ab/pelvis stone protocol (2) If no stones, CT ab/pelvis w/ contrast to eval kidney/ureters (3) Co-CT KUB x-ray (since already giving contrast), equivalent to IVP to view radiopaque stones; If low suspicion of disease, consider tx for UTI and f/u UA in 3-5 days
Indications for cystoscopy in case of hematuria
If no clear etiology and… Age > 50, Smoker, FH urinary tract cancer, PMH cyclophosphamide, suspicion for cancer => Send urine for cytology & get cystoscopy
Considerations/Next steps if basic hematuria w/u negative
IgA nephropathy, Thin basement membrane disease; Repeat U/A and urine cytology routinely, f/u w/ renal sonogram & cystoscopy in 1 yr
Glomerular diseases: Most common nephrotic syndrome in children
Minimal change disease
Glomerular diseases: Granular IF pattern on LM, hypercellularity glomeruli
Post streptococcal glomerulonephritis
Glomerular diseases: Linear pattern w/ immune complex deposition
Goodpasture’s
Glomerular diseases: Kimmelstiel-Wilson nodular glomerulosclerosis
Diabetic nephropathy
Glomerular diseases: Most common nephrotic syndrome in adults
Membranous glomerulonephritis
Glomerular diseases: EM loss of epithelial foot processes
MCD
Glomerular diseases: nephrotic syndrome assoc w/ hepatitis B
Membranoproliferative glomerulonephritis
Glomerular diseases: HIV
FSGS
Glomerular diseases: Anti-GBM antibodies, hematuria, hemoptysis
Goodpasture’s
Glomerular diseases: Subendothelial tram tracks and immune complex humbs
Membranoproliferative glomerulonephritis
Glomerular diseases: nephritic syndrome, cataracts, high frequency hearing loss
Alport syndrome
Glomerular diseases: Crescent formation in glomeruli
RPGN or crescentic glomerulonephritis
Glomerular diseases: Segmental sclerosis and hyalinosis
FSGS
Glomerular diseases: Purpura on arms & legs, Ab pain, IGA nephropathy
HSP
Glomerular diseases: Apple green birefringence w/ Congo red stain under polarized light
Renal amyloidosis
Glomerular diseases: Positive ANCA
Crescentic glomerulonephritis (aka RPGN)
Glomerular diseases: dsDNA antibodies
Lupus nephropathy
Glomerular diseases: spike and dome of basement membrane
Membranous glomerulonephropathy