FARR Renal/Geniourinary Flashcards
Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Type I (distal) RTA.
RTA associated with abnormal HCO3– and rickets.
Type II (proximal) RTA.
RTA associated with aldosterone defect.
Type IV (distal) RTA.
“Doughy” skin
Hypernatremia.
Differential of hypervolemic hyponatremia.
Cirrhosis, CHF, nephritic syndrome.
Chvostek’s and Trousseau’s signs.
Hypocalcemia.
The most common causes of hypercalcemia.
Malignancy and hyperparathyroidism.
T-wave flattening and U waves.
Hypokalemia.
Peaked T waves and widened QRS.
Hyperkalemia.
First-line treatment for moderate hypercalcemia.
V hydration and loop diuretics (furosemide).
Type of ARF in a patient with FeNa < 1%.
Prerenal.
A 49-year-old man presents with acute-onset flank pain and hematuria.
Nephrolithiasis.
The most common type of nephrolithiasis.
Calcium oxalate.
A 20-year-old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Cerebral berry aneurysms (autosomal-dominant PCKD).
Hematuria, hypertension, and oliguria.
Nephritic syndrome.
Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, and edema.
Nephrotic syndrome.
The most common form of nephritic syndrome.
Membranous glomerulonephritis.
The most common form of glomerulonephritis.
IgA nephropathy (Berger’s disease).
Glomerulonephritis with deafness.
Alport’s syndrome.
Glomerulonephritis with hemoptysis.
Wegener’s granulomatosis and Goodpasture’s syndrome.
Presence of red cell casts in urine sediment.
Glomerulonephritis/nephritic syndrome.
Eosinophils in urine sediment.
Allergic interstitial nephritis.
Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Nephrotic syndrome.
Drowsiness, asterixis, nausea, and a pericardial friction rub.
Uremic syndrome seen in patients with renal failure.
A 55-year-old man is diagnosed with prostate cancer. Treatment options?
Wait, surgical resection, radiation and/or androgen suppression.
Low urine specific gravity in the presence of high serum osmolality.
Diabetes insipidus.
Treatment of SIADH?
Fluid restriction, demeclocycline.
Hematuria, flank pain, and palpable flank mass.
Renal cell carcinoma (RCC).
Testicular cancer associated with β-hCG, AFP.
Choriocarcinoma.
The most common type of testicular cancer
Seminoma, a type of germ cell tumor.
The most common histology of bladder cancer.
Transitional cell carcinoma.
Complication of overly rapid correction of hyponatremia.
Central pontine myelinolysis.
Salicylate ingestion occurs in what type of acid-base disorder?
Anion gap acidosis and 1° respiratory alkalosis due to central respiratory stimulation.
Acid-base disturbance commonly seen in pregnant women.
Respiratory alkalosis.
Three systemic diseases that lead to nephrotic syndrome.
DM, SLE, and amyloidosis.
Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest?
RCC or other erythropoietin-producing tumor; evaluate with CT scan.
A 55-year-old male presents with irritative and obstructive urinary symptoms. Treatment options?
Likely BPH. Options include no treatment, terazosin, finasteride, or surgical intervention (TURP).
Hypernatremia causes—
The 6 D’s
Diuresis Dehydration Diabetes insipidus Docs (iatrogenic) Diarrhea
Disease (e.g., kidney,
sickle cell)
Hypervolemic hyponatremia is caused by
“nephrOSIS, cirrhOSIS, and cardiOSIS.”
Hyperkalemia HISTORY/PE
May be asymptomatic or may present with nausea, vomiting, intestinal colic, areflexia, weakness, flaccid paralysis, and paresthesias.
Treatment of hyperkalemia—
C BIG K
Calcium Bicarbonate Insulin Glucose Kayexalate
Hypokalemia HISTORY/PE
Presents with fatigue, muscle weakness or cramps, ileus, hypotension, hyporeflexia, paresthesias, rhabdomyolysis, and ascending paralysis.
Causes of hypercalcemia—
CHIMPANZEES
Calcium supplementation
Hyperparathyroidism/ Hyperthyroidism
Iatrogenic (e.g., thiazides, parenteral nutrition)/Immobility
Milk-alkali syndrome Paget’s disease Adrenal insufficiency/
Acromegaly Neoplasm
Zollinger-Ellison syndrome
(e.g., MEN 1) Excess vitamin A Excess vitamin D Sarcoidosis and other
granulomatous disease
Loops
(furosemide) Lose calcium.
Avoid thiazide
diuretics, which ↑ tubular reabsorption of calcium.
↑ anion gap caused by—
MUDPILES
Methanol Uremia
DKA Paraldehyde Intoxication Lactic acidosis Ethylene glycol Salicylates
Symptoms of uremia include
malaise, fatigue, confusion, oliguria, anorexia, and nausea.
Exam of remia may show
a pericardial rub, asterixis, hypertension, ↓ urine out- put, and an ↑ respiratory rate (compensation of metabolic acidosis or from pulmonary edema 2° to volume overload)
Indications for urgent dialysis—
AEIOU
Acidosis
Electrolyte abnormalities
(hyperkalemia) Ingestions (salicylates,
theophylline, methanol, barbiturates, lithium, ethylene glycol)
Overload (fluid) Uremic symptoms
(pericarditis, encephalopathy, bleeding, nausea, pruritus, myoclonus)
CHRONIC KIDNEY DISEASE (CKD)
Most commonly due to
diabetes mellitus (DM), hypertension, and glomerulo- nephritis.
Autosomal dominant (ADPKD):
I Most common.
I Usually asymptomatic until patients are > 30 years of age.
I One-half of ADPKD patients will have ESRD requiring dialysis by age 60.
I Associated with an ↑ risk of cerebral aneurysm, especially in patients with a
Autosomal recessive (ARPKD):
Less common but more severe. Presents in infants and young children with renal failure, liver fibrosis, and portal hypertension; may lead to death in the first few years of life.
Differential for hematuria—
S2I3T3
Strictures Stones Infection Inflammation Infarction Tumor Trauma
TB
Testicular cancer
DIAGNOSIS
I Testicular ultrasound.
I CXR and abdominal/pelvic CT to evaluate for metastasis.
I Tumor markers are useful for diagnosis and in monitoring treatment re-
sponse.
I β-hCG is always elevated in choriocarcinoma and is elevated in 10% of
seminomas.
I α-fetoprotein (AFP) is often elevated in nonseminomatous germ cell tu-
mors, particularly endodermal sinus (yolk sac) tumors. It is also elevated in hepatocellular carcinoma, hepatoblastoma, and neuroblastoma.
