General Flashcards
Urinalysis finding in:
Glomerulonephritis
Nephrotic syndrome
Interstitial nephritis
GN: RBC casts, proteinuria, hematuria
Nephrotic syndrome: fatty casts, oval bodies, proteinuria
Interstitial nephritis: WBC casts without bacteria, proteinuria
Components of nephrotic syndrome
Proteinuria, hypoalbuminemia, edema, hyperlipidemia, hypercoagulability
Will also see oval fat bodies in urine
Treatment of nephrotic syndrome
Fluid restriction, iv diuresis,ACEi
Steroids
Patient with nephrotic syndrome presents with hematuria, flank Pain and worsening renal function .. what complication should be considered
Renal vein thrombosis
Causes of pseudohematuria
Foods (beers, berries, rhubarb), meds (rifampin, phenazopyridine, nitofurantoin), porphyrias
Match clinical feature with disease. Gross hematuria with: A) dysuria, frequency B) hemoptysis C) recent URTI D) RBC casts, proteinuria E) petechiae/purpura, schistocytes F) nephrotic syndrome, flank pain G) developing countries
A) uti B) goodpastures, Wegener C) glomerulonephritis D) glomerulonephritis E) HUS / TTP F) renal vein thrombosis G) schistosomiasis
What should you consider if a dipstick is positive for heme but no RBCs are seen on microscopy
Rhabdomyolysis
Who should get imaging in hematuria
Gross hematuria and risk factors for serious etiology (>35, abdo pain , excessive analgesic use)
Where along GU tract should you suggest pathology for hematuria:
At beginning of stream
Throughout stream
At end of stream
Urethral
Proximal to urethra
Bladder neck or prosthatic urethra
Two possible treatments to relieve bladder spasms in patients with bladder cancer and hematuria
Belladonna and opium suppositories
4 renal causes of AKI
Glomerulonephritis
AIN
ATN
vascular
What should be considered as a cause of AKI in a patient who just started an ACEi
Bilateral renal artery stenosis
4 causes of pre renal AKI
Hypovolemia
Volume redistribution (third spacing, sepsis, hypoalbuminemic states eg cirrhosis)
Decreased effective cardiac output (MI, cardiomyopathy, valvular disease)
Meds limiting perfusion (ACEi, NSAIDs)
What happens to the urine sodium and the fractional excretion of sodium in pre renal AKI
Low urine sodium and low fractional excretion of sodium
Treatment of pre renal AKI
Correct hypovolemia, augment cardiac output
Discontinue ACEi, NSAIDs
Correct electrolyte imbalance
Causes of glomerulonephritis
Primary eg Post streptococcal
Secondary to systemic disease eg SLE, Goodpasture, vasculitis
Management of glomerulonephritis
Supportive care, control BP
Steroids and immunesuppressants for underlying systemic illness (not for post strep GN)
Lab and UA findings in AIN
meds that can cause AIN
Treatment of AIN
Elevated Cr
WBC, WBC casts, eosinophils on UA
Meds: penicillin, anticoagulants, NSAIDs, diuretics
Treatment is supportive, stop offending agent, steroids if no improvement in 3-7d
3 causes of acute tubular necrosis
Renal ischemia (surgery, sepsis, trauma) Nephrotoxic agents (contrasts, aminoglycosides) Pigments (myoglobin in rhabdo, hemoglobin in hemolysis)
Diagnostic criteria for ATN
Loss of urine concentrating ability
UA shows granular muddy brown casts, renal tubular casts. Consider rhabdo if UA positive for heme but never for RBCs
Urine osmolality = serum osmolality
Macro and micro vascular causes of renal AKI
Macro: renal artery occlusion, AAA
micro: HUS, TTP, embolus, malignant hypertension
6 causes of bladder outlet obstruction
BPH stones Tumor Clot Neurogenic bladder Posterior urethral valve Urethral stricture Phimosis
How does uremic frost present
Deposition of urea from evaporated sweat, fine white powder on skin
10 manifestations of CKD
Uremia
Volume overload, pulmonary edema
Hypertension
Pericarditis (look for tamponade in sick ESRD pt)
Anemia (decreased EPO)
Bleeding
Encephalopathy (altered mental status, hiccups, asterixis)
Peripheral neuropathy
Immunesuppression
Hyperkalemia
Systemic calcification (consider calciphylaxis in violaceous skin lesions with ESRD)
Management of CKD
If not in ESRD look for AKI on CKD
Manage HTN, hyperk and pulm edema
Dialysis
Renal transplant
Management of actively bleeding ESRD patient
DDAVP is first line (releases vWF)
Cryo (factors I, II, VIII, XIII, VWF)
Transfuse for symptomatic under 70
Conjugated estrogens
By what mechanism may furosemide still be helpful in cardiogenic edema in Anuric patients
Vasodilation
5 indications for emergent dialysis
Acid base disturbance (severe metabolic acidosis)
Electrolyte disturbance (hyperkalemia, hypercalcemia)
Ingestions (salicylates, alcohols, lithium, barbiturates)
Overload (severe HTN, pulmonary edema)
Uremia symptomatic (pericarditis, encephalopathy, nausea/vomiting, twitching)
5 renal colic mimics
AAA pyelonephritis Testicular torsion Ovarian torsion Acute papillary necrosis
5 sites where renal calculi cause obstruction
calyx, ureteropelvic junction, uretovesicular junction, vesical orifice, pelvic brim
This type of renal stone is caused by urea splitting bacteria (pseudomonas, klebsiella, staph, proteus) and can cause stag horn calculi
Struvite
When should imaging be performed in suspected renal colic
Patient looks sick, diagnosis in question, first episode flank pain, suspect high grade obstruction
What percentage of stones >8 mm will pass
20% only, often need lithotripsy or surgical intervention
Criteria for admission for renal colic
Solitary kidney
Acute renal insufficiency
Obstructing stone with infection
Intractable pain or vomiting
11 factors making UTI Complicated
Men Elderly (>65) Pregnant Pyelo Indwelling catheter Recent instrumentation Structural urinary tract abnormalities Treatment failure Immunesuppressed Recent hospitalization
Most likely cause of dysuria and Pyuria
Urethritis or prostatitis (not UTI)
What type of bacteria do nitrites on UA
Gram-negative UA
Duration of therapy for:
A)Uncomplicated cystitis
B)Uncomplicated cystitis with comorbidities
C)Uncomplicated pyelo
D)Complicated UTI
E)Pregnancy (including asymptomatic bacteriuria)
F)Pregnant pyelo
A) 3-5 B) 7 C) 14 D) 14 E) 7 F) 14
Admission criteria for uti
Extremes of age Systemic toxicity Renal failure Obstruction Complicated uti have lower threshold Intractable vomiting or pain
Treatment of acute bacterial prostatitis
<35 treat at STI: ceftriaxone 250 mg IM and doxy x 10d
>35 : GN predominates. Fluoroquinolone
In chronic bacterial: fluoroquinolone x 4 weeks or septa x 1-3 months
Two types of painful penile ulcers and their treatment
Hsv : acyclovir
Chancroid: azithro or cipro or ceftriaxone
Presentation of lymphogranuloma venereum and treatment
Chlamydia. Transient, painless ulcer followed by tender unilateral inguinal adenopathy
Doxy
Differential for presenting with both oral and penile ulcers
Behcets, Stevens Johnson syndrome, pemphigus vulgaris, Reiter syndrome
