Genioutinary #2 Flashcards
big 3 kidney function tests
serum creatinine
blood urea nitrogen (BUN)
glomerular filtration rate (GFR)
acute kidney injury (AKI) definition
Abrupt decline in renal function leading to increased nitrogenous waste products normally excreted by the kidney
acute kidney injury characterized by (2)
azometmia (increased BUN and creatinine)
abnormal urine volume (can manifest as anuria or oliguria)
etiology of hyponatreamia (serum Na+ <135 mmol/L)
diuretics (especially THIAZIDES)
diarrhea
excessive sweating
etiology of hypernatremamia + what is it
reduced fluid intake, increased fluid loss
serum (NA+) >145 mmol/L
hypokalemia etiology (serum K <3.5 mEq/L)
limited dietary intake GI losses (diarrhea, laxatives) hyperaldosteronism (e.g Conn's syndrome)
DIURETICS (FUROSEMIDE, HYDROCHLOROTHIAZIDE)
big sign and symptom change of hypokalemia
arrythmias, found on ECG CHANGES**
hyperkalemia etiology (serum K >5.0 mEq/L(
factitious (sample hemolysis)
renal failure
MEDS - NSAIDs, ACEI, Angiotensin 2 receptor blockers, heparin, spironolactone
symptoms of hyperkalemia
usually asymptomatic, but will see ECG changes and cardiotoxcity
what is key aspect of nephrotic syndrome
protienuria > 3.5g/day
Hallmark of NEPHRITIC syndrome
(RBCs in urine) aka hematuria
clinical features of nephritic syndrome (3)
Proteinuria (<3.5g/day)
Hematuria
Azotemia (increased creatine and urea)
Post Streptococcal Glomerulonephritis (PSGN) cause? + age
group A beta hemolytic streptococci (strep pyogenes)
5-15years old
PSGN hallmark sign
Gross hematuria (coca-cola or tea colored, brown, smoky) urine
important investigation (aside from urinalysis and kidney function) for PSGN
Elevated Antistreptolysin O (ASO) titer
NSAIDs and vasomotor acute kidney injury, what do NSAIDs cause
renal ischemia (sad!)
tx: discontinue NSAIDs
NSAIDs and Acute Interstitial Nephritis (AIN) – what primarily does this?
Fenoprofen (60%), ibuprofen, naproxen
tx: discontinue NSAIDs!
symptoms of Acute Interstiail Nephritis (AIN)
fever and rash shortly after first dose of medication
What is Chronic Interstitial Nephritis caused by with meds
excessive antipyretics (PHENACETIN or ACETOMINOPHEN) in combination WITH NSAIDs!!!
Chronic Interstitial Nephritis clinical symptoms
gross hematuria, flank pain, declining renal function
Actue tubular necrosis is caused by what med?
acetaminophen
symptoms and investigation for Acute Tubular Necrosis
mental status change, edma, fatigue, nausea + vomiting
Urinalysis, MUDDY BROWN CASTS***(dead tubular cells)
treatment for acute tubular necrosis
dialysis..
what is def of chronic kidney disease (2)
Progressive decrease of kidney function >3m
Decreased GFR <60ml/min
What is end stage kidney disease and what is needed at that point
Stave V= GRF<15
dialysis and transplantation will be required
end stage renal disease presentatiojn (4)
volume overload - weight gain + edema
electrolyte abnormalities (High K, PO4, uric acid: LOW, ca2, hco3)
retention of urine
anemia, normocytic anemia due to decreased EPO and treatrment will be EPO replacement
normocytic anemai treatment for end stage renal disease
erythropoietin replacement therapy
2 types of cystic kidney disease
simple cysts (50% at 50)
polycistic kidney disease –> 2 types, autosomal recevessive leads to renal failure in kids, while autosomal dominant causes renal failure in adults
most common adult kidney neoplasm?
renal cell carcinoma
what are the 3 subtypes of renal cell carcinomas + % + which are in pros tuvule
- Clear cell renal cell carcinoma (70-75%)
- Papillary renal cell carcinoma (10-16%)
^both in prox tubule^ - Chromophobe renal cell carcinoma (%)
hereditary renal cell carcinoma is related to?
Von Hippel_lindau (VHL) syndrome (and hereditary papillary renal carcinoma)
Von Hippel Lindau disease manifested by?
retinal angiomas, central nervous system hemangiomas, and ccRCC
VHL gene does what?
under hypoxic conditions or if inactivated the number of proangiogenic and growth factors are produced with increase tumor and endothelial cellular proliferation and angiogenesis
classic too late triad in renal cell carinoma
gross hematuria, flank pain, palpable mass
most common sites of renal cell carcinoma metastases
bone, brain, lung, and liver (1/3 of cases do)
investigations for renal cell carcinoma (aside from CBC, ESR, Urine)
contrast-enhanced CT: highest sensitivity
renal biopsy
treatment for renal cell carcinoma (3)
radical nephrectomy
patrial nephrectomy
tyrosine kinase inhibitors for metastatic disease (Sunitinib, sorafenib)
Prognosis at diagnosis for renal cell carcinoma (T1, T2/3, metastasis)
STAGE = Most important prognostic factor
T1: 90% 5 yr survival
T2: 60% 5 yr survival
Mets: <5% 10 yr survival ):
main risk factor for bladder carcinoma
smoking (implicated in 60% of cases)
bladder classification (most common?)
Urothelial carcinoma (>90%)
Clinical features of bladder carcinoma
Hematuria is KEY SYMPTOM
85-90% of the time at diagnosis
pain 50% of time
bladder cancer gold standard investigation
Transurethral resection of bladder tumor (TURBT)
2nd best- cystoscopy with biopsy
Benign prostatic hyperplasia - what will you find on digital rectal exam
prostate is smooth, rubbery, and symmetrically enlarged
investigations for BPH
PSA <4 (normal)
PSA>10 (consider prostate cancer)
between 4 and 10 is grey zone
-physical exam (DRE)
Prostate Cancer - Digital Rectal Exam finding
hard, irregular asymmetrical nodule
MC cause of prostatitis
E. Coli
Lower urinary symptoms (as they relate to prostatitis) are?
Storage symptoms (Frequency, Urgency, Nocturia, Dysuria) & Voiding Symptoms (Stream changes, Hesitancy, Incomplete Emptying, Dribbling
Etiology of chronic Prostatitis bolded term
Recurrent UTI with same organism
