Genitourinary Disorders Flashcards
triamterene
potassium-sparing diuretic
ethacrynic acid
non-sulfa loop diuretic
metolazone
thiazide diuretic indicated for cirrhosis
torsemide
loop diuretic
bumetanide
loop diuretic
amiloride
potassium sparing diuretic
diuretic indicated for acute pulmonary edema
furosemide
diuretic indicated for idiopathic hypercalciuria
HCTZ
diuretic indicated for glaucoma
acetazolamide or mannitol
diuretic indicated for mild to moderate CHF with expanded ECV
loop diuretic
diuretic indicated in conjunction with loop or thiazide diuretics to retain potassium
spironolactone
diuretic indicated for edema associated with nephrotic syndrome
loop diuretic or thalazone
diuretic indicated for increased intracranial pressure
mannitol
diuretic indicated for hypercalcemia
furosemide
diuretic indicated for altitude sickness
acetazolamide
diuretic indicated for hyperaldosteronism
spironolactone
most common nephrotic syndrome in children
minimal change disease
IF: granular pattern of immune complex deposition
LM: hypercellular glomeruli
post-streptococcal glomerulonephritis
IF: linear pattern of immune complex deposition
goodpasture’s syndrome
kimmelstiel-wilson lesions
diabetic glomerulonephorpathy
most common nephrotic syndrome in adults
membranous glomerulonephritis
EM: loss of epithelial foot processes
minimal change disease
nephrotic syndrome associated with hepatitis B
type I membranoproliferative glomerulonephritis
nephrotic syndrome associated with HIV
FSGS
anti-GBM antibodies, hematuria, and hemoptysis
goodpasture’s syndrome
EM: subendothelial humps and tram-track appearance
type I membranoproliferative glomerulonephritis
nephritis, deafness, cataracts
alport’s syndrome
LM: crescent formation in the glomeruli
idiopathic crescentic glomerulonephritis
LM: segmental sclerosis and hyalinosis
FSGS
purpura on back fo arms and legs, abdominal pain, IgA nephropathy
henoch-schonlein purpura
apple-green birefringence with congo-red stain under polarized light
renal amyloidosis
anti-dsDNA antibodies
lupus nephritis
EM: spike and dome pattern of the basement membrane
membranous glomerulonephritis
60 year old smoker has varicocele that does not empty when recumbent, what should you be suspicious of
renal cell carcinoma
next step: CT abdomen
glomerulonephritis with bilateral sensorineural deafness
alport’s syndrome
dietary recommendations to treatment of nephrolithiasis
fluid intake, adequate dietary calcium, decrease sodium intake, decrease dietary protein and oxalate
young black male presents with painless hematuria
sickle cell trait
treatment for uric acid renal stones
alkalization of urine
most common cause of nephrotic syndrome in african american males
FSGS
medications used in treatment of wegner’s granulomatosis
corticosteroids and cyclophosphamide
classic presentation of poststreptococcal glomerulonephritis
brown urine and hypertension 1-3 weeks post throat infection
most common cause of morbidity and mortality in patients with SLE
renal disease
defining characteristics of nephrotic syndrome
proteinuria > 3g/day, hyperlipidemia, hypoalbuminemia, edema, hypertension
fever, rash, elevated creatinine, and eosinophilia
acute interstitial nephritis
biggest risk factor for renal cell carcinoma
cigarette smoke
5 etiologies of temporary hematuria
endometriosis, trauma, exercise, UTI, nephrolithiasis, idiopathic
most common location of renal stone impaction
uretero-vesicular junction
class of diuretic most commonly used in patietns with renal stones due to hypercalciuria and normal serum calcium level
thiazide diuretics
name 4 potassium sparing diuretics
spironolactone, epleranone, triamterene, amiloride
what size calcium renal stone has 50% likelihood of passing without surgical intervention
8-9 mm
volume status expected in a hyponatremic patient with thiazide diuretics
dehydration
volume status expected in a hyponatremic patient with SIADH
euvolemic
volume status expected in a hyponatremic patient with hepatic cirrhosis
volume overload
volume status expected in a hyponatremic patient with addison’s disease
hypovolemic
volume status expected in a hyponatremic patient with hypothyroidism
euvolemic
volume status expected in a hyponatremic patient with renal failure
volume overload or euvolemic
volume status expected in a hyponatremic patient with psychogenic polydipsia
euvolemic
urine sodium and serum osmolality in SIADH
FeNa > 1
serum osmolality < 280
urine sodium and serum osmolality in psychogenic polydipsia
FeNa < 1
serum osmolality < 280
urine sodium and serum osmolality in thiazide use
FeNa > 1
serum osmolality < 280
urine sodium and serum osmolality in alcoholism
FeNa < 1
serum osmolality < 280
urine sodium and serum osmolality in hypothyroidism
FeNa > 1
serum osmolality < 280
differential diagnosis for hypovolemic hyponatremia if FeNa < 1
GI losses, excessive sweating, burn victims, fluid sequestration from pancreatitis
differential diagnosis for hypovolemic hyponatremia if FeNa > 1
diuretic use, adrenal insufficiency, salt-losing renal disease, urinary tract obstruction
differential diagnosis for hypervolemic hyponatremia
FeNa < 1: CHF, nephrotic syndrome, liver failure
FeNa > 1: renal failure
rapid correction with hypertonic saline can cause
central pontine myelinolysis
rapid correction with hypotonic saline can cause
cerebral edema
causes of SIADH
CNS pathology, sarcoidosis, paraneoplastic syndromes, psychiatric drugs, major surgery, pneumonia, or HIV
treatment of SIADH
first line: fluid restriction
second line: loop diuretics, hypertonic saline if symptomatic, demeclocycline may help
causes potassium to shift out of cells (hyperkalemia)
low insulin, beta-blockers, acidosis, digoxin, and cell lysis (leukemia)
causes potassium to shift into cells (hypokalemia)
insulin, beta-agonists, alkalosis, cell creation/proliferation
diagnosis: hyponatremia, low serum osmolality, high urine osmolality
SIADH
next step in management of patient with peaked T waves on EKG due to hyperkalemia
calcium gluconate
what is the most common cause of death in dialysis patients
cardiovascular disease
electrolyte abnormality associated with peaked T waves
hyperkalemia
electrolyte abnormality associated with flattened T waves
hypokalemia
electrolyte abnormality associated with U waves
hypokalemia
electrolyte abnormality associated with QT prolongation
hypocalcemia
electrolyte abnormality associated with QT shortening
hypercalcemia
characteristics of type I renal tubular acidosis
urine pH > 5.3
hypokalemia
serum bicarb can be low or elevated
characteristics of type II renal tubular acidosis
urine pH > 5.3
hypokalemia
serum bicarbonate is low
characteristics of type IV renal tubular acidosis
aldosterone deficiency
urine pH < 5.3
hyperkalemia
serum bicarbonate is normal
how rapidly can hypernatremia be safely corrected
no more than 12 mEq/day
how rapidly can hyponatremia be safely corrected
no more than 12 mEq/day
causes of euvolemic hyponatremia
SIADH, hypothyroidism, polydipsia, sometimes renal failure
treatment for nephrogenic diabetes insipidus
thiazide diuretics +/- indomethacin
for lithium induced: amiloride
how are sodium levels corrected for high glucose
add 1.6 mEq/L sodium for every 100 mg/dL glucose > 100 mg/dL
how are total calcium levels corrected for albumin
(4 - serum albumin) x 0.8 + serum calcium
causes of normal anion gap metabolic acidosis
diarrhea, sniffing glue, TPN, renal tubular acidosis, and primary adrenal failure
what medications are necessary in patients with end stage renal disease
anti-hypertensives, hyperlipidemia medications, glucose control, vitamin D, phosphate binders, kayexalate, erythropoietin
most common renal failure in multiple myeloma
toxic effect of light chain casts on renal tubules
most common renal failure in multiple myeloma
toxic effect of light chain casts on renal tubules
nephrolithiasis associated with crohn’s disease
oxalate kidney stones
hydrocele management
observe until 12 months, most resolve
remove surgically after 12 months to reduce risk of inguinal hernia
