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Clin Med 2 > Glomerulonephritis and polycystic kidneys > Flashcards

Glomerulonephritis and polycystic kidneys Flashcards

1
Q

If there is initial stream hematuria, where is the source?

A

Probably urethral

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2
Q

If there is inital stream hematuria, where is the source?

A

bladder neck or prostate

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3
Q

prostatic pain

A

perineum

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4
Q

vesical pain

A

suprapubic discomfort

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5
Q

penile pain

A

usually an STD

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6
Q

testicular pain

A

acute conditions such as torsion of testis or epididymitis

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7
Q

Irrititative processes usually present as:

A

urgency, dysuria, frequency, incontinence

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8
Q

obstructive processes classically present as:

A

urgency, frequency, NOCTURIA, HESITANCY, POST-VOID DRIBBLING, and incontinence

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9
Q

After age 40, how much does GFR drop per year?

A

1%

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10
Q

When do urea levels rise sharply?

A

With a 40-60% decrease in nephron function

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11
Q

How is dehydration different from volume depletion?

A

dehydration is pure water loss, volume depletion is water and salt loss

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12
Q

Describe the levels of SIADH

A

serum osmolality is decreased, urine osmolality is increased, patient is euvolemic

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13
Q

How do you correct asymptomatic hyponatremia?

A

water restriction of .9% NS with lasix and demeclocycline (conivaptan probably better)

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14
Q

Hypertonic hyponatremia

A

most commonly seen with hyperglycemia

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15
Q

What is dilute urine (osmo less than 250) and hypernatremia symbolic of?

A

Nephrogenic DI

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16
Q

What is the most common cause of hypokalemia?

A

Diuretic use

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17
Q

What are signs of hypokalemia?

A

muscular weakness, fatigue, muscle cramps, broad T waves, prominent U waves and depressed ST segments

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18
Q

How to correct hypokalemia?

A

slowly, monitor EKG

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19
Q

What are signs of hyperkalemia?

A

muscle weakness, abd distention, diarrhea. EKG changes show peaked T waves, widended QRS

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20
Q

How to treat a cardiac toxic or muscular paralytic hyperkalemic patient?

A

EMERGENT insulin plus 10-15% glucose, consider nebulized albuterol
DIALYSIS if renal insufficiency!

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21
Q

What is the most common cause of hypocalcemia?

A

renal failure

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22
Q

What are symptoms of hypocalcemia?

A

extensive spasming of skeletal muscles, Chvostek’s and trousseau’s sign, prolonged QT interval

23
Q

What is the treatment of hypocalcemia?

A

severe or symptomatic: IV

asymptomatic: oral

24
Q

What is the most common cause of hypercalcemia?

A

primary hyperparathyroidism

25
Q

What are symptoms of hypercalcemia?

A

constipation, polyuria, stupor, coma

26
Q

What labs to do you always check with hypercalcemia?

A

PTH and PTH related protein

27
Q

How do you treat hypercalcemia?

A

Saline with lasix to avoid fluid overload

28
Q

What if malignancy is the cause of hyperca2+?

A

use biphosphates

29
Q

What qualifies a condition as malignant hypertension?

A

HTN plus end organ damage (heart, brain, kidney, eye)

30
Q

What are two classifications of causes of glomerulonephritis?

A

Renal only

and renal caused by systemic disease (post strep)

31
Q

Hematuria, proteinuria, red cell casts

A

glomerulonephritis

32
Q

What is the most common cause of glomerulonephritis worldwide?

A

IgA nephropathy GLNITIS (Berger’s Disease)

33
Q

How does Berger’s disease present in adults?

A

asymptomatic microscopic hematuria

34
Q

How does Berger’s disease present in children?

A

gross hematuria following URI

35
Q

What is the most common systemic vasculitis in children? What does it resemble?

A

Henoch-Schonlein Purpura; IgA nephropathy but with SKIN, GI, or ARTHRALGIA

36
Q

What is one cause of glomerulonephritis that is tested with an ASO titer? In whom does it occur? What is the treatment?

A

Post group A beta-hemolytic strep; occurs in children, treatment is supportive

37
Q

What is the most common form of glomerular damage in developed countries?

A

Diabetes; ALWAYS DO A 24 HOUR URINE PROTEIN SCREEN TO CHECK FOR MICROALBUMINURIA

38
Q

What are Three systemic diseases that involve the glomerulus?

A

Lupus (SLE), amylodosis, and diabetes

39
Q

What do patients with amylodosis usually present with?

A

cardiac myopathies (restricted)

40
Q

What cause of glomerulonephritis involves the vessels, a positive ANCA test, and pulmonary hemorrhage?

A

Wegener’s granulomatosis

41
Q

What cause of glomerulonephritis involves an anti-glomerular basement membrane antibody? What other presentation might you see?

A

Goodpasture’s syndrome; hemoptysis (pulmonary involvement)

42
Q

Which ZEBRA will present with glomerulonephritis, fever, malaise, weight loss, and either superficial or deep vessel involvement?

A

Polyarteritis nodosa

43
Q

What are PE findings in glomerulonephritis?

A

Hypertension
Dark, smoky, cola-colored urine
Periorbital and sacral edema
oliguria (400 ml/day)

44
Q

What will lab findings in glomerulonephritis be?

A

RBC casts and subnephrotic proteinuria (less than 3.0g per 24 hr)=nephritic

45
Q

What should a workup for glomerulonephritis include? What if they are febrile?

A

UA, serum BUN/Cr, GFR, 24 hour urine protein and Cr clearance, streptococcal tests such as ASO, ANCA, and BLOOD CULTURES IN ALL FEBRILE PATIENTS

46
Q

What is the gold standard for glomerulonephritis diagnosis?

A

renal biopsy and immunoflourescent microscopy

47
Q

What is the treatment for glomerulonephritis?

A

Avoidance of salt, fluid restriction, avoidance of high potassium foods, correct electrolyte imbalance, treat infection if needed, LOOPS, and steroids (specialists only)

48
Q

What is the most common age for diagnosis of polycystic kidney disease?

A

20-40, 90% are inherited

49
Q

What is the most common CC for PKD?

A

Pain in flank, belly, or back

50
Q

What is the PE of PKD?

A

PALPABLE FLANK MASS and hypertension

51
Q

What are some other possible presenting sx of PKD?

A

HA, nocturia, hematuria, nephrolitiasis (20%), UTI

52
Q

What should a workup for PKD include?

A

Low hemoglobin, low HCT, low erythropoetin, (normocytic normochromic anemia), electrolytes, BUN/Cr, UA

53
Q

What is the easiest and most cost effective imaging for PKD?

A

Abd renal U/S. Abd CT is more sensitive and MRI is more sensitive still

54
Q

What drugs can you use to treat HTN of PKD?

A

ACE-Inhibitors, avoid sports, nephrolithiasis

Clin Med 2 (13 decks)

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