Glomerulonephritis and polycystic kidneys Flashcards
If there is initial stream hematuria, where is the source?
Probably urethral
If there is inital stream hematuria, where is the source?
bladder neck or prostate
prostatic pain
perineum
vesical pain
suprapubic discomfort
penile pain
usually an STD
testicular pain
acute conditions such as torsion of testis or epididymitis
Irrititative processes usually present as:
urgency, dysuria, frequency, incontinence
obstructive processes classically present as:
urgency, frequency, NOCTURIA, HESITANCY, POST-VOID DRIBBLING, and incontinence
After age 40, how much does GFR drop per year?
1%
When do urea levels rise sharply?
With a 40-60% decrease in nephron function
How is dehydration different from volume depletion?
dehydration is pure water loss, volume depletion is water and salt loss
Describe the levels of SIADH
serum osmolality is decreased, urine osmolality is increased, patient is euvolemic
How do you correct asymptomatic hyponatremia?
water restriction of .9% NS with lasix and demeclocycline (conivaptan probably better)
Hypertonic hyponatremia
most commonly seen with hyperglycemia
What is dilute urine (osmo less than 250) and hypernatremia symbolic of?
Nephrogenic DI
What is the most common cause of hypokalemia?
Diuretic use
What are signs of hypokalemia?
muscular weakness, fatigue, muscle cramps, broad T waves, prominent U waves and depressed ST segments
How to correct hypokalemia?
slowly, monitor EKG
What are signs of hyperkalemia?
muscle weakness, abd distention, diarrhea. EKG changes show peaked T waves, widended QRS
How to treat a cardiac toxic or muscular paralytic hyperkalemic patient?
EMERGENT insulin plus 10-15% glucose, consider nebulized albuterol
DIALYSIS if renal insufficiency!
What is the most common cause of hypocalcemia?
renal failure
What are symptoms of hypocalcemia?
extensive spasming of skeletal muscles, Chvostek’s and trousseau’s sign, prolonged QT interval
What is the treatment of hypocalcemia?
severe or symptomatic: IV
asymptomatic: oral
What is the most common cause of hypercalcemia?
primary hyperparathyroidism
What are symptoms of hypercalcemia?
constipation, polyuria, stupor, coma
What labs to do you always check with hypercalcemia?
PTH and PTH related protein
How do you treat hypercalcemia?
Saline with lasix to avoid fluid overload
What if malignancy is the cause of hyperca2+?
use biphosphates
What qualifies a condition as malignant hypertension?
HTN plus end organ damage (heart, brain, kidney, eye)
What are two classifications of causes of glomerulonephritis?
Renal only
and renal caused by systemic disease (post strep)
Hematuria, proteinuria, red cell casts
glomerulonephritis
What is the most common cause of glomerulonephritis worldwide?
IgA nephropathy GLNITIS (Berger’s Disease)
How does Berger’s disease present in adults?
asymptomatic microscopic hematuria
How does Berger’s disease present in children?
gross hematuria following URI
What is the most common systemic vasculitis in children? What does it resemble?
Henoch-Schonlein Purpura; IgA nephropathy but with SKIN, GI, or ARTHRALGIA
What is one cause of glomerulonephritis that is tested with an ASO titer? In whom does it occur? What is the treatment?
Post group A beta-hemolytic strep; occurs in children, treatment is supportive
What is the most common form of glomerular damage in developed countries?
Diabetes; ALWAYS DO A 24 HOUR URINE PROTEIN SCREEN TO CHECK FOR MICROALBUMINURIA
What are Three systemic diseases that involve the glomerulus?
Lupus (SLE), amylodosis, and diabetes
What do patients with amylodosis usually present with?
cardiac myopathies (restricted)
What cause of glomerulonephritis involves the vessels, a positive ANCA test, and pulmonary hemorrhage?
Wegener’s granulomatosis
What cause of glomerulonephritis involves an anti-glomerular basement membrane antibody? What other presentation might you see?
Goodpasture’s syndrome; hemoptysis (pulmonary involvement)
Which ZEBRA will present with glomerulonephritis, fever, malaise, weight loss, and either superficial or deep vessel involvement?
Polyarteritis nodosa
What are PE findings in glomerulonephritis?
Hypertension
Dark, smoky, cola-colored urine
Periorbital and sacral edema
oliguria (400 ml/day)
What will lab findings in glomerulonephritis be?
RBC casts and subnephrotic proteinuria (less than 3.0g per 24 hr)=nephritic
What should a workup for glomerulonephritis include? What if they are febrile?
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
What is the gold standard for glomerulonephritis diagnosis?
renal biopsy and immunoflourescent microscopy
What is the treatment for glomerulonephritis?
Avoidance of salt, fluid restriction, avoidance of high potassium foods, correct electrolyte imbalance, treat infection if needed, LOOPS, and steroids (specialists only)
What is the most common age for diagnosis of polycystic kidney disease?
20-40, 90% are inherited
What is the most common CC for PKD?
Pain in flank, belly, or back
What is the PE of PKD?
PALPABLE FLANK MASS and hypertension
What are some other possible presenting sx of PKD?
HA, nocturia, hematuria, nephrolitiasis (20%), UTI
What should a workup for PKD include?
Low hemoglobin, low HCT, low erythropoetin, (normocytic normochromic anemia), electrolytes, BUN/Cr, UA
What is the easiest and most cost effective imaging for PKD?
Abd renal U/S. Abd CT is more sensitive and MRI is more sensitive still
What drugs can you use to treat HTN of PKD?
ACE-Inhibitors, avoid sports, nephrolithiasis
