GU Flashcards
Defintion of nephritic syndrome (5)
Glomerulonephritis
Intrinsic form of AKI
HTN+ RBC casts in urine + Incr Creatinine + edema + dysmorphic RBCs
What two bacteria cause nephritic syndrome commonly
Staph
Strep viridans [ think kids; post strep GN]
Immune causes of GN
SLE
IgA Nephropathy
Management with GN patients?
Salt and water restriction
Diuretics
ACE/ARBS
TXT if infection
What part of the kidney is effected in good pastures syndrome
Glomerular basement membrane
Anti-GBM Abs +
TXM Good Pastures Syndrome
Tx
1. Admit
2. Plasmapheresis (plasma exchange to remove circulating anti-GBM antibodies)
3. Prednisone
4. Cyclophosphamide
What is present in nephrotic syndrome
a. S/Sx: proteinuria, hypoalbuminemia, edema, hyperlipidemia, frothy urine
i. Edema predominant feature (d/t loss of proteins and albumin; fluid leaves blood)
b. Urinalysis: proteinuria > 3.5 g/day, urine dipstick protein 3+ or 4+, fatty casts, oval fat bodies
3 important characteristics of minimal change disease
Loss of podocytes on electron microscopy
Effects children 2-7 yrs
+ Hypercoagable = DVTs and PEs
Defintion of AKI
Defined as ↑ SCr by ≥ 0.3 mg/dL w/in 48 hrs or ↑ SCr ≥ 1.5x baseline or urine output < 0.5 mL/kg/hr for 6 hr
S/Sx: dark cola-colored urine, flank pain, low urine volume; uremia → N/V, malaise, anorexia, fatigue, pruritus,
AMS
Abrupt reduction in GFR
Azotemia refers to
Abnormal levels of urea and creatinine
Pre Renal Azotemia :
Prerenal azotemia: impaired renal perfusion w/ resultant ↓ in glomerular capillary filtration pressure
i. MC cause of AKI
ii. BUN:Cr ratio often > 20:1
iii. Labs: ↑ SCr, ↑ BUN, metabolic acidosis, hyperkalemia, hyperphosphatemia, anemia, platelet dysfxn, ↓
GFR
Causes of pre renal Azotemia (3)
- Hypovolemia
- NSAIDs + ACE-I
- Iodinated radiocontrast agents (↑ risk for pts w/ renal impairment, DM, HF)
Intrinsic Azotemia represents ___ and Causes
i. Hallmark = structure injury to kidney
ii. Causes
1. Acute tubular necrosis (ATN): MC cause of AKI d/t intrinsic renal dz; can be ischemic or
nephrotoxic
a. Ischemic is common in ICU pts w/ hypotension
b. Nephrotoxic: hemoglobin, myoglobin (rhabdomyolysis), medications, or ingested
poisons (ethylene glycol)
c. Muddy brown casts-granular-ATN
- Acute glomerulonephritis (AGN): characterized by inflammatory glomerular lesions
- Acute interstitial nephritis (AIN): drug rxn
iii. ↑ FeNa
= increase in fractional excretion of sodium. Due to DIRECT INJURY
Triad of {physical exam findings} Intrinsic Azotemia
a. Triad: fever, transient maculopapular rash, arthralgias
Think what causes for post renal Azotemia and labs?
Causes
1. BPH
- Urethral obstruction: clot, kidney stones, tumor, etc.
iii. Labs: ↑ osmolality, ↓ urine sodium (FeNa), ↑ BUN:Cr
Indications for acute dialysis in patients with renal impairment?
Indications for acute dialysis
- Acidosis and refractory to HCO3
- Hyperkalemia > 6.5 mmol/L or w/ ECG changes (↑ t waves)
- Ingestion of lithium or ethylene glycol
- Uremia (may present w/ pericarditis or ↓ in mental status)
a. S/Sx: anorexia, nausea, vomiting, metallic taste
b. PE: asterixis, pericardial rub
Alarming sxs in renal impairment
a. S/Sx: anorexia, nausea, vomiting, metallic taste
b. PE: asterixis, pericardial rub
2 common complications of post renal Azotemia
Hyperkalemia
Pulmonary edema
Chronic kidney disease requires decreased GFR for how long
Greater 3 months
Markers of kidney damage (3)
Markers of kidney damage:
proteinuria,
structural abnormalities on imaging,
abnml urinary sediment or
chemistries
Decreased EPO assoc with CKD can lead to what?
Metabolic acidosis with anemia
What is a kidney related reason to add ezetimibe if dyslipedmic and over the age of 50
GFR less 60
Indications for dialysis in ESRD (7)
i. GFR < 10
ii. Fluid overload unresponsive to diuresis
iii. Refractory hyperkalemia
iv. Uremic sxs
v. Severe metabolic acidosis
vi. Neuro sxs
vii. BUN > 100
Indications for dialysis in ESRD (7)
i. GFR < 10
ii. Fluid overload unresponsive to diuresis
iii. Refractory hyperkalemia iv. Uremic sxs
v. Severe metabolic acidosis
vi. Neuro sxs
vii. BUN > 100
What is Prehns sign in epididymitis
Raising the scrotal ; relieves pain
Management of epididymitis
viii. Labs: UA, culture, STI panel, +/- US to r/o torsion
ix. Tx
- STI: Ceftriaxone + Doxycycline
- Non-STI: Ofloxacin or Levofloxacin
- Viral or non-infxn: sx care → NSAIDs, ice packs, bed rest, scrotal elevation
Acute bacterial prostatitis is usually what 2?
E Coli
Psuedomonas
TXM for prostatitis includes? Inpatient vs Outpatient
Labs: UA, pyuria, bacteriuria, hematuria, CBC, culture
Transrectal US may be needed to ID a prostatic abscess if no response to abx w/in 24-48 hrs
. Tx
a. Outpt
i. Empiric: FQ, double-strength TMP-SMX
ii. Consider tx for STI for men < 35 y/o
b. Inpt: pts who cannot tolerate PO or have major comorbidities
i. IV FQ +/- aminoglycoside ii. IV beta-lactam w/ enteric coverage +/- aminoglycosides
c. If urinary retention → catheter
d. F/u w/ urine and prostatic secretion cultures → ensure eradication
Sxs of chronic bacterial prostatitis ; get what?
S/Sx: afebrile, irritative voiding sxs, urethral pain, and obstructive urinary sxs; low back and
perineal pain; hx of UTIs
Get a UA with Culture
Bacterial prostatitis with systemic signs [ADMITTED] treatment?
Inpt: pts w/ systemic signs
i. IV therapy w/ broad-spectrum abx → Ampicillin + Gentamicin, 3rd gen
Cephalosporin, or FQ
Labs: ↑ leukocytes in prostatic secretions, negative cultures ; think?
Non bacterial Prostatitis
TXM for prostate cancer
Tx
1. Localized: acute surveillance for older pts w/ low-risk cancer; pts w/ life expectancy > 10 yrs
should be considered for with urology. [Gold Plates for Radiation/Chemo]
mean age for bladder cancer in males?
73 y/o
Over 40 with painless hematuria you’re thinking ; smoker
Bladder cancer
Painless hematuria smoker over 40 yrs old male;
Bladder cancer
Confirmed by ; Cystoscopy and Bx
Painless hematuria smoker over 40 yrs old male;
Bladder cancer
Confirmed by ; Cystoscopy and Bx
Triad of renal cell carcinoma + SMOKER
Hematuria
Flank pain
ABD/Renal Mass
3 common characteristics of testicular cancer
i. MC neoplasm in men 15-35 y/o (young man’s cancer)
ii. Typical presentation: painless mass
iii. RF: cryptorchidism, testicular trauma/torsion, infxn-related testicular atrophy, chemical exposure/pollutants
Treatment for testicular cancer
Radicle orchiectomy
Labs that are high in testicular cancer
HcG
AFP
LDH
RF and Protective Factors for Ovarian Cancer
RF = Advancing Age ; Early menarche ; Late menopause ; Nulliparity ; Fam Hx
Protective = Contraceptive Use; Tubal Ligation; Hysterectomy
Young patients with HTN / CVDz / Flank Pain / ABD mass ; may result in ESRD ; think
Polycystic kidney disease
Reasons for renal artery stenosis @ (60-70yrs) and (20-30yrs)
60-70 yrs old = atherosclerosis
20-30 yrs old = fibromuscular dysplasia
If someone develops an AKI after starting an ACE think?
renal artery stenosis
Initial and Gold Standard test for Renal Artery Stenosis
Initial = Renal U/S
Gold = CT renal A
MC pathogens in acute cystitis
E Coli
Staph
Saprophyticus
Workup for male cystitis (3)
ABD U/S
Post void residual testing
Cystoscope
TXM for acute cystitis ; first line ; pain ; and pregnant
Tx
1. Nitrofurantoin or TMP/SMX, Norfloxacin, Ciprofloxacin, Levofloxacin
- Phenazopyridine (Pyridium): 200 mg TID
- Pregnant: Amoxicillin, Cephalexin, Nitrofurantoin
Recurrent acute cystitis is defined as ; and treated with
Greater 3 episodes in a year:
TMP / SMX
Nitrofurantoin
Cephalexin
Characteristics of interstitial cystitis
Pain with bladder filling; relieved by emptying
Chracteristics of interstitial cystitis
Painful bladder filling; relieved by emptying
Negative UA/Culture
Cystoscopy = Glommerulations / Hunters Lesion
TXM of interstitial cystitis
Tx: no cure → tx aimed at sx relief
1. 1st line: general relaxation / stress management, diet, pt education, behavioral modification, pain
management
- 2nd line: medications – Amitriptyline, Hydroxyzine, Cimetidine, Intravesical dimethyl sulfoxide
- 3rd line: Hydrodistention; intradetrusor botox
TXM of Pyelo
- FQ or TMP-SMX
- If inpt or pregnant: ampicillin/gentamicin or 3rd gen cephalosporin
Discuss the 4 common types of stones in kidney disease
i. MC caused by calcium oxalate
ii. Struvite: staghorn calculi, urease-producing bacteria
iii. Uric acid: radiolucent on XR, gout
iv. Cystine: children w/ metabolic dz
Discuss txm based on kidney stone size
- < 5 mm: likely to pass spontaneously
- > 8 mm: unlikely to pass; lithotripsy
What are the obstructive vs irritative sxs in BPH
Obstructive sx: hesitancy, ↓ force and caliber of stream, sensation of incomplete bladder emptying, double voiding, straining to urinate, post-void dribbling
Irritate sxs: frequency, urgency, nocturia, dysuria
Physical exam findings BPH vs Prostate Cancer/Prostatitis
f. PE: smooth, symmetric, firm yet elastic enlargement is c/w BPH
g. If indurated or asymmetrical → further w/u to r/o cancer (TRUS) /prostatitis
Meds and definitive management of BPH
- Alpha blockers (-osin) - ALLOW DILATION OF URETER TO IMPROVE FLOW
- 5-alpha-reductase inhibitors (Finasteride/Dutasteride) -SHRINK THE PROSTATE 2 WEEKS ISH
- Tadalafil: FDA approved for BPH and/or urinary tract sxs in pts w/ ED-IF ALSO HAVE ED
ABSOLUTE = TURP ; may need a repeat TURP
5 CAUSES OF ED
i. Vascular: CV dz, HTN, DM, hyperlipidemia, smoking, major surgery, radiotherapy
ii. Neurologic: spinal cord/brain injuries, Parkinson dz, Alzheimers dz, MS, stroke, major surgery,
radiotherapy of prostate
iii. Local penile factors: Peyronie’s dz, cavernous fibrosis, penile fX
iv. Hormonal: hypogonadism, hyperprolactinemia, hyper/hypo hypothyroidism, hyper/hypocortisolism
v. Drug Induced : anti-HTN; anti-psychs ; anti-depressives anti androgens; alcohol
Management of ED
Tx
1. Lifestyle changes: smoking cessation, wgt loss, gastric bypass, CPAP for sleep apnea
- Phosphodiesterase-5 inhibitors: Sildenafil, Vardenafil, Tadalafil, Avanafil
- 2nd line: vacuum-assisted erection devices, penile self-injection, intraurethral alprostadil
- Surgery
Urge inconvenience think ; TXM
Overactive bladder -Detrusor Increased activity!
W/ Nocturia
TXM = anti Cholinergics
Stress incontinence ; description and treatment
i. MC caused by muscle weakness
ii. S/Sx: small amount of urine loss when coughing, laughing, or sneezing
iii. Tx
1. Kegel exercises (PFT) 2. Estrogen replacement 3. Surgery
Acididemia; Bicarbonate and CO2 levels
pH less than 7.35
Bicarbonate -less 24 = +
CO2- greater 40 = +
Alkalemia Bicarbonate and CO2 levels
pH greater than 7.45
Bicarbonate - greater than 24 = +
CO2 - less than 40 = +
MUDDY Brown Granular casts represent what?
Degenerating RBCs
Acute Tubular Necrosis
Waxy casts represent what?
Severe urine stasis ;
chronic renal f.
Waxy casts represent what?
Severe urine stasis ‘
Chronic renal f.
Broad casts represent what?
Dilated or atrophic renal tubules 2nd to parenychmal damage ;
ESRD
Associated state with fatty casts
Nephrotic syndrome
White cell casts are more common in ___ than ___
Pyelonephritis ; than lower bladder tract infection
What it’s the hallmark kind of cast in glomerulonephritis
Red Cell Cast
2 types of casts found in acute tubular necrosis
1) Renal tubular epithelial cell cast
2) Granular Muddy Brown Cast
