GU

Question 1

Rhabdomyolysis

Answer 1

Patho: myoglobins released from damaged muscle

S&S: acute onset muscle pain, weakness, dark urine (myoglobinaria)

Complication: acute kidney failure

Question 2

Acute pyelonephritis

Answer 2

E. Coli most common

S&S: acute onset high fever, chills, N/V, dysuria, frequent urine, unilateral flank pain (deep ache). May have recent UTI. Costovertebral angle tenderness.

Dx: Large number of leukocytes, hematuria, +/‑ nitrites, and mild proteinuria. WBC casts. Leukocytosis

Tx: can treat out patient if compliant and healthy, fluoroquinolone (Cipro or levaquin)
Hospitalize if complicated

Question 3

Acute Kidney Injury (Acute Renal Failure)

Answer 3

Causes: prerenal, intrarenal, postrenal

S&S: abrupt onset oliguria, edema, weight gain. Lethargy, nausea, anorexia. Usually lasts 7-21 days

Dx: rapid decrease in renal function

Tx: usually reversible (common causes of drug-induced AKI are aminoglycosides, contrast agents, nonsteroidal anti-inflammatory drugs (NSAIDs), angiotensin-converting enzyme (ACE) inhibitors, and protease inhibitors.)

Question 4

Bladder cancer

Answer 4

Risk: smokes

Painless hematuria
May have irritative voiding symptoms (dysuria, frequent urination, nocturia) that are not related to a UTI.
advanced disease with metastases may complain of lower abdominal or pelvic pain, perineal pain, low-back pain, or bone pain.

Question 5

What hormones do kidneys secrete?

Answer 5

erythropoietin (red blood cell [RBC] production), renin and bradykinin (blood pressure), prostaglandins (renal perfusion), and calcitriol/vitamin D3 (bone).

Question 6

Normal kidney labs

Answer 6

Serum Creatinine
Male: 0.7 to 1.3 mg/dL
Female: 0.6 to 1.1 mg/dL
- affected by muscle mass
- inc is bad

Creatinine Clearance (24-hour Urine)
- more sensitive than serum

Estimated Glomerular Filtration Rate
Normal: eGFR >90 mL/min
Chronic kidney disease: eGFR <60 mL/min for at least 3 months (or longer)
-best test to measure kidney function
-The more damaged the kidneys, the lower the eGFR.

BUN
A high BUN may be caused by acute kidney failure (lowers GFR), high-protein diet, hemolysis, congestive heart failure, or drugs
Low BUN can be caused by liver damage or dz

Question 7

UA

Answer 7

Large amounts of squamous epithelial cells in a urine sample indicate contamination.

Normal white blood cells (WBCs) in urine: ≤2 to 5 WBCs/hpf

Few RBCs (<3 cells) is considered normal.

Protein = kidney damage

Nitrates = UTI

Question 8

What is The gold-standard test for measuring protein excretion of the kidneys?

Answer 8

24-hour urine for protein

Question 9

types of proteinuria

Answer 9

glomerular, tubular, overflow, and postrenal.

Question 10

Asymptomatic Bacteriuria

Answer 10

Patho: bacteria in urine w/o symptoms

If fever, could be sepsis

Should screen pregnant women and treat

Question 11

UTI

Answer 11

Usually caused by E. Coli

UTIs in children younger than age 3 and pregnant women (20%–40% chance) are more likely to progress to pyelonephritis.

S&S: onset of dysuria, frequency, frequent urge to urinate, and nocturia. Afebrile
if fever >99.9°F, chills, significant fatigue or malaise, flank pain, or CVA tenderness, rule out acute pyelonephritis.

Dx: + leukocytes, + nitrites
C&S

Tx:
Uncomplicated (Acute Simple Cystitis)
-Nitrofurantoin
- bactrim
Complicated ( male, child, pregnant, etc)
-cipro or levofloxacin

Question 12

Male UTI

Answer 12

UTIs in newborn males, infants, and older men are considered complicated.

Underlying structural issues (urethral stricture, benign prostatic hyperplasia [BPH], calculi, uncircumcised) should be considered.

S&S: dysuria, frequency, hesitancy, slow urinary stream, nocturia, and urgency; some have suprapubic pain.

If sexually active, rule out gonorrhea and chlamydia infection (use nucleic acid amplification test [NAAT]).

Question 13

Nephrolithiasis (Renal Calculi)

Answer 13

Most stones are calcium oxalate
Risks: h/o stones, fam hx, bariatric sx

S&S: acute onset of severe colicky flank pain (renal colic) on one side that comes in waves. Pain can cause N/V. Hematuria

Dx: strain urine
CT preferred

Tx: most will pass in 48hr
For large stones: extracorporeal shock wave lithotripsy (ESWL)
NSAID or opioid for pain
Inc fluids
Avoid high-oxalate foods such as rhubarb, spinach, okra, nuts, beets, chocolate, tea, and meats.

Avoid high-oxalate foods such as rhubarb, spinach, okra, nuts, beets, chocolate, tea, and meats.