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SmartyPance:GU & Renal > GU Pearls - Sheet1 > Flashcards

GU Pearls - Sheet1 Flashcards

1
Q

Eosinophils, WBC casts and hematuria

A

Interstitial nephritis. Usually an allergic reaction to a drug. Dx: renal biopsy - will see interstitial inflammatory cell infiltrates. Tx: discontinuing offending drug, corticosteroids, Dialysis if needed, usually self limiting if caught early

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2
Q

FENa > 2% + MUDDY, PIGMENTED, GRANULAR CASTS, Renal tubular epithelial cells, + High Urine Osmolality

A

Acute tubular necrosis (ATN) - Often caused by Ampho”terrible”, contrast, NSAIDs. –Damage to the tubules means you are unable to concentrate urine which means a high FENa

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3
Q

Hematuria and RBC casts

A

glomerulonephritis

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4
Q

Causes of glomerulonephritis

A

1)Autoimmune; 2)Post streptococcal = (+) ASO Titer;

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5
Q

Broad waxy casts in urinary sediment

A

Chronic renal failure

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6
Q

Measurement of ______ is the gold standard for diagnosing and following the progression of chronic renal failure

A

GFR - Glomerular filtration rate. Measurement of GFR is the gold standard - The Cockcroft - Gault formula (requires age, body weight and serum creatinine) or Modification of Diet in Renal Disease equation

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7
Q

What is the GFR for Chronic Renal Failure

A

Typically applied to patients with GFR < 60 mL/min

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8
Q

TRIAD: Hematuria + pretibial edema + hypertension

A

Glomerulonephritis

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9
Q

Peaked T-Waves

A

Hyperkalemia

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10
Q

Flattening of T waves, U wave

A

Hypokalemia

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11
Q

Long QT

A

Hypocalcemia - Low and “slow” calcium has a long QT

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12
Q

Short QT

A

Hypercalcemia; “hyper” fast calcium can shorten the QT

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13
Q

Tall T wave

A

Hypomagnesemia

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14
Q

Prolonged PR, Widened QRS

A

Hypermagnesemia

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15
Q

How does chronic renal failure effect serum phosphate and calcium levels

A

Hyperphosphatemia (lack of urinary secretion) and Hypocalcemia. **(An impaired gastrointestinal absorption, related to low 1,25-dihydroxyvitamin D3 levels, and a decreased renal excretory capacity may render chronic kidney disease (CKD) patients at risk for either a negative or a positive calcium balance). Increased PTH and osteoporosis

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16
Q

Young child with massive edema. Urine showing gross protein, no casts and oval fat bodies on microscopy hypoalbuminemia, hyperlipidemia and lipiduria

A

Nephrotic syndrome

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17
Q

Nephrotic syndrome is defined as urinary excretion of greater than ___________ of protein on a 24 hour urine.

A

Nephrotic syndrome is defined as urinary excretion of > 3 g of protein on a 24 hour urine due to a glomerular disorder plus edema and hypoalbuminemia. –Proteinuria occurs because of changes to capillary endothelial cells, the glomerular basement membrane (GBM), or podocytes, which normally filter serum protein selectively by size and charge

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18
Q

Child with idiopathic nephrotic syndrome improves after treatment with corticosteroids

A

Minimal change disease - Most common cause of nephrotic syndrome in children (25% of adult cases) Usually idiopathic. Dx: renal biopsy

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19
Q

Non diabetic adult with nephrotic syndrome and history of cancer

A

Membranous nephropathy- Most common cause of nephrotic syndrome in adults. Immune mediated with immune complex deposition. Secondarily associated with hep B, syphilis, lupus, carcinoma and several others

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20
Q

Adult with nephrotic syndrome and history of heroin or cocaine abuse and HTN

A

Focal segmental glomerulosclerosis- More nephrotic than others with RBCs. Tx: prednisone. ESRD in 5-10 years

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21
Q

Nephrotic syndrome - glomeruli fill with amorphous deposits that stain with Congo red showing green birefringence

A

Amyloidosis- Accumulation of protein in various organs. ESRD in 2-3 years with five year survival < 20%

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22
Q

Is the FENa (fractional excretion of sodium) low normal or high in acute tubular necrosis?

A

High- Damage to the tubules means you are unable to concentrate urine which means a high excretion of sodium into the urine

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23
Q

Is the FENa (fractional excretion of sodium) low normal or high in pre renal failure?

A

Normal- Tubules work fine and are concentrating ue urine normally so you have a normal FENa

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24
Q

Elevation of the testicle relieves the pain

A

a positive Prehn’s sign seen in epididymitis

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25
Q

What urinalysis findings are consistent with acute tubular necrosis?

A

Muddy casts and renal tubular cells

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26
Q

Which type of acute renal injury is most likely following injection of radiocontrast dye?

A

Acute Tubular Necrosis (ATN)

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27
Q

What is the most common cause of prerenal failure?

A

Dehydration

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28
Q

What type of incontinence results from activity such as laughing or coughing?

A

Stress incontinence

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29
Q

What type of incontinence results from an over active detrusor muscle?

A

Urge incontinence

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30
Q

What are the most common causative agents for prostatitis in an 15-30 year old male?

A

Chlamydia and/or gonorrhea

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31
Q

What is the most common causative agent for prostatitis in an elderly male?

A

E. Coli

32
Q

What nephropathy is associated with lupus and +ANA

A

Membranous nephropathy

33
Q

The most common type of bladder cancer

A

Transitional cell carcinoma

34
Q

Patient presents with flank pain and a palpable flank mass

A

Renal cell carcinoma

35
Q

Name the two most common causes of nephrotic syndrome

A

Focal Segmental Glomerulosclerosis (FSGS) - Membranous glomerulonephritis

36
Q

The most common type of kidney stone

A

Calcium oxylate

37
Q

Inability to retract the foreskin from the penis

A

Phimosis

38
Q

Inability to return foreskin to normal position causes tourniquet effect, is a medical emergency

A

Paraphimosis

39
Q

Facial muscle contracts in response to tapping of the facial nerve

A

Chvostek’s sign - seen in patients with hypocalcemia

40
Q

Described as Bag of worms in scrotum?

A

Varicocele

41
Q

Most common presentation for bladder carcinoma?

A

Painless hematuria

42
Q

Proteinuria and fatty casts in urine

A

Nephrotic syndrome

43
Q

Antineutrophilic cytoplasmic autoantibodies (ANCA)

A

Wegener’s granulomatosis

44
Q

Name the most common type of renal cell carcinoma

A

Clear Cell

45
Q

Most common mechanism of acute renal failure? Prerenal, renal or postrenal

A

Prerenal- will have a low FENa < 1 (kidney has decreased perfusion which results in ↑ aldosterone and NA+ retention in an attempt to increase pressure) Since sodium is retained you will have a low to normal amount of sodium in the urine.

46
Q

What type of nephropathy is associated with carcinomas?

A

Membranous nephropathy

47
Q

Most common type of kidney damage associated with HIV?

A

Focal Segmental Glomerulosclerosis (FSGS) presenting as nephrotic syndrome

48
Q

A 33 year old female presents with persistent hypertension refractory to medical treatment with ≥ 3 drugs. She has an abdominal bruit on exam

A

Think Renal Artery Stenosis

49
Q

In hyponatremia serum Na should be corrected slowly by no more than ____________ 24 h to avoid osmotic demyelination syndrome

A

≤ 10 mEq/L = Except possibly during the first few hours of treatment of severe hyponatremia, Na should be corrected no faster than 0.5 mEq/L/h

50
Q

Hyponatremia is defined as plasma sodium concentration less than ____________ mEq/L

A

135 mEq/L

51
Q

Definition of hypernatremia

A

By definition, plasma sodium will be greater than 145 mEq/L

52
Q

Deficient secretion of vasopressin (ADH - anti-piss-hormone) from the posterior pituitary

A

Neurogenic (central) diabetes insipidus

53
Q

kidneys that are unresponsive to normal vasopressin levels

A

Nephrogenic diabetes insipidus - Usually inherited X-linked or from lithium or renal disease

54
Q

What is the treatment for asymptomatic hyponatremia?

A

Fluid restriction

55
Q

Transitional cell carcinoma

A

bladder cancer

56
Q

Clear cell carcinoma

A

renal cell carcinoma

57
Q

Most common type of testicular cancer

A

seminoma- Seminomatous tumors are radiosensitive and can be treated with radiation therapy. –Nonseminomatous tumors are radioresistant

58
Q

What PSA level is considered elevated

A

PSA > 4 think BPH, prostate CA and prostatitis

59
Q

When to start screening for prostate cancer

A

White male average risk: 50 years old - Black male, + FMHX or + BRCA mutations: 40 years old

60
Q

Which of the following tumor markers can be used to identify early relapse in testicular cancer?

A

Alpha fetoprotein (AFP)

61
Q

Child with painless, unilateral abdominal mass with no other signs of symptoms

A

Wilms tumor- also known as nephroblastoma, is the most common solid renal tumor of childhood. Most cases of Wilms tumor are curable

62
Q

Treatment of lower UTI in pregnancy

A

Nitrofurantoin (Macrobid): 100 mg PO BID × 7 days 0r Cephalexin (Keflex): 500 mg PO BID × 7 days

63
Q

Urinalysis reveals crystals resembling coffin lids. KUB reveals a staghorn calculus in the right kidney

A

Struvite stones

64
Q

When to refer for orchiopexy in a patient with cryptorchidism

A

If still non-palpable at 6 mo well-child exam, refer to urology/surgery for evaluation and possible orchiopexy

65
Q

Asymmetric high riding testicle “bell clapper deformity”

A

Testicular torsion

66
Q

Hyaline casts

A

non-specific may be seen in normal urine

67
Q

Fatty casts and oval fat bodies

A

nephrotic syndrome due to hyperlipidemia

68
Q

Waxy casts

A

chronic renal failure - likely chronic ATN or glomerulonephritis

69
Q

WBC casts

A

Acute interstitial nephritis or pyelonephritis

70
Q

muddy brown fasts or epithelial casts

A

acute tubular necrosis

71
Q

RBC casts

A

acute glomerulonephritis

72
Q

Three Step Approach to Acid Base Disorders

A

1)Look at PH is it acidosis or alkalosis (7.35-7.45 is normal);< 7.35 = acidosis; > 7.45 = alkalosis. 2)Look at your PCO2 is it normal, low, or high (35-45 normal); ↑ CO2 and ↓PH = respiratory acidosis; ↓ CO2 and ↑ PH = respiratory alkalosis. 3)If you don’t see a change in the CO2 in relation to the PH then take a look at the HCO3. 4)Finally look at the HCO3 is it normal, low, or high (20-26 normal); ↓ HCO3 and ↓PH = metabolic acidosis; ↑ HCO3 and ↑ PH =metabolic alkalosis

73
Q

A patient with the following ABG has what type of acid-base disorder? PH 7.52 (7.35-7.45 normal); PCO2 25 (35-45 normal); HCO3 22 (20-26 normal)

A

A high PH means this is alkalosis. Next look at the PCO2 it is not normal and is low. Therefore this is a RESPIRATORY ALKALOSIS.

74
Q

Elevated BUN disproportionate to Creatinine indicates?

A

The ratio is predictive of prerenal injury when BUN:Cr exceeds 20 or when urea:Cr exceeds 100. In prerenal injury, urea increases disproportionately to creatinine due to enhanced proximal tubular reabsorption that follows the enhanced transport of sodium and water.

75
Q

Fever and Oliguria after kidney transplant

A

Acute rejection

SmartyPance:GU & Renal (4 decks)

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