GU - UWorld Flashcards
Elderly patient with bone pain, hypercalcemia and renail failure has what unless proven otherwise?
Multiple myeloma
Why do upto 50% of multiple myeloma patients have some degree of renal insufficiency?
Most likely due to obstruction of the distal and collecting tubules by large laminated casts containing paraproteins (mainly Bence Jones)
Contrast administration has the potential to cause ?, particularly in patients with ?
Contrast induced nephropathy, particularly in patients with diabetes and or renal insufficiency (Cr>1.5)
Emergency plasmapharesis is required in patients with which pulmonary-renal syndrome?
Goodpasture’s sydnrome
Whenever test results demonstrate a large amount of blood on urinalysis with a relative absence of RBCs on urine microscopy, what should you suspect?
Myoglobinuria
Is a detailed metabolic evaluation needed for a patient who presents with first renal stone?
No
Rheumatoid arthritis predisposes to what nephrotic syndrome?
Amyloidosis
What is the most common cause of AA amyloidosis and AL amyloidosis?
1) AA amyloidosis – rheumatoid arrhtitis 2) AL amyloidosis – Multiple myeloma
What are the renal biopsy findings of amyloidosis?
Congo-red staining fo the deposits, characteristic apple-green birefringence under polarized light.
Which renal stones are radiolucent?
Uric acid, xanthine stones
Uric acid stones are radioluecent but can be seen on? In what are they soluble and what is the treatment of choice?
CT scan or ultrasound. Highly soluble in alkaline urine; alkalinization of the urine to pH 6-6.5 with oral potassium citrate is the treatment of choice.
What is hyperuricosuria?
Abnormally high amounts of uric acid in the urine.
Gross painless hematuria is a/w what in adults?
Bladder tumors/malignancies
Patients age >35 with gross hematuria should be evaluated how?
Evaluated for urological neoplasms with imaging (CT urogram) and cystoscopy.
75-90% of kidney stones are composed of?
Calcium oxalate
What conditions/diseases predispose to formation of calcium oxalate stone formation?
small bowel disease, surgical resection or chronic diarrhea can lead to malabsorption of fatty acids and bile salts => unabsorbed fatty acids chelate to calcium => more absorption of oxalate
What renal disease can occur 10-20 days after streptococcoal throat or skin infection?
Post-streptococcal glomerulonephritis
Treatment of choice for fibromuscular dysplasia that causes renal artery stenosis is?
Percutaneous angioplasty with stent placement.
Features concerning for malignant renal mass include?
Multilocular mass, irregular walls, thickened septae, and contrast enhancement.
What are the major extra-renal complications of ADPKD
Potential HTN, hepatic cysts, valvular heart disease (MVP and aortic regurgitation), colonic diverticula, intracranial berry aneurysms.
What is the first renal change in diabetic nephropathy?
Glomerular hyperfiltration
What is the first change that can be quantitated in diabetic nephropathy?
Thickening of glomerular basement membrane
What are the common complications of nephrotic syndrome?
Hypercoagulability of which renal vein thrombosis is the most common, other complications protein malnutrition, iron microcytic hypochromic resistant anemia, increased susceptbility to infection, and vit D deficiency.
What measures can be taken to prevent urinary calcium formation?
Increase fluid intake, follow a low-sodium, low-protein diet, maintain moderate calcium intake, take thiazide diuretics to reduce urinary calcium excretion.
Long-term analgesic use with 1 or more analegesics can cause what kind of kidney disease?
Chronic kidney disease due to tubulointerstitial nephritis and hematuria due to papillary necrosis
Drugs with anticholinergic properities (for eg?) can cause what urinary problem?
For example, amitriptyline.
Acute rejection after renal transplant is best treated by?
IV stesroids
How does anabolic steroid use produce infertility?
Anabolic steroids contain exogenous testosterone => suppresses GnRH release from hypothalamus => decreased FSH and Lh release from pituitary => decreased sperm and testosterone production from testes.
Patients with diabetes > 10 years can develop what kind of renal disease?
Microangiopathy, nephropathy and glomerulosclerosis.
What are the clinical findings for chronic kidney disase?
Mild to moderate proteinuria, CKD, elevated creatinine.
What is the best diagnostic test for renal stones?
CT without contrast
What is hepatorenal syndrome and what is the treatment?
Complication fo end stage liver disease in which the kidney does not respond to volume resuscitation. Only treatment with proven benefit is liver transplantation.
Example of first generation H1 antihistamine?
Diphenhydramine, chlorpheniramine, doxepin and hydroxyzine.
H1 antihistamines have what kind of effects?
Anti-cholinergic effects such as urinary retention, oropharyngeal dryness, dry eyes
what is the qualitative screening test for cystinuria?
Urinary cyanide nitroprusside test
What is cystinuria?
Inherited group of disorders of dibasic amino acid transport. Causes recurrent renal stones.
What are the clues for diagnosis for cystinuria?
Recurrent renal stone formation, positive family history, hexagonal crystals on urinalysis, and positive urinary cyanide test.
What is interstitial cystitis?
AKA plainful bladder syndrome is a chronic idiopathic condition characterized by bladder pain that is relieved by voiding and worsened by filling. Dysparaeunia, urinary frequency and urgency may also be experienced.
What test confirms the dx of uncomplicated cystitis?
Urinalysis.
Do you need a urine culture for patients with uncomplicated cystitis?
Patients can be treated without a urine culture, which may be done later in patients with failed initial therapy
What are the effective first-line tx options for uncomplicated cystitis?
Nitrofurantoin for 5 days (avoid in patients with creatinine clearance 20%), fosfomycin single dose, fluoroquinolines if above can’t be used. Urine culture only if initial tx fiails.
What is the mnemonic that describes indication for urgent dialysis?
AEIOU (Acidosis, electrolyte abnormalities, intestion, overload, uremia)
Asterixis is seen in?
Hepatic encelphalopathy, uremic encelphalopathy, CO2 retention.
Muddy brown granular casts
Acute tubular necrosis
RBC casts
Glomerulonephritis
WBC casts
Interstitial nephritis and pyelonephritis
Fatty casts
Nephrotic syndrome
Broad and waxy casts
Chronic renal failure
Prolonged hypotension from any cause can lead to what renal condition?
Acute tubular necrosis.
Wht is the most common form of drug induced chronic renal failure?
Analgesic nephropathy
What are the most common pathologies seen in analgesic nephropathy?
Tubulointerstitial nephritis and papillary necrosis
Patients with chronic analgesic abuse are more likely to develop?
Premature aging, atherosclerotic vascular disease, urinary tract cancer.
Initial hematuria indicates
urethral damage.
Total hematuria indicates
Renal or ureter damage
Terminal hematuria indicates
Bladder or prostatic damage
What are the common causes of acute pericarditis?
Most common - viral. Other common - uremia, bacterial infections, and connective tissue diseases.
Drug induced interstitial nephritis is usually caused by?
Cephalosporins, sulfonamides, penicillins, allopurinol, phenytoin, rfampin, NSAIDS
Clinical PPT of drug induced allergic interstitial nephritis
Eosinophiluria, arthralgias, rash, renal failure
Pathologic hallmark for diabetic nephropathy/most common hallmark?
Nodular glomerulosclerosis (Kimmelstiel-Wilson nodules) and diffuse glomerulosclerosis
Diabetic neprhopathy is characterized by?
Increased proteinuria and decreased GFR
How does renal vein thrombosis presents?
Sudden abdominal pain, fever and hematuria
What form of neprhotic syndrome presents most commonly with renal vein thrombosis?
Membranous glomerulonephritis
Main differences between IgA nephropathy and post infectious glomeruloneprhitis
IgA nephropathy: earlier onset (5 days after onset of pharyngitis) - synpharyntigic vs Post-infectious glomeruloneprhitis is 10-21 days after (post-pharyngitic). IgA usually occurs in young adults, especially men ages 20-30, Post-infectious glomeruloneprhitis usually occurs in children but can also occur in adults. Dx wise, IgA nephropathy usually has normal complement levels whereas low C3 levels with post-infectious glomerulonephritis. Kidney biopsy: mesangial IgA deposits seen in kidney biopsy with IgA nephropathy. supeptihelial humps consisting of C3 complement in post-infectious glomerulonephritis.
What is the major cause of anemia (normocytic normochromic) in patients with end stage renal disease
Defieciency of EPO
What is the tx of choice for patients with anemia and ESRD?
Recombinnant EPO
Most common side effects of recombinant EPO?
worsening of HTN (30%), headaches (15% of patients) and flu like symptoms (5%)
Membranoprolfierative glomerulonephritis, type 2 (also called dense deposit disease) stains for?
C3
What are the top two leading causes of ESRD in the US?
1) Diabetic neprhotpathy 2) HTN
What are the most common renal vascular lesions seen in HTN and diabetic nephropathy?
o HTN: Arteriosclerotic lesions of afferent and efferent arterioles and glomerular capillary tufts
o Diabetic nephropathy: Increased extracellular matrix, BM thickening, mesangial expansion and fibrosis
Mechanism of action for Tacrolimus and cyclosporine?
calcineurin inhibitors that result in blocking of the transcription of IL-2 and several other cytokines, mainly for the T helper lymphocytes
Major toxocities for tacrolimus and cyclosporine?
Nephrotoxicity, hyperkalemia, hypertension, gum hypertrophy, hirsutism and tremor. Tacrolimus is similar except for hirsutism and gum hypertrophy
Major side effects of azathioprine (purine analog that acts primarily by inhibiting purine synthesis) is ?
dose-related diarrhea, leukopenia, and hepatotoxicity
Major side effect for mycophenolate (reversible inhibitor of inosine monophosphate dehydrogenase IMDPH which is the RLS of de novo purine synthesis?
Bone marrow suppression
What is the most common form of nephrotic syndrome a/w carcinoma?
Membranous nephropathy
What is the most common form of nephrotic syndrome a/w lymphoma?
Minimal change disease
How does contrast induced nephropathy present?
Spike in creatinine within the first 24 hours with a return to normal renal function wtihin 5-7 days.
Who is at risk for contrast induced nephropathy?
Diabetics and patients with chronic renal insufficiency (creatinine 1.5mg/dL)
What can be done to minimize contrast induced nephropathy?
Adequate pre-CT IV hydration (isotonic bicarbonate or normal saline) and administration of acetylcsysteine
What kind of drug is amikacin?
Aminoglycoside. Amikacin is usually used for multi-drug resistant gram negative rods.Potentially nephrotoxic and drug levels and renal function must be monitored closely during therapy.
Rifampin causes what to body fluids?
red to orange discoloration of body fluids including urine, saliva, sweat and tears. Red urine is usually a benign drug effect.
Acute bacterial prostatitis presents with what additional sx compared to UTIs?
Perineal pains, pronounced systemic sx (fever, chills, ) and a tender, boggy prostate on exam.
What is the most common cause of abnormal hemostatisis in patients with chronic renal failure?
Platelet dysfunction
What tests (times) are normal and abnormal?
aPTT, PT, and TT are normal. BT is abnormally long.
What is the tx of choice for platelet dysfunction?
Desmopressin. Platelelet transfusion is not indicated
Varicoceles are what? And how do they present?
Torturous dilation of pampniform plexus. Present with bag of worms scrotal mass. Usually on left side due to compression of left renal vein by aorta and SMA. Worsens with standing and Valsalva maneuver and regresses in supine position.
What medicationss cause priapism?
Trazadone and prazosin
What is seen on gram stain and urine culture for chlamydia trachomatis?
Nothing visualied on gram stain and nothing recovered in conventional culture.
How is dx made for chlamydial urethritis and what is tx?
Chlamydial urethritis: nucleic acid amplification. Tx: azithromycin or doxycycline.
Uric acid stones are radio-opque or radiolucent?
Radiolucent
How are uric acid stones evaluated?
CT of the abdomen, ultrasonography or IV pyelography
ADPKD ppt?
Renal cysts, bilateral flank pain, hematuria, UTIs a and nephrolithiasis.
How should uric acid stones be evaluated?
They are radiolucent and should be evaluated by CT of abdomen, ultrasound, or IV pyelography (imaging of the ureter and renal pelvis by injecting contrast).
Patient’s gross hematuria with normal appearing RBCs suggests what kind of etiology?
Extra-glomerular
What are the renal complications of sickle cell trait?
Hematuria – usually from papillary necrosis/ischemia, UTIs and renal medullary cancer.
Rhabdomyolysis is marked by what kind of labs?
Marked elevations in serum creatine phosphokinase (CPK), potassium.
Renal failure in rhabdomyolysis is caused by?
Acute tubular necrosis from excess filtered myoglobin. Risk of myoglobin induced renal failure increases when CPK > 20,000 units/L.
Acyclovir nephrotoxicity usually causes what kind of kidney damage?
Acute kidney injury due to tubular obstruction and not acute interstitial nephritis or ATN.
Most common cause of death in dialysis patients?
Cardiovascular disease (also in renal transplant patients).
