Module 4B Genitourinary and Renal Flashcards
1
Q
What is dysuria?
A
the subjective experience of pain or a burning sensation on urination and can also be accompanied by urinary frequency, hesitancy, urgency, and strangury (slow painful urination).
2
Q
what are some medications that can cause dysuria?
A
citalopram (celexa), escitalopram (lexapro), paroxetine (paxil), fluoxetine (prozac), and sertraline (zoloft), scopolamine
3
Q
what are some causes of hematuria?
A
infection, menstruation, vigorous exercise, viral illness, and trauma
4
Q
the specific gravity in a person who is dehydrated, has CHF, has diabetes mellitus, nephrosis will like have what kind of result?
A
increased specific gravity
5
Q
the specific gravity in a person with diabetes insipidus, pyelonephritis, glomerulonephritis, and excess fluid intake will have what kind of result?
A
decreased specific gravity
6
Q
positive bilirubin is associated with what differential diagnosis?
A
jaundice and hepatitis
7
Q
blood in urine is associated with what differential?
A
kidney stones, tumors, kidney disease, trauma, infection, injury for instrumentation, coagulation problems, menses
8
Q
glucose in urine is associated with what differentials?
A
diabetes mellitus, pancreatitis, cushing’s disease, shock, burns, corticosteroids, renal disease, hyperthyroidism, cancer
9
Q
ketones in urine is associated with what differentials?
A
starvation, diet, ketoacidosis, vomiting, diarrhea, pregnancy
10
Q
nitrates in urine is associated with what differentials?
A
infection
11
Q
protein in urine is associated with what differentials?
A
kidney disease, pregnancy, congestive heart failure, diabetes mellitus, cancer, benign cause
12
Q
leukocyte esterase in urine is associated with what?
A
infection
13
Q
proteinuria and hematuria is suggestive of what?
A
glomerular or interstitial nephritis
14
Q
what dietary substances act as irritants to the bladder?
A
caffeine, spices, tomatoes, chocolate, aged cheeses, citrus fruits, soy sauce, alcohol, cigarette smoking.
15
Q
hematuria accompanied by hypertension, edema, and a sore throat or a skin infection may be indicative of what?
A
post-streptococcal glomerulonephritis
16
Q
what are the two primary proteins found in the urine?
A
globulin and albumin
17
Q
What is the most accurate way to quantify the amount of protein in the urine?
A
24 hour urine measurement
18
Q
what is considered abnormal measurement for a 24 hour urine measurement?
A
a 24 hour urine collection with more than 150 mg of protein is considered abnormal
a specimen with more than 3.5 grams is indicative of a nephrotic process
19
Q
a urine albumin to urine creatinine ratio of less than 0.2 is considered what?
A
normal and corresponds to an excretion of less than 200 mg/dL of protein.
20
Q
if a 24 hour urine measurement has 3.0-3.5 gram of protein, the patient has what?
A
nephrotic syndrome
21
Q
what is the etiology of stress incontinence?
A
hypermobility of bladder neck, sphincter deficiency (intrinsic or neuro) or meds
22
Q
what is the etiology of urge incontinence?
A
UTI, vaginitis, bladder stones/tumors, cortical/subcortical suprasacral lesions, CVA, dementia, MS, parkinson’s, spinal cord injury, meds
23
Q
what is the etiology of function incontinence?
A
delirium, fecal impaction, lack of manual dexterity, or decreased mobility
24
Q
what is the etiology of overflow incontinence?
A
underactive detrusor activity, outlet obstruction DM or meds
25
what is the management of stress *incontinence?
kegel exercises, weight loss, electrical stimulation, HRT, alpha adrenergic agonists, surgical correction
26
what is the management of urge* incontinence?
antimicrobial agents, antiseptics, topical estrogens, anticholinergics, muscle relaxants smooths, antidepressants, biofeedback, bladder training
27
what is the management of overflow incontinence ?
scheduled toileting crede's maneuver, treat underlying conditions, alpha blockers, resection of prostate, balloon dilation
28
what is the management of function incontinence?
remove barriers to rapid toileting, provider barrier-free environment, bowel and bladder program, PT, habit training
29
what conditions are anticholinergics prescribed for?
Oxybutynin, tolterodine, darifenacin, trospium
Urge incontinence, overactive bladder, stress incontinence
30
when should you not use anticholinergics?
patients with closed-angle glaucoma, myasthenia gravis, gastric obstruction, colitis, urinary retention, gastric resection
31
what are side effects of anticholinergics?
dry mouth, dizziness, blurred vision, urinary hesistancy/retention, decreased GI motility, HA, constipation, vertigo/dizziness, abdominal pain
32
what are alpha 1 adrenergic blocking medications used to treat?
Benign prostate hyperplasia and related urinary symptoms
33
what are the side effects of alpha 1 adrenergic blocking medications?
doxazosin, terazosin, alfuzosin, tamsulosin
orthostatic hypotension, palpitations, dizziness, impotence, GI upset, headache
34
what is botulinum toxin used for ?
used for overactive bladder
se: utis, need for transient self catheterization
35
what is the crede's maneuver?
Involves applying pressure over the symphysis pubis and slowly pressing down
36
what is overflow incontinence?
the involuntary leakage of small amounts of urine, caused by overdistended bladder in a patient who does not feel the need to void b/c of atonic detrusor muscle
37
what does the Questionnaire for female urinary incontinence diagnosis (QUID) assess for?
stress incontinence
38
what does the SHIM score test for?
Erectile dysfunction
39
what is chronic kidney disease?
evidence of kidney damage for more than 3 months (urine albumin >30 mg/g creatinine, hematuria, or parenchymal abnormalities) and/or decreased kidney function (GFR<60ml/min per 1.73m2)
40
what is advanced chronic kidney disease ?
when GFR is less than 30 ml/min per 1.73 m2, characterized by accumulation of metabolic waste products in the blood, electrolyte abnormalities, mineral and bone disorders, and anemia.
41
chronic kidney disease is classified based on what ?
cause, GFR, albuminuria
42
what are some symptoms of chronic kidney disease?
skin pallor, ecchymosis, sleep disorder, hypertension, edema, JVD, leg cramps, restless leg, peripheral neuropathy, emotional lability, depression, decreased cognitive function, uremic frost, odor, generalized fatigue, nausea, anorexia, pruritis, smell and taste disturbances, hiccoughs, and seizures
43
what is the diagnosis of chronic kidney disease ?
An estimated GFR less than 60 ml/min
kidney damage markers:
albuminuria (AER >30mg/24 hour; ACR> 30mg/g)
urine sediment abnormalities
electrolyte abnormalities
structural abnormalities
kidney transplantation
44
what are the diagnostics for chronic kidney disease?
UA (look for albumin, RBC, WBC, casts and crystals)
Urine albumin to creatinine ration
serum creatinine
BUN
CMP (K+, NA+, chloride, carbon dioxide, calcium, phosphorous, glucose and uric acid)
urinary protein excretion
eGFR
CBC (anemias)
Cystatin C (used to estimate GFR)
BP
Glucose
Lipids
45
what is the treatment for level 1?
control BP
start the patient on an ACE or ARB (only 1 of them)
direct renin inhibitor
AVOID dihydropyridine Calcium channel blockers
control protein intake
46
what is the treatment for level 2?
restrict sodium intake
avoid anti-inflammatory drugs
control metabolic syndrome
beta blocker therapy
mineralocorticoid receptor antagonist therapy
control serum phosphorus
smoking cessation
alkali therapy
control serum phosphorous
avoid anticoagulant related nephropathy
monitor serum creatinine in pts on PPIs
47
why start a level 1 patient on a ACE or ARB?
decreased cardiovascular risk and slows progression of CKD
48
why start a level 1 patient on SGLT-2 inhibitor? (Canaglifozin, dapaglifozin)
slows progression of ESRD
49
why start a level 1 patient on a diuretic?
to avoid cardiopulmonary congestion
50
why start a level 1 patient on a statin?
adults older than 50 yrs with eGFR less than 60 should be on one
51
what are some nonpharmacologic therapies to avoid chronic kidney disease?
dietitian referral (restrict sodium, potassium, phosphorous)
control BP (
52
what are criteria for referral?
elevated protein
elevated hematuria
progression of CKD (look at GFR)--if decrease of GFR of 5 in 1 year of 10 in 5 yrs, refer!
uncontrolled HTN
Genetics
53
what diagnostic is most useful for acute kidney injury of unknown etiology ?
Kidney biopsy
54
what is cystain C?
a small protein biomarker used for determination of glomerular filtration.
55
what is the recommended protein intake for patients with CKD?
0.8g/kg per day
56
when should referral for kidney transplantation be considered for a CKD patient/
when the GFR is below 20
57
what stage is this?
Defined as a GFR between 30 and 59
Stage 3
58
what stage is this?
characterized by albuminuria with a GFR between 60 and 89
stage 2
59
what stage is this?
characterized by a GFR between 15 and 29
stage 4
60
what stage is this?
defined as a GFR less than 15
stage 5
61
what stage is this?
characterized by persistent albuminuria with a normal GFR greater than 90
stage 1
62
what is the diagnostic gold standard for evaluating renal artery stenosis?
renal angiography
63
what is acute kidney injury?
rapid impairment in kidney function that results in oliguria (abnormal small amt of urine) and retention of nitrogenous produces in the blood normally excreted by the kidneys
64
what is azotemia?
increase in urea and other nonprotein nitrogen (starts increasing as you see a decrease in GFR)
65
what is oliguria?
decrease in urine output
66
what meds can cause allergic interstitial nephritis?
the patient who takes NSAIDS, antibiotics, proton pump inhibitors
67
what is the classic triad for allergic interstitial nephritis?
fever, rash, and eosinophilia
68
what is acute tubuar necrosis?
the tubules in the kidneys become ischemia
(sepsis, rhabdo)
69
what is microvascular disease?
can be from thrombosis or ITP, cholesterol emboli
70
what is acidosis?
having too much acid in the body
the kidneys stop working and the body becomes acidic
ph is low
71
anemia in chronic kidney disease is caused
a decrease in their erythropoietin secretion
always develops in patients with severe kidney disease
(remember the kidneys produce erythropoietin)
72
what is osteomalacia ?
this is a condition in which the bones are partially absorbed and then they become weakened.
decrease of active vitamin D because of phosphate retention by the kidnesy
73
what is osteomalacia ?
this is a condition in which the bones are partially absorbed and then they become weakened.
decrease of active vitamin D because of phosphate retention by the kidneys (pts can end up with 2nd hyperparathyroid hormone)
74
what is the etiology of prerenal azotemia?
inadequate renal perfusion caused by hypovolemia, CHF (impaired cardiac output), cirrhosis (3rd spacing) sepsis (vasodilation), abdominal compartment syndrome.
75
what is the etiology of postrenal azotemia?
bladder outlet obstructions (BPH, urethral fibrosis), urethral obstruction (stones, bladder masses, retroperitoneal fibrosis, ureteral fibrosis, or renal vein occlusion. if 2 functioning kidneys, bilateral obstructions is usually required to produce significant AKI 5-15% of community acquired AKI
76
what is the etiology of intrinsic renal azotemia?
acute tubular necrosis, glomerulonephritis, allergic nephritis
77
when looking at kidney failure you would want to look at?
elevated serum creatinine, elevated BUN, hyperkalemia, hyperphosphatemia, metabolic acidosis, hypocalcemia, hyponatremia or hypernatremia
78
serum creatinine and GFR are what?
assessments of renal function
79
serum sodium, if high suggests what?
primary aldosteronism.
80
serum sodium, if low suggests what?
alerts to the need to avoid diuretics
81
serum calcium, if high suggests what?
primary hyperparathyroidism
82
UA with microscopic eval, what are signs of glomerulopathy?
may be normal in prerenal and postrenal AKI. Heavy proteinuria and hematuria identify a possible secondary cause (glomerulonephritis)
83
on an EKG, if concerned about hyperkalemia, what will you look for?
peaked T waves, widening QRS interval and bradycardia
84
on a chest x-ray, what are you looking for?
look for CHF, pulmonary renal syndromes that present with alveolar hemorrhage
85
what will you look for when using a bladder scanner?
to assess post-void residual urine when urinary obstruction is suspected
86
what will you look for with a kidney ultrasound?
US of kidneys determines the kidney sizes, presence of obstruction, and renal vascular status (doppler study)
87
what are the pearls for acute kidney injury?
watch for infection
obtain thorough medication hx
monitor for CKD in AKI survivors annually for at least 3 yrs. An initial visit within 3 months after d/c from the hospital
88
who gets UTIs?
infancy
childhood
adolescents
adult women
postmenopausal women
men
89
what is considered an uncomplicated UTI?
no structural or functional abnormality
healthy pre-menopausal woman
not pregnant
no significant comorbidities that could cause a worse outcome
90
what is considered a complicated UTI?
children
MEN
PREGNANT
obstruction of urine flow
At increased risk for infection (DM, immunocompromised, resistant organisms, upper tract infections)
surgery (instrumentation)-catheter
91
what are the common symptoms of cystitis (lower UTI)?
dysuria, frequency, urgency, lack of vaginal discharge, mental status change in elderly
92
what are the diagnostics for cystitis ?
UA, urine culture
93
what is the recommended follow up for lower UTI (Cystitis) ?
Follow up for recurrent or un-resolved UTIs, no test for cure in asymptomatic
94
what is the treatment for cystitis?
Nitrofuratonin (Macrobid) 100 mg twice daily for 5 days
Bactrim 160/800mg twice daily for 3 days (uncomplicated)
Fosfomycin trometamol 3 g orally in a single dose
pyridium--used for pain, urispas--dysuria and frequency
95
what are the symptoms of pyelonephritis?
Classic TRIAD: fever/chills, flank pain, nausea/vomiting; mental status change in elderly
96
what are the diagnostics for pyelonephritis (upper UTI)?
UA, urine culture, imagining if no response in 72 hours
97
what is the treatment for pyelonephritis?
Bactrim DS, IV abx--dependent on the severity of illness, treatment is 7-10 days for mild cases, 14 for severe, 21 days for slow responders
98
what is defined as recurrent UTIs?
that is defined as two episodes of acute bacterial cystitis within 6 months or three episodes within 1 year
99
men younger than the age of 50 are more likely to have what than a UTI?
STI (sexually transmitted infection)
100
what are the symptoms of UTI in men?
urethritis
dysuria
hesitancy frequency
urgency
101
what is urethritis?
most common etiology is from chlamydia. Other bacteria includes M.genitalium and T.vaginalis.
Non-STI may be from trauma. May occur in men and women.
102
what are the diagnostics for urethritis?
NAAT, urine (first catch for men)
103
what is the treatment for urethritis?
doxycycline 100 mg BID for 7 days
OR
Azithromycin 1 g orally in a single dose
OR
Levofloxacin 500 mg orally once daily for 7 days
104
what are the symptoms of urethritis?
dysuria
urethral pruritis
urethral discharge
105
what are the symptoms of interstitial cystitis (bladder pain syndrome)?
pain, pressure, or discomfort in the pelvic area
daytime urinary frequency
urethra, vulva, lower back pain is common
106
what is incidence for nephrolithiasis?
renal calculi 20-60 yrs of age
peaks at age 20-30
sedentary lifestyle, high environment temps
calcium oxalate-men
struvite in women
low calcium diet
vasectomy and HTN increases risk
107
what the symptoms of nephrolithiasis?
sudden flank pain not relieved by changes in position
colicky pain can progress to be excruciating
nausea, vomiting, and pain that extends from abdomen to groins and thigh
108
what are some diagnostics used to diagnose nephrolithiasis?
UA
CBC
CMP
ultrasound
IVP
cystourethroscopy
CT
109
what is the treatment for nephrolithiasis?
pain management, antispasmodics, refer for invasive or non-invasive treatments (shockwave, lithotripsy, stents)
110
what is the follow up for nephrolithiasis?
increase fluids, increase activity as tolerated
111
what are the common risk factors for kids for UTIs?
constipation
anatomical abnormalities
sickle cell disease
diabetes
immunocompromised
being uncircumcised
112
what is the most common symptom children having with UTIs?
fever
113
what is the bacterial count that is considered for a diagnosis of UTI in children?
greater than 100,000
for children 2 months to 2 yrs, a bacterial count of 50,000 is suggestive of a UTI
114
Renal ultrasound would be necessary to do in kids if you suspect?
obstruction
115
After the age of 2, what drug can they take for treatment of a UTI?
Bactrim (sulfa) or penicillin (Augmentin)
2-3rd generations cephalosporins ceclor, ceftin
need to be treated for 7-10 days
considered a complicated UTI
can't take Macrobid under the age of 12
116
what is vesicouretral reflux?
where the urine travels backwards from the bladder to the ureters to the kidneys
due to an anatomical or functional disorder
most common in children but can be seen adults
MOST COMMON SYMPTOM IS A UTI
117
what are the characteristics of primary vesicoureteral reflux?
most common
unilateral
infant born with shorter ureter, valve malfunction
improves as child grows older
118
what are the characteristics of secondary vesicoureteral reflux?
usually bilateral
incomplete ureterovesical junction closure
may be anatomical or dysfunction
119
what are the diagnostics for a child who you think may have vesicoureteral reflux?
renal and bladder ultrasound
120
what is enuresis?
elimination disorder
incontinence during sleep
121
what is primary enuresis?
a child who have never achieved overnight continence
122
what is secondary enuresis?
a child who HAS achieved overnight continence but they are becoming incontinent again
123
what are some possible causes for primary and secondary enuresis?
inheritance in 75% of pts
idiopathic is the primary cause
sleep arousal disorder
lack of inhibition of the micturition reflex
cystitis
constipation
overactive bladder
dysfunctional voiding
psychological
124
what is cryptochidism?
Undescended testicle
125
when do the testicle descend into the scrotum in fetus?
7-8 months in utero
126
when do you NEED TO REFER a child whose testes haven't descended?
by the age of 6 months
(they usually spontaneously descend by age 3 months)
127
A child with cryptorchidism is at higher risk for what type of cancer?
Testicular cancer
they will be at higher risk for decreased fertility rate, also for inguinal hernias and testicular torsion
128
what is hypospadias?
an abnormality of the urethra and penile development
the urethral opening is located on the ventral aspect of the penis
129
what are some risk factors for a child who has hypospadias?
genetic
endocrine dysfuncion
advanced maternal age
multiple births
maternal DM
exposure to smoke or pesticides by mother
exogenous progesterone intake by mother
presence of undescended testicles, inguinal hernia or hydrocele
130
who do you need to refer a child with hypospadias to?
a pediatric urologist or a surgeon
131
what is the most common age for testicular cancer?
15-35 years of age, white men
132
what is the most common age for testicular torsion?
12-18 years of age, winter months, during puberty
133
what causes testicular torsion?
the spermatic cord twists and causes constriction on the vascular supply to the testicle
134
what is varicocele ?
collection of large dilated veins in the scrotum situated above the tests
use ultrasound for diagnostic
135
what is spermatocele?
benign scrotal mass along the spermatic cord
use ultrasound for diagnostic
136
what is hydrocele?
collection of serous peritoneal fluid with the scrotum
common in infants-especially preemies
resolves on its own
137
What is wilm's tumor?
tumor or neoplasm that is a major cause of renal malignancy in children
138
when you see a patient with hematuria, along with abdominal swelling and pain, and hypertension in children,
can also present with anorexia, weight loss, shortness of breath, nausea, vomiting, diarrhea
Wilm's tumor
139
what are diagnostic studies for evaluation of Wilm's tumor?
UA, CBC, liver, and renal function tests
KUB, CXR, CT scans, MRI
140
it is important when you palpate the abdomen in a child with an abdominal mass why should you be gentle?
you don't want to rupture the tumor
141
Girls who survive wilm's tumor malignancy, have an increased risk for what kind of breast cancer?
breast cancer
142
IF a patient has an AUA score greater than 8, what does this indicate?
Warrants treatment for BPH
143
what is the most common treatment for BPH?
Tamsulosin or Flomax
144
The AUA and ACS recommend to start screening for prostate cancer at what age?
at age 50,
this is an approach and discussion should be had about doing a PSA and DRE
if men have a familial hx or high risk, you can start at 45 yrs
NO ONE GETS SCREENED BEFORE THE AGE OF 40.
145
what is the recommendation for AUA?
The AUA recommends the use of PSA base screening in conjunction with digital rectal exam for men aged 55 to 69 yrs old who are at average risk and asymptomatic but remember this is an individualized approach with shared decision making.
for older pts, with a life expectancy of less than 10 yrs, it is not necessary
146
if you see a PSA between 4 and 9.9 what would you do?
send that patient for a biopsy
there is a good chance that the patient would not have cancer
greater than 10%, order a biopsy
147
In patients with chronic prostatis, they should avoid?
spicy food, caffeine, and alcohol
sitz baths will alleviate pain
148
Acute prostatitis occurs in?
20-40, and older than 60
149
what is the treatment for acute prostatitis?
Bactrim 10-14 days
Fluroquinolones (ciprofloxacin, levofloxacin)
150
what is the treatment for chronic prostatitis?
Fluoroquinolones are the first line choice for 4-6 weeks
151
what is the treatment for epididymitis?
ice packs, pain relief, Ceftriaxone IM + Doxycycline 10 days for acute
Ofloxacin or levofloxacin for 10 days
152
what diagnostics would you do for orchitis?
CBC with diff, UA and culture, viral titer for mumps, STI
153
SHRM will help differentiate what causes of ED?
organic or psychogenic causes for ED
154
PDE-5 inhibitors should never be taken with what medication?
nitrates
155
what are the contraindications for patients taking PDE5 inhibitors?
hx of MI, stroke, or life-threatening arrhythmia, resting hypotension or hypertension, hx of HF, unstable angina, concomitant admin of alpha blockers
156
what are the most common side effects of PDE5 inhibitors?
headache, flushing, nasal congestion, nasopharyngitis, dyspepsia
157
when is it best to test for testosterone?
between 7 to 10 am
158
what are some causes of testosterone deficiency?
normal aging
hypogonadism
stress
obesity
tobacco
alcohol
OSA
DM
illness and medications
159
What is the diagnosis of acute kidney injury?
increase in serum creatinine of 0.3 mg/dl within 48 hours or 1.5 times baseline serum creatinine over 7 days and/or decline in urine in output to <0.5ml/kg/hr for 6-12 hours.
