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Neph Flashcards

1
Q

What are the bugs for acute cystitis?

A 
e coli
enterococcus
klebsiella
pseudomonas
enterobacter
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2
Q

How does the bacteria grow?

A

colonizes in the urethra and works its way down the bladder

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3
Q

Child has acute cystitis - PE?

A

strong smelling urine
suprapubic pain
bloody urine

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4
Q

What are acute cystitis PE for adult?

A 
increase freq
Burning
Itching
Dysuria
Suprapubic pain
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5
Q

What to expect on urine dipstick for acute cystitis?

A

(+) uluekocyte esterase

(+) nitrite

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6
Q

What does leukocyte esterase mean? nitrite?

A

leukocyte esterase - pyruia - WBC present

nitrite - bacteria present

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7
Q

When should you do a urine C&S?

A

acute cystitis suspicion is HIGH but sx are not classic

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8
Q

When should you do a US in acute cystitis?

A

MALE children w/UTI

GU anomalies

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9
Q

When should you do a VCUG in acute cystitis?

A

recurrent in FEMALE CHILDREN

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10
Q

How to tx acute cystitis- uncomplicated?

A

bactrim DS BID x3days
cipro/levofloxacin - fluoroquinolone
ceftriaxone - 3rd gen

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11
Q

How to acute cystitis -complicated/pregnant?

A

nitrofurantoin BID x5-7days
ampicillin
amoxicillin
oral cephalosporin

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12
Q

How to acute cystitis - complicated/men?

A

bactrim DS BID x7days

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13
Q

What should ALWAYS be added when tx acute cystitis?

A

pyridium (phenazopyridine) x2-3days to control BURNING/pain

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14
Q

What should be warned about pyridium?

A

urine turning orange - shows that meds are working

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15
Q

How to prevent acute cystitis?

A

cranberry juice
pee after sex
shower>bath

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16
Q

What are bugs for pyelonephritis? Why?

A 
e coli
klebsiella
enterobacter
pseudomonas
same as acute cystitis b/c it is a bug that works UP from the bladder to KIDNEY
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17
Q

What are the types of pyelonephritis?

A

emphysematous

xantogranulomatrous

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18
Q

What is emphysematous in pyelonpehritis?

A

gas in renal tissues

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19
Q

What is xantogranulomatrous?

A

occurs w/ obstruction

leads to tissue destruction

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20
Q

What PE to expect in pyelonephritis?

A

FEVER
N/V
CVA tenderness

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21
Q

What labs to run in pyelonephritis?

A

UA - WBC casts + proteins
UA+C&S
BC

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22
Q

How to tx uncomplicated pyelonpehritis?

A

fluroquinolone x5-7days

augmentin x14days

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23
Q

How to tx complicated pyelonephritis?

A

IV fluids

ampicillin + gentamicin/cipro

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24
Q

Pt has bladder pain that is relieved w/ urination? What to expect on UA and C&S?

A

interstitial cystisis
neg urine dipstick
neg culture

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25
Q

How to tx interstitial cystisis?

A

lifestyle changes
bladder training
refer

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26
Q

Pt has post dribbling of urine and decrease force?

A

urinary track obsturction-post renal

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27
Q

What is post renal problems?

A

stones
strictures
tumor
FB

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28
Q

What labs to run for urinary tract obstruction?

A

KUB
CT
US
UA w/ C&S

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29
Q

Tx urinary tract obstruction?

A

surgery

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30
Q

What are the types of nephrolithiasis?

A

hypercalcicuria
hyperoxaluria
urate/cystine
struvite/staghorn

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31
Q

What is hypercalcicuria?

A

secondary prob to hyperparathyroidism

renals are unable to reabsorb Ca

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32
Q

How to tx hypercalcicuria- parathyroid? -renals?

A

resect parathyroid

renals: TZD longterm

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33
Q

Pt had stones as a child-Type of nephrolithaisis? Tx?

A

hyperoxaluria-primary

tx: low fat, oxalate diet

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34
Q

Pt had gastric bypass w/chronic diarrhea-type of nephrolithasis? Tx?

A

hyperoxaluria-enteric

tx: ca supplements

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35
Q

Pt has gout w/ stones-type of nephrolithiasis? Expect pH to be? Tx?

A

gout

pH

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36
Q

Pt has recurrent UTI-type of nephrolithiasis? pH?

A

struvite/staghorn

ph> 7.2

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37
Q

Pt is in fetal position + flank pain radiating to groin?

A

nephrotlithiasis

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38
Q

When to admit nephrolithiasis?

A 
vomiting
UTI
pain
Stone is >6mm via US
impaired renal fxn
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39
Q

How can UA pH help determine what type of nephrolithiasis? What other labs to order?

A

pH 7.2 - struvite/staghorn

order CT

40
Q

How to tx nephrolithiasis?

A 
pass on own IF 5-7mm
fluids
pain control
abx for infxn 
if bigger then 7mm - surgery (lithotripsy, uretroscopy) + flomax
41
Q

What to tell pts if treating outpt?

A

50% pass sponatenously w/48hrs

50% can reoccur w/in 5yrs if not txd

42
Q

How can acute kidney injury be categorized into?

A

pre renal
intrarenal
post renal

43
Q

What are types of pre renal AKI?

A

hypoperfusion/hypovolemia
trauma
artery stenosis
CHF, NSAID –> INCREASE IN VASOCONSTRICTION

44
Q

What are types of intrarenal AKI?

A

tubulointerstital disorders

  • tubular injury (amniglycosides, NSAID, vancomyocin, contrast, ACUTE TUBULAR NECROSIS)
  • interstitial nephritis
  • glomerular disorder
45
Q

How to differeniate between prerenal and intrinsic?

46
Q

What labs to order in AKI?

A

BUN and Cr - increased in both

47
Q

How to tx prerenal AKI?

48
Q

Pt has SUDDEN HTN? What to expect on PE?

A

renal artery stenosis

bruit @ L1 + L2

49
Q

Imaging for renal artery stenosis?

A

renal angiogram - gold standard

CT

50
Q

How to tx renal artery stenosis?

A

stents
bypass
anioplasty

51
Q

What is glomerulonephritis type of AKI?

52
Q

What are the types of glomerulonephritis?

A

nephrotic and nephritic

53
Q

How to differentiate nephrotic and nephritic - looking at it?

A

nephrotic - frothy

nephritic - bloody

54
Q

Which is more likely AKI then CKD - nephrotic or nephritic?

A

nephrotic - chronic

nephritic - acute

55
Q

In adults, nephrotic can be secondary d/t?

56
Q

Pt has HTN and mild edema - nephritic/nephrotic?

57
Q

Pt has edema - nephritic/nephrotic? Why?

A

nephrotic b/c of the increase protein leaving the body

58
Q

What to expect for labs and UA on nephrotic?

A

HYPOalbuminemia-protein is all pee’d out

UA- lipiduria and protein

59
Q

What to expect for labs and UA on nephritic?

A

LOW GFR - cxing the HTN

UA: rbc casts

60
Q

How to tx nephrotic?

A

sx based:
protein leakage - ACE /ARB
hyperlipidema - statins
hypercoaguble - warfarin

61
Q

How to tx nephritic?

A

corticosteroids

ACE for HTN

62
Q

What are probs that nephrotic can lead to?

A

minimal change
membranous
focal segmental

63
Q

What are probs that nephritic can lead to?

A 
IgA /berger
membranoproliferative
rapidprogressive/crescentic
post infectious
pauci-immune/ANCA/WEgners/Chrugstrause
good pasture
alport syndrome
64
Q

Child had post URI and now has lipiduria? How to differentiate?

A

minimal change OR focal segmental -nephrotic

bx

65
Q

Why is differentiating minimal change and focal segmental important? How to tx?

A

minimal change does NOT lead to ESRD but focal does

tx: corticosteroid in both; focal - renal transplant

66
Q

Adult has edema + cloudy urine? Tx? Prognosis?

A

membranous

tx: corticosteroid +/- renal transplant
prognosis: 1/3 spontaneous remission; 1/3 relapse but GFR is ok; 1/3 ESRD

67
Q

Child has post URI and hx of hematuria? What to expect on PE?

A

IgA/berger

PE: henoch-schnlein purpura - DOES NOT BLANCH

68
Q

What labs for IgA and tx?

A

IgA will be high
UA: hematuria
tx: mild-supportive; mod: ACE/ARB; high - corticosteroid for 6mo; ESRD - renal transplant

69
Q

Pt has fever + post strep A 3wks ago? How to dx?

A

post infxn
serum-ASO
UA- RBC casts

70
Q

How to tx post infxn? Prognosis?

A

tx strep A and DO NOT USE CORTICOSTEROIDS

children have better prognosis; adults have ESRD 10-20yrs

71
Q

What are the post URI + renal probs?

A

IgA/berger
pauci immune: ANCA
goodpasture

72
Q

What are the types of pauci immune: ANCA? What is ANCA-nephrotic or nephritic?

A

C ANCA- wegners
P ANCA
Churg strause - eosinophils
nephritic

73
Q

What s ANCA associated with?

A

RPGN -rapidly progressive GN

74
Q

Pt has post URI + hemotypysis?

A

wegners OR goodpasture

75
Q

Pt has post URI + asthma? What else to expect on PE?

A

churg strauss

PE: purpura

76
Q

What to expect on bx for ANCA?

A

necrotizing lesions + crescents

77
Q

How to tx ANCA?

A

plasmpharesis/plasma exchange

78
Q

How to differentiate between wegners and goodpasture?

A

blood - wegners: ANCA; goodpasture: anti GBM antibodies

79
Q

What to expect on bx for goodpasture?

A

crescent

linear igG immunofluroscence

80
Q

How to tx goodpasture?

A

plasma exchange

corticosteorids

81
Q

Pt has hearing loss and vision loss? How to dx? Tx?

A

alport syndrome

dx: bx
tx: transplant

82
Q

Pt has proteinuria AND hematuria? What are the types?

A

membranoproliferative glumerulnephritis
type I - secondary to chronic infxn
type II - inherited

83
Q

How to tx membranoproflierative glumerulnephritis?

A

type I - tx chornic infxn

type II - corticosteroids + renal transplant

84
Q

Which renal probs can you tx with corticosteroids?

A

membranoproliferative
good pasture
all ANCA (wegners, churg-strauss)

85
Q

What are the types intrinsic AKI?

A

acute tubular necrosis

acute interstitial nephritis

86
Q

Pt has muddy brown urine, casts and epithelial cells + casts? What to expect on lab results? How to tx?

A

acute tubular necrosis
blood: high K b/c Na is NOT absorbed into body so K is high
FEna >1

87
Q

How to tx acute tubular necrosis? What to avoid?

A

hemodialysis

avoid: diuretics, proteins, mg antacids

88
Q

Pt has fever + rash + NO edema + hematuria? Cx?

A

acute interstitial nephritis

d/t drug hypersensitivity

89
Q

Labs for acute interstitial nephritis? Tx?

A

Eos
WBC casts
Tx: corticosteroids

90
Q

Pt has Dm and HTN + edema in LE? What to expect on labs?

A

chronic kidney dz

ua: casts and proteins
blood: HIGH BUN/Cr

91
Q

How to tx chronic kidney disease?

A

ACE/ ARB/ CCB to control DM and HTN

92
Q

Pt has abdominal mass + flank pain + HTN? How to dx?

A

polycystic kidney dz

dx: US

93
Q

What renal dz are genetically related?

A

IgA/berger
polycystic kidney dz - autosomal dominant
wilms’ tumor

94
Q

How to tx polycystic kidney dz?

A

renal transplant

95
Q

Pt has flank pain + abdominal mass + hematuria? What other sx could they have?

A

renal cell carcinoma
anemia - d/t decrease of erythopoiten
osteoporosis - d/t decrease of Ca absoprtion

96
Q

Labs for renal cell carcinoma will show? Tx?

A

blood - hypercalcemia
nephrectomy
chemo is not effective

97
Q

Child has painless abdominal mass? How to tx?

A

wilm’s tumor
surgery
chemo is very effective

WHOLE PT (19 decks)

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