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NPLEX II TIA > Nephro/Uro > Flashcards

Nephro/Uro Flashcards

1
Q

sweet smelling urine indicates

A

DM

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2
Q

maple syrup smelling urine indicates

A

congenital metabolic disease

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3
Q

musty or mousy smelling urine indicates

A

phenylketonuria

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4
Q

pungent smelling urine indicates

A

bacterial contamination

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5
Q

hyaline casts in urine indicates

A

can be pos after exercise

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6
Q

RBC casts in urine indicates

A

renal hematuria; GN, goodpastures, bacterial endocarditis, lupus nephritis

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7
Q

WBC casts in urine indicates

A

renal infection or inflammation

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8
Q

waxy casts in urine indicates

A

chronic renal failure, diabetic nephropathy

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9
Q

fatty casts in urine indicates

A

fatty degeneration of tubular epithelium, nephrotic syndrome, chronic GN, degenerative tubular disease

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10
Q

low/high specific gravity indicates

A

low: dilute urine, DI, absence of ADH
high: DM, nephrosis

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11
Q

acidic urine is present with

A

e coli
acidosis
dehydration
DM

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12
Q

alkaline urine is present with

A

proteus
pseudomonas
urea spitting bugs

bacterial infxn or renal failure

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13
Q

albumen/protein in urine indicates

A

may be normal, esp after exercise/excess intake/cold temps
may be pos in nonrenal dz (fever, ascites, liver dz)
may be indicative of renal dz, glomerular damage

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14
Q

glucose in urine indicates

A

DM, endocrine dz, CNS dz, renal tubular disorder
can have transient pos with inflammatory dz/high amounts of vit C

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15
Q

ketones in urine indicates

A

fat catabolism
rise BEFORE blood ketones (ketosis)
DM, liver dz, fasting, high fever

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16
Q

pos bilirubin in urine indicates

A

biliary obstruction “dark urine, light stool”
liver/gall bladder dz

prolonged exposure to light degrades bilirubin; test urine right away

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17
Q

urobilinogen in urine indicates

A

normally trace+
should not be absent
inc in liver dz, hemorrhage, hemolytic anemia
dec in cholelithiasis, severe diarrhea

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18
Q

hb (hemoglobin) in urine indicates

A

extraurinary dz (hemolysis)
burns, crushing injuries, chemical toxins, transfusion rxn with incompatible blood

can have false results with high amounts of vit C, certain meds

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19
Q

RBCs in urine indicates

A

genitourinary dz

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20
Q

nitrites in urine indicates

A

urea splitting organisms, gram neg bacteria; do a culture

high vit C can interfere w results

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21
Q

leukocyte esterase in urine indicates

A

presence of WBC/WBC casts > UTI

high amounts of vit C, trich, vag dc can alter test

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22
Q

cloudy urine may be caused by

A

WBC in the urine

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23
Q

green urine may be caused by

A

pseudomonas

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24
Q

WBC clumps in urine is indicative of

A

acute infxn/lithiasis

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25
Q

typical UA findings with urolithiasis/nephrolithiasis

A

gross hematuria, + RBC
WBC+, WBC clumps
neg protein
pos mucus
calculi may be present

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26
Q

what is VMA (vanillmandelic acid)

A

24 hour urine marker for suspected pheochromocytoma; check for metanephrines and catecholamines

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27
Q

what is the best assessment of renal function?

A

corrected GFR
24 hour creatinine clearance

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28
Q

hypercalciuria is present in

A

primary hyperparathyroidism
bone neoplasms
vit D toxicity
various drugs

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29
Q

elevated uric acid in the urine is present in

A

gout, dehydration, renal disease, acute inflammation

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30
Q

elevated oxalate in the urine is present in

A

pts who form calcium oxalate stones
ethylene glycol poisoning
certain foods (beans, strawberries, rhubarb, spinach, chocolate)

31
Q

what test would be useful for early dx of DM to avoid/delay the onset of diabetic renal disease?

A

24 hour urine microalbumin

32
Q

most sensitive test for kidney damage, particularly in diabetes?

A

microalbumin 24 hour urine

33
Q

MOA of most bladder control drugs

A

anti-muscarinic (PS MIMETIC)
aka belladonna like activity
SE like dry mouth, flushing ,etc

similar MOA for BPH meds

34
Q

ED drugs suffix/MOA

A

-fil
PDE5 inhibitors
G protein activation for NO synthesis

35
Q

natural supplements that inc NO activity/can be used for ED

A

l-arginine
magnesium glycinate
zinc (take in middle of meal)

36
Q

painful vs painless hematuria

A

pain > stone, UTI
painless > renal, prostate dz, tumor, polycystic kidney, trauma post exercise, BPH —– CANCER UNTIL YOU PROVE ITS NOT

37
Q

hematuria causes that are not pathological

A

menses, beets, anticoags, red clover
recent physical activity

38
Q

if hematuria is noted at the start of the urine steam, it indicates bleeding is coming from:

A

urethra, bladder

39
Q

if hematuria is noted at the end of the urine steam, it indicates bleeding is coming from:

A

prostate or higher

40
Q

azotemia types

A

azotemia = inc BUN in blood
kidney has to be sick to have cre rise = to BUN so differentiate types through creatinine excretion

prerenal (impaired renal blood flow) - Bun and Cr both rise but BUN rises faster
- high BUN/Cre
- healthy kidney with low GFR

intrarenal (injury to glomeruli, tubules, small vessels) - both high but equally so
- BUN/Cr ratio normal

postrenal (obstruction)
- BUN/Cre normal early > rises after lone oliguria

41
Q

types of acute renal failure

A

pre-renal: inadequate renal perfusion from dec extracellular volume

renal: prolonged ischemia, toxins, acute GN, tubular necrosis

post renal: glomerular and tubular dysfunction, obstruction from calculi, inc prostate, tumors

42
Q

dx criteria acute renal failure

A

sudden onset oliguria/anuria
proteinuria, hematuria, isosthenuria
anorexia, N/V, lethargy, HBP
EDEMA!! (“weight gain”) esp face, hand, feet
changes in mental status/mood
signs of interrenal failure
dec Na, Ca, HCO3

43
Q

causes of acute renal failure

A

dec blood flow (recent surgery, trauma, septic shock, hemorrhage, burns)
arterial occlusion of kidney/rental artery stenosis
ingestion of toxin, exposure to metals/solvents
infxns such as pyelonephritis, septicemia
urinary tract obstruction
IV contrast (angiography, others)

44
Q

acute glomerulonephritis etiology, presentation

A

most common acute post strep GN
RBC casts, 1-2 weeks recovery after sore throat
children 6-10
moderate proteinuria

45
Q

causes/markers of GN

A

C3,C4 low in: SLE, MPGN, infective endocarditis, post-strep/postinfectious GN

pANCA and cANCA pos in wegener, microscopic polyangiits, churg strauss

ANA: pos in SLE (antidsDNA and antiSmith)

antiGBM pos in anti-GMN GN and goodpasture

blood cultures: infective endocarditis

hep B/C associated with cryoinduced GN

46
Q

stages of CKD GFR levels

A

stage 1: 90+ GFR with proteinuria, HTN, abn kidney anatomy

stage 2: 60-89 with above

stage 3: 30-59

stage 4: 15-29

stage 5: 15 or less / dialysis

47
Q

two most common causes for chronic renal insufficiency

A

diabetes and HTN

48
Q

signs/sx chronic renal insufficiency

A

creatinine and BUN prog inc
creatinine clearance prog dec
elevated K + phosphate
dec calcium and protein
azotemia, uremia

weakness, fatigue, HA, anorexia, N/V, pruritis, polyuria, nocturia

49
Q

signs/sx IC and diagnostics

A

frequency (up to 60-70x daily)
urgency
dysuria
dyspareunia

cytoscopy (endoscopy of bladder) and bladder biopsy > pinpoint bleeding (hemorrhage) in lining of bladder

50
Q

inc risk present with cryptorchidism

A

(undescended testes)
even if corrected, inc lifetime risk of infertility and testicular cancer

51
Q

varicocele

A

scrotal varicosity, abn dilation and tortuosity of pampiniform plexus of veins

bag of worms; may cause infertility

52
Q

hydrocele

A

accumulation of serous fluid in scrotum, occurs in descent of testes or secondary to inflammations

painless enlarged fluctuant scrotum

will transilluminate

53
Q

hematocele

A

blood in scrotal sac due to trauma or sex
spontaneous in atherosclerosis, DM, scurvy, tumors, syphilis

will NOT transilluminate

54
Q

what uro/repro ddx would you want to consider in an inconsolable male baby?

A

testicular torsion

55
Q

seminoma

A

most common tumor with cryptoorchism
best prognosis of testicular tumors
mets to lymphatics
inc HCG

56
Q

etiology and presentation of acute prostatitis

A

usu bacterial; GC/CT in men < 35
in men >35, e coli (esp if recently catheterized)

chills, fever, lower abdominal discomfort, perineal pain, burning with urination

57
Q

workup for acute prostatitis

A

triple void urine specimens for UA and culture (intial stream, mid stream, after prostatic massage)

STI screening

58
Q

chronic prostatitis etiology, presentation

A

e coli, proteus, enterobacter, klebsiella

low back pain
perineal or pelvic floor pain
testicular pain
pain/burning with urination
pain with ejaculation
pain with BM

59
Q

most common cancer in men

A

carcinoma of prostate
usu post lobe
heme spread > lumbar spine, femur, pelvis, thoracic spine, ribs
AA men, men with primary male relative with dz

60
Q

common causes of acute interstitial nephritis

A

meds: penicillins, sulfa meds

61
Q

alport syndrome

A

x linked mutation for collagen formation > chronic GN with ultimate destruction of the glomeruli
hematuria
loss of hearing
eye defects

62
Q

cysts in the kidneys are associated with

A

aneurysms of BV in the brain
diverticula of the colon
cysts in the liver, pancreas, and testes

63
Q

single renal cyst

A

often born with and found incidentally on imaging
mostly benign
common cause of painless hematuria
follow up with UA and imaging

64
Q

nephrotic syndrome sx and etiology

A

proteinuria
low blood protein
high cholesterol
edema/wt gain/ascites
fat in urine/foamy urine

due to drugs, DM, HTN

65
Q

edema from kidney pathology is most significant where

A

eyes/face
legs, ankles, feet

66
Q

IgA nephropathy (Buergers dz)

A

“primary recurrent hematuria”
immune complex glomerulopathy with deposition of IgA with C3 and fibrin related antigens in granular pattern in glomerulus

macro and microscopic hematuria, mild proteinuria

progresses over 2-3 decades > loss of renal function, HTN

dx by renal biopsy; IgA also found in skin capillaries

67
Q

henoch schonlein purpura

A

kids 3-8
purpuric skin lesions on extensor surface of extremities and buttock (painful)
IgA precipitation after respiratory infxn
hematuria recurrences for years

68
Q

goodpastures syndrome

A

antiglomerular BM nephritis (rapidly progressive)

hematuria
hemoptysis

ab in glomerulus and alveoli in lungs > bleeding in lungs, glomerulonephritis

69
Q

adenocarcinoma/hypernephroma presentation

A

painless hematuria
smokers
upper kidney pole, solitary, unilateral
mets to lung and bone before sx appear

70
Q

wilms tumor presentation

A

common primary renal tumor in kids, genetic, 2-5 years
large abdominal mass
painless hematuria
good prognosis with tx

71
Q

malignant ureteric tumors presentation

A

primary rare; normally mets dz
transitional cell CA
obstruction
painless hematuria

72
Q

tumors of bladder etiology/presentation

A

RF: industrial solvents, cigarette smoking
transitional cell tumors, benign papilloma; 90% transitional cell carcinoma, squamous cell carcinoma
painless hematuria
HCG in urine = aggressive tumor
tends to recur after excision

73
Q

renal cell carcinoma etiology and presentation

A

cancerous changes in cells of renal tubules
most common type of kidney cancer in adults
hx of smoking greatly inc risk
hematuria > anemia
dark, rusty urine
flank/back pain, abdominal pain
weight loss
ascites

74
Q
A

NPLEX II TIA (18 decks)

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