Nephro/Uro Flashcards
sweet smelling urine indicates
DM
maple syrup smelling urine indicates
congenital metabolic disease
musty or mousy smelling urine indicates
phenylketonuria
pungent smelling urine indicates
bacterial contamination
hyaline casts in urine indicates
can be pos after exercise
RBC casts in urine indicates
renal hematuria; GN, goodpastures, bacterial endocarditis, lupus nephritis
WBC casts in urine indicates
renal infection or inflammation
waxy casts in urine indicates
chronic renal failure, diabetic nephropathy
fatty casts in urine indicates
fatty degeneration of tubular epithelium, nephrotic syndrome, chronic GN, degenerative tubular disease
low/high specific gravity indicates
low: dilute urine, DI, absence of ADH
high: DM, nephrosis
acidic urine is present with
e coli
acidosis
dehydration
DM
alkaline urine is present with
proteus
pseudomonas
urea spitting bugs
bacterial infxn or renal failure
albumen/protein in urine indicates
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
glucose in urine indicates
DM, endocrine dz, CNS dz, renal tubular disorder
can have transient pos with inflammatory dz/high amounts of vit C
ketones in urine indicates
fat catabolism
rise BEFORE blood ketones (ketosis)
DM, liver dz, fasting, high fever
pos bilirubin in urine indicates
biliary obstruction “dark urine, light stool”
liver/gall bladder dz
prolonged exposure to light degrades bilirubin; test urine right away
urobilinogen in urine indicates
normally trace+
should not be absent
inc in liver dz, hemorrhage, hemolytic anemia
dec in cholelithiasis, severe diarrhea
hb (hemoglobin) in urine indicates
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
RBCs in urine indicates
genitourinary dz
nitrites in urine indicates
urea splitting organisms, gram neg bacteria; do a culture
high vit C can interfere w results
leukocyte esterase in urine indicates
presence of WBC/WBC casts > UTI
high amounts of vit C, trich, vag dc can alter test
cloudy urine may be caused by
WBC in the urine
green urine may be caused by
pseudomonas
WBC clumps in urine is indicative of
acute infxn/lithiasis
typical UA findings with urolithiasis/nephrolithiasis
gross hematuria, + RBC
WBC+, WBC clumps
neg protein
pos mucus
calculi may be present
what is VMA (vanillmandelic acid)
24 hour urine marker for suspected pheochromocytoma; check for metanephrines and catecholamines
what is the best assessment of renal function?
corrected GFR
24 hour creatinine clearance
hypercalciuria is present in
primary hyperparathyroidism
bone neoplasms
vit D toxicity
various drugs
elevated uric acid in the urine is present in
gout, dehydration, renal disease, acute inflammation
elevated oxalate in the urine is present in
pts who form calcium oxalate stones
ethylene glycol poisoning
certain foods (beans, strawberries, rhubarb, spinach, chocolate)
what test would be useful for early dx of DM to avoid/delay the onset of diabetic renal disease?
24 hour urine microalbumin
most sensitive test for kidney damage, particularly in diabetes?
microalbumin 24 hour urine
MOA of most bladder control drugs
anti-muscarinic (PS LYTIC)
aka belladonna like activity
SE like dry mouth, flushing ,etc
similar MOA for BPH meds
ED drugs suffix/MOA
-fil
PDE5 inhibitors
G protein activation for NO synthesis
natural supplements that inc NO activity/can be used for ED
l-arginine
magnesium glycinate
zinc (take in middle of meal)
painful vs painless hematuria
pain > stone, UTI
painless > renal, prostate dz, tumor, polycystic kidney, trauma post exercise, BPH —– CANCER UNTIL YOU PROVE ITS NOT
hematuria causes that are not pathological
menses, beets, anticoags, red clover
recent physical activity
if hematuria is noted at the start of the urine steam, it indicates bleeding is coming from:
urethra, bladder
if hematuria is noted at the end of the urine steam, it indicates bleeding is coming from:
prostate or higher
azotemia types
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
types of acute renal failure
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
dx criteria acute renal failure
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
causes of acute renal failure
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)
acute glomerulonephritis etiology, presentation
most common acute post strep GN
RBC casts, 1-2 weeks recovery after sore throat
children 6-10
moderate proteinuria
causes/markers of GN
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
stages of CKD GFR levels
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
two most common causes for chronic renal insufficiency
diabetes and HTN
signs/sx chronic renal insufficiency
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
signs/sx IC and diagnostics
frequency (up to 60-70x daily)
urgency
dysuria
dyspareunia
cytoscopy (endoscopy of bladder) and bladder biopsy > pinpoint bleeding (hemorrhage) in lining of bladder
inc risk present with cryptorchidism
(undescended testes)
even if corrected, inc lifetime risk of infertility and testicular cancer
varicocele
scrotal varicosity, abn dilation and tortuosity of pampiniform plexus of veins
**may be painful/feeling full or asx
**
bag of worms; may cause infertility
hydrocele
accumulation of serous fluid in scrotum, occurs in descent of testes or secondary to inflammations
painless enlarged fluctuant scrotum
will transilluminate
hematocele
blood in scrotal sac due to trauma or sex
spontaneous in atherosclerosis, DM, scurvy, tumors, syphilis
**painful
will NOT transilluminate**
what uro/repro ddx would you want to consider in an inconsolable male baby?
testicular torsion
seminoma
most common tumor with cryptoorchism
best prognosis of testicular tumors
mets to lymphatics
inc HCG
etiology and presentation of acute prostatitis
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
workup for acute prostatitis
triple void urine specimens for UA and culture (intial stream, mid stream, after prostatic massage)
STI screening
chronic prostatitis etiology, presentation
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
most common cancer in men
carcinoma of prostate
usu post lobe
heme spread > lumbar spine, femur, pelvis, thoracic spine, ribs
AA men, men with primary male relative with dz
common causes of acute interstitial nephritis
meds: penicillins, sulfa meds
alport syndrome
x linked mutation for collagen formation > chronic GN with ultimate destruction of the glomeruli
hematuria
loss of hearing
eye defects
cysts in the kidneys are associated with
aneurysms of BV in the brain
diverticula of the colon
cysts in the liver, pancreas, and testes
single renal cyst
often born with and found incidentally on imaging
mostly benign
common cause of painless hematuria
follow up with UA and imaging
nephrotic syndrome sx and etiology
proteinuria
low blood protein
high cholesterol
edema/wt gain/ascites
fat in urine/foamy urine
due to drugs, DM, HTN
edema from kidney pathology is most significant where
eyes/face
legs, ankles, feet
IgA nephropathy (Buergers dz)
“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
henoch schonlein purpura
kids 3-8
purpuric skin lesions on extensor surface of extremities and buttock (painful)
IgA precipitation after respiratory infxn
hematuria recurrences for years
goodpastures syndrome
antiglomerular BM nephritis (rapidly progressive)
hematuria
hemoptysis
ab in glomerulus and alveoli in lungs > bleeding in lungs, glomerulonephritis
adenocarcinoma/hypernephroma presentation
painless hematuria
smokers
upper kidney pole, solitary, unilateral
mets to lung and bone before sx appear
wilms tumor presentation
common primary renal tumor in kids, genetic, 2-5 years
large abdominal mass
painless hematuria
good prognosis with tx
malignant ureteric tumors presentation
primary rare; normally mets dz
transitional cell CA
obstruction
painless hematuria
tumors of bladder etiology/presentation
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
renal cell carcinoma etiology and presentation
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
fanconi syndrome etiology and presentation
inadequate reabsorption in proximal renal tubules > malabsorption of electrolytes/substances
thirst, fatigue, weakness, polyuria
Most common cancer seen w cryptorchidism
seminoma
causes of testicular torsion
cryptoorchidism
injury to testes
may occur in sleep
phimosis vs paraphimosis
phimosis: foreskin cant be retracted
paraphimosis: foreskin cant be moved OUT of retraction; EMERGENCY
