Nephrology Flashcards
Acute renal failure - renal causes (4), most common (bolded)
glomerulonephritis, and most common pathophysiology
most common cause, others
–Vascular - Dissection, Thrombosis, Emboli
–Glomerular - Glomerulonephritis (GN)
–Interstitial - Acute Interstitial Nephritis (AIN)
–Tubular (most common) - Acute Tubular Necrosis (ATN)
pathophysiology-immune complexes/antibodies in glomeruli
–Autoimmune / Vasculitities
- Post-streptococcal GN
- Wegeners, Goodpastures Hepatitis B/C
- SLE, PAN, HSP, HUS, TTP, HELLP
–Malignant Hypertension
Glomerulonephritis - key urine finding
tx
acute interstitial nephritis (AIN) cause categories (2)
key urine finding (2)
urine finding - RBC casts
steroids, immunosuppressive agents
AIN: drugs and infections
key urine finding: eosinophiluria, WBC casts
–Drugs
- Penicillin, Sulpha
- Diuretics
- NSAIDs
–Infections
ATN, cause categories (2), review subcategories
Ischemic and toxic
•Ischemic
–Usually oliguric (<500 mL/day)
–Leading causes: trauma and sepsis
–
•Toxic
–Usually not oliguric
–Causes: Contrast media
Myoglobin(rhabdomyolysis)
Hemoglobin (hemolysis)
Aminoglycosides
Multiple myeloma
Ethylene glycol
hem+ urine dip, no RBCs = (2)
treatment for this condition (3)
medications to reduce risk of contrast -induced nephropathy (form of ATN) - (4)
= Rhabdomyolysis; note: can also be hemoglobinuria from intravascular hemolysis (MAHA etc)
hydration, treat hyperkalemia/hypocalcemia, alkalinization of the urine with bicarb
meds: HCO3, NAC, hypertonic saline, volume expansion
Nephrotic syndrome features (5)
most common cause, other causes (review)
–Massive proteinuria (>3g / 24h)
–Hypoalbuminemia
–Edema
–Hyperlipidemia
–Thrombotic diathesis
•DVT/PE
most common cause: idiopathic
Secondary
–Diabetes mellitus
–Henoch-Schonlein purpura (HSP)
–SLE / Syphilis / Hepatitis B/C
–HIV
–Cancer
–Drugs (gold, mercury. heroin)
Polycystic kidney disease
inheritance pattern
primary symptom and association
ESRD: indications for dialysis (5)
Autosomal dominant
progressive renal failure and cerebral aneurysms/SAH
refractory acidosis, electrolyte disturbance (Na, K), volume overload, symptomatic uremia, toxins
ESRD
hematologic complications (3)
stealth cardiac + treatment
neurologic (2)
calcium and magnesium tend to be
Heme: depression of all cell lines, RBCs, malfunctioning WBCs, platelets
cardiac: uremic pericarditis treated with dialysis
neuro: SDH more common, uremic encephalopathy
tend to be low
Dialysis complications related to acces + treatment
Bleeding
clotting
infection - cause, tx
cardiac - type
Bleeding - DDAVP, protamine for uremic platelet dysfunction
clotting - inject thrombolytic into site versus surgical; thrill gone
infection - cause: staph, vanc/gent
cardiac - type: high-output failure
AMS after dialysis (5)
diagnostic criteria for peritoneal dialysis peritonitis, most common cause, tx
Hypotension, hypoglycemia, hypercalcemia, subdural, disequilibrium syndrome (elevated ICP due to osmotic shifts during dialysis often accompanied by headache, nausea, generally resolve spontaneously)
dx: > 100 WBC/mL; staph epi #1, also aureus and strep
tx: intraperitoneal antibiotics and lavage, consider systemic antibiotics
Sterile pyuria: most common and classic
scrotal/rectal/peritoneal pain out of proportion to clinical findings =
etiology
tx
Sterile pyuria: chlamydia, TB
= Fournier’s gangrene
polymicrobial
surgical and antibiotics
Balanitis vs posthitis
Balanoposthitis tx
Balanitis (glans) vs posthitis (foreskin)
tx: soap and water hygiene, bacitracin and paren peds), clotrimazole (adults)
Priapism types (2) + tx;
subcategories of first type (4) and most common
•Low-flow priapism (ischemic): terbutaline/phenylephrine injected to corpora; transfusion for sickle cell associated, copora aspiration/irrigation
–Sickle cell or other hematologic diseases
–Intracavernosal injections - most common
–Drugs (phenothiazines, SSRIs, Viagra et al., neuroleptics)
–Spinal cord injuries
–
•High-flow priapism (arterial injury) - embolization or surgery
–Trauma (straddle mechanism)
Pictured entity
Fever, chills, headache, myalgia, rash onset 2-6 hours after tx, lasts a few hours =
Secondary syphilis
Jarisch-Herxheimer – Antibiotic treatment causes organism death and the release of endotoxins
–Occurs in 50% of cases of primary syphilis (90% of secondary cases)
–Treat with acetaminophen two hours before and after antibiotic treatment
Pictured entity, cause
other rash sx
tx
Lymphogranuloma venereum (LGV)
Chlamydia trachomatis
painless herpes like genital ulcers
doxycycline three weeks
Pictured entity, painful
cause
dx
tx
Granuloma Inguinale - what, salient difference, tx
Chancroid
Haemophilus ducreyi
culture
azithromycin or ceftriaxone
Granuloma Inguinale - progressive, mutilating painless ulcer without lymphadenopathy
doxycycline three weeks
Testicular torsion, peak incidence
associated with this congenital deformity
cremesteric reflex and Prehn’s sign
direction of first attempt detorsion maneuver
Puberty
Bill Klapper deformity that allows free rotation of testis
reflex absent, Prehn’s sign absent (relief of pain with scrotal elevation)
medial to lateral-open book
Acute prostatitis treatment procedures (2), contraindicated procedure, long term
non-traumatic hematuria, see chart
Prostate massage, consider suprapubic drain, no Foley!; Antibiotics long-term
Kidney stone, most common site of impaction
hematuria absent ?%
Fluid boluses indicated?
Passage rate 5 mm and greater than 6 mm
UVJ
absent 15%
bolus relatively contraindicated per board review
passage: 50% versus 10%
