Nephrology Flashcards
Clinical Presentation of Obstructive uropathy
> Flank pain
> Low volume voids with or without occasional high volume voids
> If bilateral, renal dysfunction
Does RAS cause flank pain?
No
Measures to prevent urinary calcium stone formation (5)
- Increase fluid intake
- Low sodium diet
- Low protein diet
- Moderate calcium intake
- Thiazide diuretics
Effect of high dietary sodium on hypercalciuria
Reduces the reabsorption of sodium and thereby reduces the passive reabsorption of calcium
Effect of reduced dietary calcium on hypercalciuria
Leads to increased absorption in the gut, which is excreted into urine and binds urinary calcium to form calcium oxalate stones
Calcium oxalate crystals can result from
- Ethylene glycol (antifreeze ingestion)
- Vitamin C abuse
- Hypocitraturia (citrate binds calcium)
- Malabsorption (Crohns’s, gastric bypass)
Types of calcium stones
- Ca Phosphate (precipitates at basic pH)
2. Ca Oxalate (acidic pH)
S&S of Hydronephrosis
Flank pain that radiates to the groin
Flank pain that radiates to the groin
Hydronephrosis
Causes of Hydronephrosis (6)
Urinary Tract obstruction
- BPH
- Cervical Cancer
- Renal stones
- Ureter injury
- Retroperitoneal fibrosis (methysergide for HA).
- Vesicouretral reflux
Bilateral Hydronephrosis leads to
Elevated creatinine
MCC of isolate proteinuria in children
Transient proteinuria
Treatment for transient proteinuria
Repeat urine dipstick on two separate occasions to r/o persistent proteinuria (which requires further evaluation for underlying renal dz).
Proteinuria in children can be 1 of 3
- Transient (intermittent)
- Orthostatic
- Persistent
Causes of transient proteinuria in children
Exercise, Fever, seizures, stress or volume depletion
Positive Urinary nitroprusside
Cystinuria
Pathophysiology of Cystinuria
Impaired transport of cystine and diabasic aa ornithine, lysine and arginine by brush borders of renal tubular and intestinal epithelium cells. This leads to decreased reabsorption and increased urinary excretion of these aa. Cystine unlike the others are poorly soluble in water.
Which urinary test can detect elevated cystine levels
Cyanide-Nitroprusside test
UTI caused by
Bacteria ascending into the bladder & vaginal introitus
S&S off UTI
Suprapubic pain, dysuria, pyuria, bacteriuria
MCC of UTI
E.coli
Positive leukocyte esterase signifies
Pyuria
Positive nitrites signifies
Enterobacteriaceae
Indications for cystoscopy
- Gross hematurua with no evidence of glomerular dz or infection.
- Microscopic hematuria w/o evidence of glomerular dz or infection but increased risk of malignancy.
- Recurrent UTI
- Obstructive systems with suspicion for stricture, stone
- Irritative symptoms w/o urinary infection
- Abnormal bladder imaging or urine cytology
Familial Hypocalciuric hypercalcemia vs Primary HyperPTH
Both: hypercalcemia, elevated or high normal PTH
FHH: Low urinary excretion (increased reabsorption in renal tubules 2/2 defective CaSR)
HPTH: increased urinary calcium excretion (excessive mobilization of Ca from bones)
Pathophysiology Familial Hypocalciuric Hypercalcemia
Mutation in CaSR
Diffuse abdominal pain with guarding
Peritonitis
Acute Chemical Peritonitis following blunt abdominal trauma can be caused by
Spillage of blood, bowel contents, bile, pancreatic secretions or urine into peritoneal cavity
Which parts of the bladder are bordered by the peritoneal cavity
Dome (superficial n lateral surfaces) of the bladder
Kehr sign
Referred pain to the ipsilateral shoulder from right or left hemidiaphragm
Phrenic Nerve n sensory innervation of shoulder arise from sensory root C3 to C5
Extraperitoneal structures of bladder
- Anterior bladder wall
2. Bladder Neck
Damage to extraperitoneal structures of bladder lead to (s&s) and can be caused by
Leads to localized lower abdominal pain and can be caused by pelvic fracture
ARF and oliguria in post op patient (immediate procedures)
- Bladder scan
2. Catheterization
Post OP Urinary Retention (PUR) is
Common complication of surgery and anesthesia. Can lead to decrease detrusor muscle activity
Most sensitive & specific test for diagnosing RCC
Abdominal CT
Unilateral varicocele that fail to empty when patient is in recumbent raise suspicion for
Underlying mass pathology such as RCC that obstruct venous flow
Is there screening for bladder cancer?
No
What metabolic disorder can occur following tonic-clonic seizure
Postictal lactic acidosis 2/2 skeletal muscle hypoxia and impaired hepatic lactic acid uptake
Management for postictal lactic acidosis
Observation and repeat chemistry panel after 2hrs. It is transient.
