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Nephrology and Urology Flashcards

1
Q

What is Acute Renal Failure

A

Rapidly deteriorating glomerular filtration rate with accumulation of nitrogenous waste like urea and creatinine (Azotemia)

High Creatinine, Decreased GFR

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2
Q

What are the categories of Acute Renal Failure

A

Pre-Renal
Intrinsic
Post-Renal

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3
Q

Sx of Acute Renal Failure

A

N/V, Diarrhea, pruritis, hiccups, SOB

Tachycardia, hypotension, CVA tenderness, enlarged prostate, oliguria, change in volume status, edema

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4
Q

Dx of Acute Renal Failure

A

GFR and Cr measurement

BUN, but not as reliable indicator

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5
Q

Dx features of Prerenal Cause

A

Hyponatremia
Urine Osmolality greater than 500
Elevated BUN:Plasma Cr ratio

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6
Q

Dx features of Intrinsic Cause

A

Hypernatremia
Low Urine Osmolality
Decreased BUN:Plasma Cr ratio

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7
Q

Dx features of Postrenal Causes

A

Variable depending on cause

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8
Q

Tx of Acute Kidney Injury

A

Tx underlying problem
Prerenal: IV fluids, improved CO
Avoid triggering meds
Postrenal: Ureteral stends, urethral catheter

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9
Q

What is Chronic Kidney Disease
What defines each stage
Most common Causes

A

Progression of ongoing loss of kidney function
Stage 1: Normal GFR (>90mL/min)
Stage 2: Mild decrease in GFR (60-90)
Stage 3: Moderate decrease in GFR (30-60)
Stage 4: Severe decrease in GFR (15-30)
Stage 5: Kidney failure with GFR <15

DM is most common cause followed by HTN, Glomerulonephritis, PCKD

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10
Q

Sx of Chronic Kidney Disease

A

Patients typically become sx ate stage 3 and 4 with anemia, acidosis, hyperkalemia, hypocalcemia

Fatigue, anorexia, N/V, hiccups, dyspnea
Cachexia, weight loss, muscle asting, pallor

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11
Q

Dx of Chronic Kidney Disease

A

GFR is gold standard with Cockcroft-Gault Formula (needs patient age, body weight, serum creatinine) or Modification of Diet in Renal Disease Equation (MDRD), but the latter needs serum albumin and BUN as well

Microalbumin occurs early
Proteinuria
BUN and Cr are elevated

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12
Q

Tx of Chronic Kidney Disease

A 
Ace-I/ARB
Control HTN, DM, and Cholesterol
Erythropoietin and iron supplements
Restriction of protein, limitation of water, sodium and potassium
Pneumococcal vaccine
Hemodilaysis
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13
Q

What is Glomerulonephritis

Most common causes

A

Think Protein and RBC in urine

Damage of renal glomeruli by inflammatory proteins
Children: Post-infectious GN is most common
IGA Nephropathy, Post-Infectious, Membranoproliferative, Goodpasterus, Vasculitis

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14
Q

Dx of Glomerulonephritis

A 
Hematuria, cola or tea colored urine
Oiguria or anuria
Edema of face and eyes
HTN
Antistreptolysin-O titer will indicate recent Strep Infection, indicating post-infectious GN
UA: Hematuria, RBC casts, Proteinuria
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15
Q

Tx of Glomerulonephritis

A

Steroids
Salt and lfuid restriction
Ace-I/ARB

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16
Q

What is Nephrotic Syndrome

Types

A

Protein in urine, hypoalbuminemia, hyperlipidemia, edema

Excretion of more than 3.5g of protein in 24 hours

Minimal Change Disease (most common in children)
Focal Segmental Glomerulosclerosis
Membranous Nephropathy
Systemic disorders that damage kidney

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17
Q

Sx of Nephrotic Syndrome

A

Malaise, abdominal distention, anorexia, facial edema

Ascites, edema, HTN

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18
Q

Dx of Nephrotic Syndrome

A

UA: Proteinuria, Lipiduria, Glycosuria, Foamy Urine
Micro: Granular, Hyaline Casts, FAtty casts
Hypoalbuminemia, azotemia, hyperlipidemia

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19
Q

Tx of Nephrotic Syndrome

A

Ace-I, Diuretics

Sodium and water restriction to manage edema

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20
Q

What should you think about with each urinary pattern
RBC Casts
Muddy Brown Casts or Epithelial Cell Casts
White Blood Cell Casts, Pyuria
Waxy Casts
Hyaline Casts

A

RBC Casts: Acute Glomerulonephritis, Vasculitis
Muddy Brown Casts/Epithelial: Acute Tubular Necrosis
WBC Casts: Acute Interstitial Nephritis, Pyelonephritis
Waxy Casts: Chronic Acute Tubular Nephritis
Fatty Casts: Nephrotic Syndrome
Hyaline Casts: Nonspecific

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21
Q

What is Polycystic Kidney Disease

What is the most common form

A

Many cysts in the kidney, made of epithelial cells from renal tubules and collectins sytem
Autosomal dominant polycistic kidney disease is most common, almost always bilateral

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22
Q

Sx of Polycystic Kidney Disease

A 
Back and Flank Pain
Headaches
Nocturia
Hematuria, HTN, recurrent UTI
Palpable flank mass
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23
Q

Dx of Polycystic Kidney Disease

A

Ultrasound

UA: Proteinuria, hematuria, pyuria, bacteriuria

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24
Q

Tx of Polycystic Kidney Disease

A

Supportive, Ace-I, increase fluid intake, decrease protein intake

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25
What is Nephrolithiasis | Most common type
Kidney Stones | Calcium is most common, they are radiopaque
26
Which type of kidney stone in common in people with frequent UTI's, abnormal kidney/urine anatomy, frequent catheterizations
Struvite
27
Sx of Nephrolithiasis
Back pain, renal colic that waxes and wanes Hematuria, dysuria, frequency, fever, chills, N/V Diaphoresis, tachycardia, tachypnea, restlessness, CVA tenderness
28
Dx of Neprholithiasis
UA: Hematuria | CT without contrast
29
Tx of Nephrolithiasis
Less than 5mm: Fluids, analgesics, alpha-blocker or CCB 5mm-10mm: Increased fluids, analgesics, elective lithotripsy or ureteroscopy with stent Greater than 10mm: Percutaneous Nephrostomy, for Struvite too
30
``` What are features of Hypernatremia What causes it Sx Dx Tx ```
Too much salt or not enough water Due to inadequate fluid intake or excess water loss: Deficit of thirst, urinary loss, GI loss, burns, osmotic diuresis, dosium excess, DI Sx: Thirst, restlessness, irritability, disorientation, convulsions, coma, dry mouth, lack of tears Dx: Plasma Sodium>145 Tx: Oral free water is preferred, IV or 5% dextrose solution in water or saline Hypovolemia is treated first with Isotonic Saline or Lactated Ringers then Hypernatremia
31
Why do you need correct Hypernatremia slowly
It can cause pulmonary or cerebral edema especially in patients with DM
32
``` What are features of Hyponatremia What causes it Sx Dx Tx ```
Too much water/fluid intake not enough salt CHF, Nephrotic syndrome, renal failure, Hypothyroidism, glucocorticoid excess, SIADH Sx: Lethargy, disorientation, muscle cramps, anorexia, hiccups, N/V, seizures, weakness, agitation, hyporelfexia, Cheyne-Stokes, Delirium Dx: Serum sodium <135 Tx: Treat underlying cause, suually needs fluid restriction
33
Why do you need to correct Hyponatremia slowly
Central Pontine Myelinolysis, resulting in neurologic damage
34
What is Diabetes Insipidus Sx Dx Tx
Disorder of water Central: No vasopressin produced Nephrogenic: Kidneys are unresponsive to normal vasopressin Sx: Polyuria, nocturia, polydipsia Dx: Withold water, if patient continues to produce DILUTE urine Nephrogenic: Give vasopressin and patient resopnds with decreased urine ouput and increase in urine osmolality Central: No change in urine output or urine osmolality Tx: Central: Give Desmopressin Nephrogenic: Diuretics, HCTZ or other diuretics, limit salt and protein intake
35
What are features of Hyperkalemia What do you see on EKG Tx
Can result in dysrhythmia and cardiac arrest Nubmness, tingling, weakness, falccid paralysis EKG: Peaked T-waves Tx: Calcium gluconate via IV, Sodium Bicarbonate, Glucose, Insulin to drive potassium back into cellular compartment Sodium Polystyrene Sulfonate removes potassium from body
36
What are features of Hypokalemia What do you see on EKG Tx
Usually due to diruetics, renal butular acidosis or GI loss Ventricular arrhythmias, hypotension and cardiac arres Malaise, cramps, ileius, constipation EKG: Flattened or inverted T-waves, U-Waves, Depression of ST segments Tx: Ptoassium therapy in acute cases, if emergency IV replacement
37
What is Cystitis Sx Dx Tx
Infection of the bladder usually by E.Coli and occasionally Gram-Positive Bacteria (Enterococci) Sx: Frequency, rugency, d ysuria, suprapubic discomfort May see gross hematuria Dx: UA shows Pyuria, bacteriuria, Urine culture may be positive Tx: Uncomplicated is FQ (Cipro) or Nitrofurantoin (Macrobid), Bactrim can be used for resistant Complicated: FQ or Aminoglycosides
38
What is Pyelonephritis Sx Dx Tx
Ifnectious process involving kidney parenchyma and renal pelvis Usually due to E.Coli, Proteus, Klebsiella, Pseudomonas Sx: Fever, Flank Pain, Shaking Chills, N/V, CVA tenderness Dx: Leukocytosis, UA shows pyuria, bacteriuria, WBC casts Tx: FQ or Bactrim for 1-2 weeks or Aminoglycoside
39
What is Prostatitis Sx Dx Tx
Usually due to Gram-Negatives Sx: Sudden onset of high fever, chills, low back pain and perineal pain, Frequency, urgency, dysuria, some obstruction Prostate is swollen and tender Dx: UA shows pyuria, hematuria and bacterieuria Tx: FQ or Bactrim, if chronic use FQ for 1-3 weeks NSAIDS, Alpha-1 Blockers for sx
40
What is Orchitis Sx Dx Tx
Usually due to ascending bacteria from urinary tract Associated with Mumps Sx: Testicular swelling and tenderness, fever, tachycardia Dx: UA shows pyruia, bacteriuria, positive cultures Tx: If mumps is cause tx sx, ice, and analgesia If bacteria is cause tx with Ceftriaxone and Azithromycin (if young men), or Cipro for older men
41
What is Epididymitis
Infection of epididymis usually spread through vas deferens Young Men: Chlamydia and Gonorrhea Older Men: E.Coli Sx: Heavy, dull, aching discomfort, may radiate to flank, swollen testes, elanrged scrotal mass Positive Prehn sign (relief with elevation), Positive Cremasteric reflex Dx: UA shows pyruia and bacteriuria, culture shows organism Tx: Young men tx like STD (Ceftriaxone and Azithromycin) Older men tx with FQ (Cipro) for 10-14 days
42
What is Benign Prostatic Hyperplasia Sx Dx Tx
Proliferation of fibrostromal tissue of prostate that leads to compression of prostatic uretrha, creates outlet obstruction Sx: Hesitancy, straining, postvoid dribbling, sensation of incomplete emptying, frequency, nocturia, urgency DRE shows uniformly enlarged prostate Dx: DRE, PSA Tx: 5-Alpha Reductase Inhibitors (Finasteride, Dutasteride) slow progression of disease Phosphodiesterase-5-Inhibitors (Tadalafil, Verdenafil) alleviate sx TURP
43
What are sx of Stress Incontinence
Leakage of urine with increased intra-abdominal pressure, like sneezing, coughing, laughing Usually due to dysfunctional uretrhal sphincter allowing urine to leak with increased pressure
44
What are sx of Overflow Incontinence
Involuntary release of urine from overfull bladder Absence of urge to urinate Frequency, Urgency, Nocturia
45
Tx of Incontinence
Pelvic floor muscle training, bladder training | Anticholingerics like oxybutynin or tolterodine
46
What is Prostate Cancer Sx Dx Tx
Adenocarcinoma Sx: Urinary obstruction, irritative voiding Dx: Elevated PSA, Biopsy using Gleason Grading System Tx: Staging done by CT or MRI Stages A and B tx with radical retropubic prostatectomy, or external beam readiation Stage C same Stage D with hormonal manipuation using antiandrogens, orchiectomy, LH-releasing hormone agonists or estrogen
47
What is Bladder Cancer Sx Dx Tx
Tobacco exposure is most common reason, folllowed by occupational exposure from rubber, dye, printing and chemical industries Uroepithelial tumors, most are transitional cell carcinomas Sx: Painless hematuria, Bladder irritability and infection Dx: Cytostcopy with Biopsy. IV urogram, Pelvic and abdominal CT, chest xray, retrograde pyelograph for staging Tx: If muscle is involved, bladder must be removed, Chemo
48
What is Renal Cell Carcinoma Sx Dx Tx
Adenocarcinoma is most common Cigarette smoking is most common cause Sx: Gross or microscopic hematuria, abdominal mass Dx: Ultrasound to rule out stone, CT without contrast is diagnositc Tx: Radical nephrectomy for localized Radiation for disseminated to brain, bone, and lungs Interferon-Alpha and Interleukin slow growth of cancer
49
What is Wilms Tumor Sx Dx Tx
Nephroblastoma Most common solid renal tumor in KIDS Sx: Abdominal mass, anorexia, N/V, Fever, abdominal pain, hematuria Dx: Abdominal CT is diagnostic, but ultrasound done first UA first shows hematuria, ultrasound is initial study of choice to evaulate mass, then CT or MRI shows tumor extension, Chest Xray for mets assessment Tx: Surgery, chemo and radiation
50
What is Testicular Cancer Sx Dx Tx
Most common malignancy in YOUNG men SEMINOMA is most common type, spread in stepwise fashion Rf are cryptorchidism or previous hx of testicular CA Sx: Painless, solid testicular swelling, Heaviness in testicle Dx: Ultrasound first, followed by CT of chest, abdoimen and pelvis, CXR for mets Tx: Seminoma is sensitive and simple (radiosensitive and no tumor markers), tx with radiation therapy, more severe stages use chemo Nonseminoma has elevated alpha-fetoprotein or Beta-HCG, tx with Surgery or chemo
51
What is Phimosis Sx Dx Tx
Inability to retract foreskin over gland penis Sx: Erythema with tenderness, purulent drainage Tx: Circumcision, Broad Spectrum Abx if infection present
52
What is Paraphimosis Sx Dx Tx
Entrapment of foreskin behind glans penis Usually seen in pts with frequent caths, vigorous sexual activity Sx: Pain, edema, tenderness, erythema of glans and foreskin Tx: Emergency, manual retraction first (squeeze glans to reduce tissue edema then try bringing foreskin back over glans), surgery if this fails, then referral for circumcision
53
What is Erectile Dysfunction Sx Dx Tx
Consistent inability to maintain erect penis Sx: Medications like antihypertensives (Beta Blockerss) Dx: Rule out underlying biological causes with CBC, UA, Lipid, Thyroid Tx: Phosphodiesterase-5 (PDE-5) inhibitor (sildenafil, Vardenafil, Tadalafil) SE: Headache, flushing, dyspepsia, rhinitis, AVOID NITRATES WITH THIS may lead to severe hypotension
54
What is a Hydrocele Sx Dx Tx
Mass of fluid-filled congenital remnants of tunica vaginalis Sx: Soft, non-tender fullness of hemiscrotum It does transilluminate, mass may wax and wane Dx: Ultrasound, UA Tx: Surgery
55
What is a Spermatocele Sx Dx Tx
Painless cystic mass containing sperm, usually superior and posterior and distant from testes Sx: Palpable, round, firm cystic mass with distinct borders, free floating above testicle which transilluminates Dx: Scrotal Ultrasound Tx: None needed, large ones may be removed surgically
56
What is Testicular Torsion Sx Dx Tx
Abnormally twisted testis on spermatic cord, compromises arterial supply and venous drainage Hx of Cryptocrhcidism is important Sx: Sudden onset of severe unilateral pain and scrotal swelling Testis are painful to palpation, Negative Prehn Sign, Negative Cremasteric Reflex Dx: Doppler Ultrasound shows decreased blood flow Tx: Surgery, must be done wtihin 6 hours to avoid infertility
57
What is a Varicocele Sx Dx Tx
Formation of venous varicosity with spermatic vein (Pampiniform Plexus) Sx: Chronic, nontender mass that does NOT transilluminate Usually seen on left side Bag of worms, increases in size with valsavla, decreases in size with supine Dx: Doppler ultrasound Tx: Surgery if painful or risk of infertility
58
What is the most common pathogen for Cystitis/Pyelonephritis What is the Dx Gold Standard Tx
E.Coli most common Urine Culture is gold standard (clean catch) UA shows WBC in urine, WBC casts indicates pyelonephritis Tx: Analgesics: Phenazopyridine FQ is 1st choice (Ciprofloxacin or Levofloxacin), Nitrofurantoin (Macrobid), Amoxicillin, Bactrim if resistant
59
What is Stress Incontinence What is Urge Incontinence What is Overflow Incontinence Tx
Stress: Small volumes, coughing, sneezing, laughing -Treat Stress with Kegel, Pessary, Surgery, Estrogen Urge: Large volumes, spontaneous, nocturia, polyuria -Treat Urge with Oxybutynin (anticholingerig) or Tolterodine (Anticholinergic) or Antispomadics (Solifenacin, Fesoterodine) Overflow: Small, Dribbling, High residual Volume, due to Detruso Hypoactivity (inability to contract) -Tx: Intermitten Catheter, Cholinergic (Bethanechol), Surgical repair
60
Which Kidney Stones are Radio-Opaque
Visible on Xray, Bright | Calcium (most common type) and Struvite
61
Which Kidney Stones are Radio-Lucent
Not visible on Xray but may be seen on Ultrasound | Uric Acid, Cysteine
62
Sx of Kidney Stones Dx of Kidney Stones Tx of Kidney Stones
Asymptomatic Flank Pain, Episodic with radiation, Diaphoresis, Tachycardia, CVA tenderness Dx: Non-Contrast CT, Renal Ultrasound (especially pregnant pts), UA shows hematuria and pH Tx: Low sodium diet, increased fluids >5mm: Fluids, Analgesics, Alpha Blockers 5-10mm: Lithotripsy, Ureteroscopy >10mm: Ureteral Stent Placement, Percutaneous Nephrostomy
63
What is the treatment of Erectile Dysfunction | What should you be careful with
PDE-5 Inhibitors, careful with pts who take Nitrates because it can cause hypotension Injection of Prostaglandins, Vacuum Erection Devices
64
What is Phimosis Sx Dx Tx
Inability to retract foreskin over glans penis Sx: Erythema with tenderness, may have purulent drainage Tx: Refer for circumcision Abx if infected
65
Which drugs used for BPH improve the clinical course vs. relieve sx
Improve Clinical Course: 5-Alpha-Reductase Inhibitors (Finasteride) Improve sx: Alpha-Blockers (Prazosin/Terazosin/Doxazosin)
66
Which Male Disorder should you associated with MUMPS Sx Tx
Orchitis Unilateral testicular swelling and tenderness, fever, tachycardia Tx: Scrotal Elevation, Ice, Opioids or Injections for pain

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