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PANCE > Nephrology and Urology > Flashcards

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
Q

What is Nephrolithiasis

Most common type

A

Kidney Stones

Calcium is most common, they are radiopaque

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26
Q

Which type of kidney stone in common in people with frequent UTI’s, abnormal kidney/urine anatomy, frequent catheterizations

A

Struvite

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27
Q

Sx of Nephrolithiasis

A

Back pain, renal colic that waxes and wanes
Hematuria, dysuria, frequency, fever, chills, N/V
Diaphoresis, tachycardia, tachypnea, restlessness, CVA tenderness

28
Q

Dx of Neprholithiasis

A

UA: Hematuria

CT without contrast

29
Q

Tx of Nephrolithiasis

A

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
Q 
What are features of Hypernatremia
What causes it
Sx
Dx
Tx
A

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
Q

Why do you need correct Hypernatremia slowly

A

It can cause pulmonary or cerebral edema especially in patients with DM

32
Q 
What are features of Hyponatremia
What causes it
Sx
Dx
Tx
A

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
Q

Why do you need to correct Hyponatremia slowly

A

Central Pontine Myelinolysis, resulting in neurologic damage

34
Q

What is Diabetes Insipidus
Sx
Dx
Tx

A

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
Q

What are features of Hyperkalemia
What do you see on EKG
Tx

A

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
Q

What are features of Hypokalemia
What do you see on EKG
Tx

A

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
Q

What is Cystitis
Sx
Dx
Tx

A

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
Q

What is Pyelonephritis
Sx
Dx
Tx

A

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
Q

What is Prostatitis
Sx
Dx
Tx

A

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
Q

What is Orchitis
Sx
Dx
Tx

A

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
Q

What is Epididymitis

A

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
Q

What is Benign Prostatic Hyperplasia
Sx
Dx
Tx

A

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
Q

What are sx of Stress Incontinence

A

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
Q

What are sx of Overflow Incontinence

A

Involuntary release of urine from overfull bladder
Absence of urge to urinate
Frequency, Urgency, Nocturia

45
Q

Tx of Incontinence

A

Pelvic floor muscle training, bladder training

Anticholingerics like oxybutynin or tolterodine

46
Q

What is Prostate Cancer
Sx
Dx
Tx

A

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
Q

What is Bladder Cancer
Sx
Dx
Tx

A

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
Q

What is Renal Cell Carcinoma
Sx
Dx
Tx

A

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
Q

What is Wilms Tumor
Sx
Dx
Tx

A

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
Q

What is Testicular Cancer
Sx
Dx
Tx

A

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
Q

What is Phimosis
Sx
Dx
Tx

A

Inability to retract foreskin over gland penis
Sx: Erythema with tenderness, purulent drainage
Tx: Circumcision, Broad Spectrum Abx if infection present

52
Q

What is Paraphimosis
Sx
Dx
Tx

A

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
Q

What is Erectile Dysfunction
Sx
Dx
Tx

A

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
Q

What is a Hydrocele
Sx
Dx
Tx

A

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
Q

What is a Spermatocele
Sx
Dx
Tx

A

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
Q

What is Testicular Torsion
Sx
Dx
Tx

A

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
Q

What is a Varicocele
Sx
Dx
Tx

A

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
Q

What is the most common pathogen for Cystitis/Pyelonephritis
What is the Dx Gold Standard
Tx

A

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
Q

What is Stress Incontinence
What is Urge Incontinence
What is Overflow Incontinence
Tx

A

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
Q

Which Kidney Stones are Radio-Opaque

A

Visible on Xray, Bright

Calcium (most common type) and Struvite

61
Q

Which Kidney Stones are Radio-Lucent

A

Not visible on Xray but may be seen on Ultrasound

Uric Acid, Cysteine

62
Q

Sx of Kidney Stones
Dx of Kidney Stones
Tx of Kidney Stones

A

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
Q

What is the treatment of Erectile Dysfunction

What should you be careful with

A

PDE-5 Inhibitors, careful with pts who take Nitrates because it can cause hypotension
Injection of Prostaglandins, Vacuum Erection Devices

64
Q

What is Phimosis
Sx
Dx
Tx

A

Inability to retract foreskin over glans penis
Sx: Erythema with tenderness, may have purulent drainage
Tx: Refer for circumcision
Abx if infected

65
Q

Which drugs used for BPH improve the clinical course vs. relieve sx

A

Improve Clinical Course: 5-Alpha-Reductase Inhibitors (Finasteride)
Improve sx: Alpha-Blockers (Prazosin/Terazosin/Doxazosin)

66
Q

Which Male Disorder should you associated with MUMPS
Sx
Tx

A

Orchitis
Unilateral testicular swelling and tenderness, fever, tachycardia
Tx: Scrotal Elevation, Ice, Opioids or Injections for pain

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