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PANRE > nephrology and urology > Flashcards

nephrology and urology Flashcards

1
Q

most active secretion happens in the

A

distal convulted tubel

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2
Q

most reabsorption occurs at the

A

proximal tubule

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3
Q

early proximal convulted tuble

A

tubular reabsoprtion

acetazolamide and mannitol are diuretics that work on this

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4
Q

loop of hnle

A

thin descending loop of henre- passively absorbs H20, but does not let sodium and solutes through

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5
Q

THICK ASCENDING limb of loop of henley

A 
impereable to h20 but allows na, k , cl via na/k/2cl trasportor
reabsortpi on of magnesium and calciumloop diuretics work on this!!! ---STRONGEST class of diuretics!!
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6
Q

s.e of loop diuretics

A

hypocalcemia, hypomag, hypokalemia!!

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7
Q

thiazides

A

more likely to cause hyponatremia

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8
Q

early distal convuluted tuble

A

tubular SECRETION MAIN JOB!!- dilutes the urine!!
parathyroid hormone acts on the distal tuble to increase calcium reabsorption!!
THIazides also work on this- causing hyponatremia.

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9
Q

distal collecting tubule

A

determines the final oslmoalarity of urine (via aldosterone and ADH)

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10
Q

potassium sparing diuretics

A

associated with hyperkalemia and metabolic acidosis

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11
Q

hyperaldosteronism

A

associated with hypokalemia

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12
Q

ADH

A

peremable to H20 only in the presense of ADHD
present of ADH—> concentrated urine
ADH absence::: dilute urine

increased adh: production of a concentrated urine during times of hypoveolemia, hyperosmolarity and RAAS activation

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13
Q

nephrotic syndrome

A

proteinuria, hypoalmbuinemia, hyperlipidemia and EDEMA

glomerular damage causes tubular protein loss into the urine, urine loss of albumin ases hypoalbumin—which causes hyperlipideamia as liver makes more protein!! including lipoprotein

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14
Q

minimal change disease (nephrotic)

A

80% of nephrotic syndrome in children
podcyte damage seen on electron microscope- loss/fusion/diffuse effacement of the foot process
loss of negative charge
PREdENISON

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15
Q

focal segemental glomerucslerosis(nephrotic)

A

HTN- african american- heroin abuse

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16
Q

membranous nephropathy (nephrotic)

A

thickened glomerular basement membrane!!- idiotpathic!- caucsian male

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17
Q

secondary causes (nephrotic)

A

mc diabetes - for adults

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18
Q

nephoritc syndrome

A

edema, peripheral, periorital edeam, worse in morning, scorotal edema, DVT!!!
more than 3.5 g/day of urine is nephrotic syndrome
proteinuria, oval fat bodies, maltese cross shaped, hypoalbuminemia, hyperlipidemia

tx: direetics for edema, ACEI or ARBS for proteinuria

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19
Q

acute glomerulonephitis

A

htn, mehamturia, rbc casts, dependent enemia, azotemia
iga nephropathy- mc cause of agn in adults worldwide- igA mesangial deopsoits

post infectious: MC AFTER GABHS!!!!!cola clored/dark urine!!
increased antistreptolysis tigers, low serum complement

rapidly progressive glomerulephritis: goodpastuerus disease: anti gbm antibodies, kidney failure and hemoptysis- antibodies to glomerular basement membrae of kidney and lung alveoli
corticosteroids and cyclophosphamide

vasculitis: microscopic polyangitis- vasciulitis of small renal vessel: +p-anca

wegner’s: +c-anca: granulomatosis with polyangitis- necrotizing vasculitis!!!

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20
Q

acute glomerulonephritis

A

hematuria, peripheral, periorbital edema, cola colored/dark urine, oliguria, RBC cast,
DO RENAL BIOPSY!!
loss of protein and RBC loss!!

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21
Q

acute kidney injury

A

increased serum creatinine or BUN

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22
Q

prerenal

A

reduced renal perfusion- hypovoleia, MC type of AKI!!!
leads to intrinsic ATN if not orrected
volume repletion is tx

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23
Q

post renal

A

obstruction

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24
Q

intrinsic

A

direct kidney damage: nephrotoxic, cytotoxic, prolonged ischemia- cellular CAST formation!!
ischemic: prolonged prenrenal, hyoptension, hypovolemia
nephrotoxx: aminolycosdes, contrast dye, cyclosoproine- ATN MC type of intrinsic!!
epitehlia cell casts and muddy brown casts
remove offending agents, iv fluids

25
acute tubulointestial nephritis (intrinsic damage to kidney)
inflammatory or allergic response- penicillins, NSAIDS, SULFA, cephalosporin, cipro, autoimmune, fever, eosinophilia, WBC CASTS ARE pathognomonic!!! increased serum IGE for allerGEEE remove offending agents
26
urinary pattery
muddy brown or epithelial casts: acute tubular necoriss rbc casts: acute glomerulphenritis fatty casts: nephroti syndrome hyaline cats: nonspecific (may be normla)
27
prerenal
fena less than 1%, decreased urine NA- it keeps all the sodium!! high specific gravity- increased urine osmolarity bun and cr ore tha n20:1
28
ATN
increased urine NA, FENA more than 2%- releases all the sodium out in the urine.! kidney is damaged and can't really reabsorpt solutes
29
adult polycystic kideny disease
autosomal dominant kidney cysts and cysts in other organs can lead to ESRD over time abd flank pain, palpable flank mass, htn, hematuriaRENAL ULTRASOUND!!! simple cysts: ace and observation multiple: increase fluid intake- control htn
30
chronic kidney disease
``` gfr less than 15 is ESRD dm is most common cause htn 2nd mc cause of esrd spot uablumin/ucreativene ration 24/hour urine coloection broad waxy casts small kidneys classic!! bp goal less than 140/90 ```
31
siadh
posterior pitutary secrets ADH!!!- free water retention- adh is increased from pitutary or ectopic source MC: STROKE, head trauma, cns tumors!!! pulm: SMALL cell lung cancer hypotnatremia!! h20 restriction!!! cuz everytime u drink water- it gets retained otherwise!! severe hyponatremia or intracranial bleed: iv hypertonic saline with furosemide
32
DIABETES INSIPIDUS
ADH (vasopressin deficiency) central DI or insensitive to ADH due to kidney problems!! central DI mc type nephrogenic: lithium!! polyuria, polydipsia, ncturia!!, hypernatremia! fluid deprivation test!!!- continues to produce dilute urine which is abnormal! adh stimulations tests: differentiates nephro from central DI if its nephro: continued production of dilute urine which is abnormal!! central dI: replace adh- desmopressin!! nephrogenic di: hydrochlorithiazide, na/protein restriction!
33
hyponatremia!!!
hypotonic hyponatremia is TRUE hyponatreia if its normal serum osmlarity and hyopnatremia: lab error- increased protein and increased triglycerides if its high serum osmolarity and hyponatremia: hyperglyemia and mannitol in the true hypotnonic hyponatremia!!: - hypovoleia- thiazides, extra renal loss like bleed, burns, n/vdiarrhea- correct with normal saline isovolemia: SIADH, post op- WATER RESTRICTION!! hypervolemic: chf, cirrhosis, nephrosis,--h20/salt restriction!!
34
hyponatremia
can cause cns dysunction to cerebral edema- ams, vomiting, muscle cramps,siezures, coma
35
hypernatremia
shrinkage of brain cells: cns dynsfucntion- seizures, coma, muscle waekness hypovolemic: sweating, resp loss, gi loss, dehydration, severe hyperglycemia, osmotic diurectics isoovelmica: diabetes inspidus hypervolemic: mineralocorticoid excess
36
hypomag
malabsopriton, ETOHics!! proton pump inhibitors! increased DTR, tetany, arrhythmias palpiations prolonged PR and QT interval!!- can lead to torsades!! mild: magensium oxide (ORAL) severe: iv mag sulfate!! (hypocalcemia and hypokalemia associated with hypo mag will need to be treated first)
37
hypermag
mg intake, renal insufficiency!!, acute or chronic renal failure decreased DTR respiratory depression!!! mild: iv fluids and foresemide- leads to hypomag severe: calcium gluconate!!- stabilizes cardiac membrane
38
hypokaelmia
mc: diuretic tehrapy!!, vomiting , diarrhea, metabolic alkalosis severe muscle weakness, decreased DTR prominent U waves, t wave flattening first give potassium, kcl oral , hypokalemia increases risk of digoxin tox
39
hyperkalemia
t wave is tall!! acute or chornic renal failure, ace/arbs/beta blockers, k sparing diuretics! pseudohyperkalemia- venipuncture mc weakness, flaccid paralysis, iv calcium gluconate - stabilizes cardiac membrane insuline kayexlate!
40
epidiymitis and orchitis
men less than 35: chlamydia men more than 35 and childrren: Ecoli most common viral: mumps postiive phren's sign: elevation of scorotum relieves pain positive remasteric refeex: testicle elevates after stroking inner thigh!! pyruia, bacteriuria DOXY plus ceftraixone for less than 35 flouroquinoes for e.coli - for children: ephalexin or amoxcillin
41
cryptorchidism
orchiopexy recommended at 6 months- performed before 1y ears old. observation only if less than 6 months of age!!- most descend by 3 months!
42
testicular cancer
15-40 year old- mc solid tumor!! MC RIGHT SIDED!!!!- because cryptorchidism mostly coccurs on the right side seminoma!!!!- most common!= sesntiive to radiation, simple, slower growing , stepwise spread non seminomas- more aggressive- associated with increased alpha fetoprotein, increased beta hcg scrotal ultrasound!!
43
hydrocele
cystic testicular fluid collection- painless scrtoal swelling- most common transillumination
44
vacicocele
testicular mass of vacicose veins- pampiniform venous plexus and internal spermatic veins MC on the LEFT side!!! bag of warms- can cause inferitility dilation worsens when patient is upright or valsalva
45
cystitis
rare for males to have UTI!!! women: intercourse-honeymoon cystitis, spermidcidal use! e coli- most common cause for complicated and uncomplicated pyelo; +cva tenderness , back/flank pain, nausea vomiting- pyuria. IF WBC casts- pyelo urine culture= DEFINITIVE DIAGNOSIS!!!- needs clean catch specimen if epithelia- contaminated uncomp cystitis: nitrofurantoin, cipro, bactrim complicated: flouro IV or po, aminoglycosides pregnant: amoxicilin or nitrofurontoin pyelo: cipro Po or IV, aminoglycosides!!!
46
prostatis
e coli: more than 35 years old less than 35 years old: chamlydia and gonorrhea e.coli!!!!- in chronic prosttius fever, chills, frequency, urgency, PErinela pain in acute prostatius acute pro: tender, normal or hot , boggy prostate chronic: non tender, bogg prostate no prostatic massage in acute prostatitsi acute prost : cipro or bactrim less than 35: ceftriaxone plus doxy chronic prostitis: bactrim X 6-12 weeks!!! resection (TURP) for refractory
47
bph
prostate hyperplasia - bladder outlet obstruction, increased dihydrotestoestoner production UNIFORMLY , ENLARGED< FIRM, RUBBEry prostate!!! 5alpha reductase inhibitors: finasteride- androgen inhibitor- inhibits coversion of testosterone to dihydrotestosterone- psitive effect on clinic course alpha blockers: tamsulosin MOST urosselective- provides rapid symptom relief!! surgery!- TURP
48
prostate cancer
adenocarcinoma HIGH INCIDENCE OF METS TO BONE- back pain/bone pain!!, uretrhal obstruction!- HARD, NODULAR, eNLARGED ASSYMETRICAL!!! prostate: increased PSA!!! ultrasound with needle biopsy!!!
49
bladder cancer
``` TRANSITIONAL CELL - most common!!! smoking MC risk factor cyclophasphamide and pioglitazone!! cystoscopy with biopsy painless gross of microscopic hematuria ```
50
renal cell carincoma
smoking, dialysis, htn | flank pain, hematuria, palpable mass, left sided varicocle!!
51
wilm's tumor
nephroblsatoma mc in children- 1-5 th year!! painless, palpable abd mass , heamturia, anemia abd ultrasound
52
nephrolithiassis
calcium oxalate MC!! struvite- infection- proteus, kelbsiella- staghorn calciuli) renal coliv, CVAT, hematuria, groin apain non contrast CT ABD/pelvis- !!!!!! NON CONTRAST!!!! only CALCIUM AND STRUVITE will show up on radiographs, not URIC acid stones!! iv fluids, analgsic, antimetics, TAMUSOLOSIN!!- FOR STONES LESS THAN 5 mm in diamenter FOR MORe than 7 mmg- extracorproean shock way lithrtripsy, stet
53
erectile dysunfciton
phosphodiesterase 5 inhibitors: sildenafil- increased nitric oxide level, cyclic GMP- maintain errction longer- dont use with nitrates!!
54
priapism
decreased venous outflow- MC! or increased arterial inflow sickle cell disease- common in it!! phenylephrine- 1st line!!!
55
URETHRITIS
urethral discharge or pruritis: CHAMydIA most common!!, or gonorrehea!! neonatal: gonorreha if 2-5 days, chlamydai if 5-7
56
renovascular htn
htn!!!!!- ATHEROSCLEROSIS!! abdominal BRUITS!!! renal arteriorgraphy!!
57
stress inconvitnenceq
urine leaks cuz of increased intraabdominal pressure!!- pregnancy, childbirt, surgery, estroge loss, postmenopasual sneeze, cough, laughing- urine leaks pevilc floor exercise: kegel exercise,
58
urge incontinence
``` URGE to pee!!! detrusor muscle overactivity!! OVERACTIVE BLADADER!!! = bladder training first, or anticholitergics like oxybutynin- blocks cholinergic receptors or TCA!!!- have antichol efects ```
59
overflow incontinence
urinary REtentions DUE TO UNDER ACTIVE BLADDEr most commoly due to BLADDER ATONY!!! intermittent or indwelilng catheteriziation!!! even Bph can cause this!! for bpha: tamsulosin for bladder atony: cholinergics: bethancol!

PANRE (18 decks)

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