Nephrology, Fluids, Electrolytes Flashcards
Treatment for epididymitis without concern for STI
- Levofloxacin/Ciprofloxacin or Bactrim
What is Prehn sign
Relief of pain with elevation of affected testicle (sensitivity of 90% for epididymitis)
Most common cause of nephrotic syndrome in children? Tx?
Minimal change nephrotic syndrome
- can be preceded by URI
- Tx = steroids
Lab work in nephrotic syndrome
- Proteinuria > 3.5 g/24hr (3+ or 4+ on dipstick)
- Hypoproteinemia
- Hyperlipidemia
- Hypercoagulability
- Fatty casts
Management of peritonitis in PD patient
Outpatient with intraperitoneal abx for 10-14 days
Laboratory values in post-streptococcal glomerulonephritis
- Elevated antistreptolysin O titers
- Elevated anti-DNase B titers
- Decreased C3 levels
What is the most common cause of death in patients with SLE?
Kidney disease, particularly diffuse proliferative glomerulonephritis
When is the cremasteric reflex absent?
- Testicular torsion
- Upper and lower motor neuron disorders
- Spinal injury of L1-L2
- Iatrogenic transection of ilioinguinal nerve during surgery for hernia repair
What is Prehn sign?
Relief of pain with elevation of a painful testicle -> epididymitis
AV Fistula Complications
- Dialysis-Associated Steal Syndrome
- occurs secondary to retrograde flow from artery distal to AV anastomosis
- most common when a large artery supplies blood through fistula into a large, low-pressure vein - Hemorrhage
- often due to platelet dysfunction, supratherapeutic anticoagulation, or fistula abnormalities
- hemostasis via direct pressure, topical hemostatic agents, desmopressin, suture, tourniquet - Stenosis
- upper extremity and chest wall edema
- outflow stenosis (bounding pulse, absent thrill)
- inflow stenosis (weakened radial pulse and high pitched bruit)
- vascular surgery consult - Thrombosis
- Most commonly due to venous outflow stenosis, venous stasis, or compression
- Absence of bruit and thrills
- Vascular surgery consult for thrombectomy or thrombolysis - Aneurysm or pseudoaneurysm
- aneurysms form 2/2 repetitive cannulation and weakening of vessel walls
- pseudoaneurysms are rare
- vascular surgery consult
Presentation of autosomal dominant polycystic kidney disease
- HTN
- Hematuria
- Proteinuria
- Impaired kidney function
- Flank pain often due to renal hemorrhage, calculi, or UTI
- Cerebral aneurysms
What is the most common cause of death in people with autosomal dominant polycystic kidney disease?
CAD
Features of nephrotic syndrome
NAPHROTIC N- Na decrease (hyponatremia) A- Albumin decrease (hypoalbuminemia) P- Proteinuria >3.5 g/day H- Hyperlipidemia R- Renal vein thrombosis O- Orbital edema (and peripheral edema) T- Thromboembolism I- Infection (due to loss of immunoglobulins in urine) C- Coagulability (due to loss of antithrombin III in urine) and Casts (fatty)
Pediatric definition of nephrotic syndrome
- Proteinuria greater than 50 mg/kg/day
- Urine protein/creatinine ratio more than 2.0 mg/mg
- Hypoalbuminemia of less than 2.5 g/dL
- Presence of edema and hyperlipidemia
Causes of nephrotic syndrome
- Minimal change disease: children, preceded by URI - rx: steroids
- Focal segmental glomerulosclerosis: African-Americans, HIV/IVDA
- Membranous nephropathy: Caucasians, HBV, HCV, SLE, gold, penicillamine, malignancy
- Membranoproliferative glomerulonephritis
- Diffuse mesangial proliferation
- Secondary associated with systemic disease or infection
- Congenital occurring within first 3 months of life
Most common cause of prostatitis
Most common: E. Coli
Others: proteus, other enterobacteriaceae, pseudomonas
Sexually active men, think of N. Gonorrhoeae, chlamydia
Tx of acute prostatitis
> 35: Bactrim or fluoroquinolone (cipro) for 4 weeks
Sexually active men (<35): Ceftriaxone IM and doxycycline x14 days
HUS triad and clinical presentation
- Renal insufficiency
- Thrombocytopenia
- Microangiopathic hemolytic anemia (schistocytes)
Prodrome of abdominal pain, vomiting, bloody diarrhea to triad to seizures/lethargy
Which carries a higher mortality, strep pneumo vs. E. Coli HUS?
Strep pneumo
What is the recommended empiric antibiotic therapy for a patient with a renal abscess and a severe penicillin allergy?
Meropenem or imipenem
Differentiating features of lymphogranuloma venereum
- Unilateral inguinal lymphadenopathy (develops 1-3 weeks after appearance of initial lesion)
- Chancre described to have purplish hue
- Duration of lesion typically only up to 3 days
Tx for lymphogranuloma venereum
Doxycycline (caused by chlamydia trachomatis)
Ulcer appearance of granuloma inguinale
Beefy red ulcer - caused by klebsiella granulomatis
At what ages are patients most likely to develop testicular torsion?
During puberty or the neonatal period
Symptoms of BPH
HI FUN Hesitancy Intermittence, incontinence Frequency, fullness Urgency Nocturia
What other lab findings aside from BUN:Cr ratio are consistent with prerenal AKI?
Urine Na <20 mEq/L and FENa <1%
What labs could be elevated in testicular cancer
- beta-hcg
- alpha-fetoprotein (AFP)
- LDH
What lab study can be obtained to differentiate between ischemic and nonischemic priapism?
Cavernous blood gas analysis
Tx of balanitis (inflammation of glans penis) or balanoposthitis (inflammation of distal foreskin)
Antifungal cream
Potentially abx
Tx of phimosis
(Inability to retract the foreskin)
- Topical steroid cream for 1-2 months (maybe, but not normally necessary only if chronic)
- Periodic gentle retraction
- Signs of ischemia->dorsal slit procedure
What electrolyte abnormalities are associated with renal tubular acidosis?
Hyperchloremic metabolic acidosis with low bicarb and potassium
What is the tx for epididymitis in patients >35 years old?
Bactrim or fluoroquinoline as gram-negative rods (E. Coli, Klebsiella, Enterobacter, and Citrobacter species) are more common
What medication can induce epididymitis?
Amiodarone
