Nephrology Quiz 2 Flashcards
regarding urinary casts, RED CELL CASTS are markers of what?
glomerular injury
IgA Nephropathy is also known as?
Berger Disease/IgA
on physical exam, combination HTN + abdominal mass is suggestive of which renal disease?
polycystic kidney disease
Which gene (on which chromosome) is responsible for slower progression of polycystic kidney disease?
ADPKD2 on chromosome 4
which diagnostic test is performed first when evaluating polycystic kidney disease
Ultrasound (if unclear, CT scan)
What is the criteria regarding number of cysts on each kidney, diagnosing polycystic kidney disease?
age < 60: 2+ cysts on each kidney
age > 60: 4+ cysts on each kidney
hematuria that is persistent and recurring in someone with polycystic kidney disease suggests what?
renal cell carcinoma
Patient with polycystic kidney disease endorses flank pain + fever + leukocytosis. What do you suspect?
renal infection
on CT, infected cysts have increased wall thickness
kidney stones in polycystic kidney disease are which type?
calcium oxalate
cerebral aneurysms are commonly located where in the brain?
Circle of Willis
This disease is benign at birth, and then diagnosed at age 40-50
Medullary Sponge Kidney
What area of the kidney is affected in medullary sponge kidney?
enlarged at interpapillary collecting ducts
you’ll see a “swiss cheese appearance” on imaging of this disorder
medullary sponge kidney
can you transplant a non-PKD kidney to a PKD patient with success?
YES - they will NOT develop PKD
what does gross hematuria in PKD patient typically represent?
rupture of a cyst into the renal pelvis (resolves within 7 days)
in a patient with suspected renal infection, you get a UA. It is normal, but you can’t rule out infection…why?
UA may be normal because cyst may not communicate with the urinary tract
True or false: 50% patients with PKD present with hypertension, but it will develop in most patients at some point in the course of the disease anyways.
TRUE
True or false: aggressive BP control seems to help slow the decline in GFR with a patient who has PKD
false - it does not stop the decline in GFR
this common, BENIGN disorder is present at birth and diagnosed at age 40-50
medullary sponge kidney
symptoms of medullary sponge kidney
hematuria recurrent UTI nephrolithiasis nephrocalcinosis tubular acidosis
Diagnosing medullary sponge kidney? (what is seen on this imaging?)
CT - cystic dilation of distal collecting tubule, striated appearance, calcifications i collecting duct
medullary sponge treatment?
none - keep hydrated, add thiazide diuretics to decrease calcium excretion
common cause of ESRD in young individuals
juvenile nephronophthisis
patient aged 14 with ESRD, suspicious of what?
juvenile nephronophthisis
what do kidneys look like on CT/US in patient with juvenile nephronophthisis?
small, scarred
kidneys look small and scarred on imaging, but what is diagnostic for medullary cystic kidney disease?
open biopsy
____ are contractile cells that constitute the central stalk of the glomerulus
mesangial cells
what is the glomerular basement membrane made of?
Type 4 collagen fibers
pan relief for acute uncomplicated bacterial cystitis?
Phenazopyridine
Treatment for uncomplicated bacterial cystitis?
Nitrofuratnoin
-sulf/trim
fluoroquinolones
pyelonephritis is also known as
acute complicated bacterial cystitis - upper and lower tract
patient presents with an obstruction of urination, NO tenderness on prostate exam, chills/rigors. What do you suspect?
acute complicated bacterial cystitis
Diagnostic for acute complicated bacterial cystitis
UA + microscopy/culture
Treatment for outpatient acute COMPLICATED bacterial cystitis?
ceftriaxone + Bactrim/augmentin/fluoroquinolone (broad coverage until culture comes back)
interstitial cystitis/bladder pain syndrome (IC/BPS) requires what duration of bladder symptoms for diagnosis?
> 6 weeks
discomfort associated w/ bladder filling, relieved by emptying. Patient explains he prefers to maintain lower bladder bolumes.
Interstitial cystitis/bladder pain syndrome
Allodynia is when non-noxious stimuli is perceived as painful stimuli. It is a hallmark symptom in?
IC/BPS
what will you see on UA and prostate exams of possible IC/BPS patient?
unremarkable
most common pathogens for urethritis
gonorrhea & chlamydia
patient presents with burning and mucopurulent discharge. you obtain UA and it reveals leukocyte esterases and WBC. Suspected diagnosis?
urethritis
urethritis treatment of gonorrhea?
ceftriaxone + azithro
urethritis treatment chlamydia
azithro or doxy
higher risk of acute bacterial prostatitis with what ?
HIV
what to be aware of if prostatitis is from s. aureus?
s. aureus infection elsewhere too
results of acute bacterial prostatitis prostate exam
firm, edematous, exquisitely tender
what other labs would you see in patient with acute bacterial prostatits
UA: bacteremia, pyuria, hematuria
elevated PSA
elevated ESR/CRP
gram positive cocci in chains (bacterial prostatitis) indicates what type of infection?
enterococcal infection
amox and ampicillin treatment
gram positive cocci in clusters indicates?
s. aureus
* treat with cephalosporin)
ok to use nitrofurantoin in acute or chronic bacterial prostatitis?
NO - poor penetration
staph aureus infections in patients with valvular disease are at high risk for what?
endocarditis
in order to diagnose CHRONIC bacterial prostatitis, how long do they need to have symptoms?
> 3 months (OR recurrent urogenital symptoms)
AND bacteriuria is present
treatment chronic bacterial prostatitis?
Fluoroquinolones - even if they previously had it
risks of using fluoroquinolones?
c.diff, CNS toxicity, tendon rupture
patient has chronic pelvic pain for 3 of past 6 months, and inflammatory cells post prostatic massage. NO bacteriuremia Thoughts?
chronic prostatitis
pt presents with 4 month pelvic pain, ED, hx fibromyalgia. Prostate exam and UA unremarkable. differential?
chronic prostatitis
what is the most common cause of scrotal pain?
epididymitis/orchitis
commonest pathogen of epididymitis?
gonorrhea, chlamydia
when would you perform the NAAT test?
with UA + culture for suspected epididymitis
what other virus could cause epididymitis?
Mumps
treatment of epididymitis?
Abx + NSAIDs+ local heat/ice
how long should it take patient to improve with Abx therapy for epididymitis?
48-72 hours. If doesn’t improve, do scrotal US and refer
are there serologic tests for IgA nephropathy?
no - do renal biopsy + immunofluorescence
treatment IgA nephropathy
depends on risk for progression to renal failure. Low risk - monitor
high risk - ACE/ARB
when would you see elevated antistreptolysin O titer?
post-streptococcal glomerulus
where would you see anti GBM antibodies?
goodpastures/IgG
what does immunofluorescence look like for goodpastures?
linear, smooth outline of capillaries.
treatment of IgG
plasmapheresis + oral prednisone + cyclophosphamide
will kidney transplant in a patient with IgG be successful?
ONLY if there are no more antibodies present, otherwise they will get it again
what causes hyperlipidemia in patients with minimal change disease?
reduction in plasma oncotic pressure which directly stimulates hepatic APOPROTEIN B gene transcription, increasing levels of LDL
treatment minimal change
prednisone HIGH DOSE
immune complex deposition in SUBEPITHELIAL of glomerular capillary walls
membranous nephropathy
IgG and C3 are found in which disorders?
IgG and membranous nephropathy
in which glomerular disease is it especially important to monitor for thrombosis/DVT?
membranous nephropathy
higher risk of hypercoagulable state in patients with membranous nephropathy where?
Renal vein thrombosis
treatment of membranous nephropathy
antiprotein + ACE
-immunosuppressants for high risk patients with salvageable kidney function
persistent albuminuria on 2 occasions 3-6 months apart
diabetic nephropathy
what are kimmelstiel-wilson nodules and where would you see them?
large accumulations in glomerulus,forms thickened nodules
what kind of finding might you see in the urine of someone with diabetic nephropathy?
foamy urine
this disorder, most common in African americans, progresses to ESRD in 6-8 years
focal segmental
treatment focal segmental glomerularsclerosis
diuretics + ACE+ statins
2 most common glomerular diseases in kinds and young adults
IgA nephropathy
minimal change disease
which hormones are involved in BPH?
testosterone, dihydrotestosterone, estrogen
BPH occurs in the ______ zone of the urethra while prostate cancer occurs in the _____ zone
central/transitional zone; peripheral zone
gold standard diagnostic for kidney stones?
noncontrast helical CT (US and XRAY can only identify small stones)
what size kidney stone is usually passed on own?
<5 mm
>10 mm needs surgical intervention
treatment calcium kidney stones <10 mm
hydration, pain manage (NSAID/opioids)
alpha blockers/CCBs to help it pass
strain the urine to collect!
between lithotripsy and laparoscopic stone removal of stones, which is preferred?
laparoscopic - lithotripsy has lower success rates
what is the correlation between parathyroid hormone (PTH) and stones?
elevated PTH puts patient at higher risk of making stones (related to calcium levels)
childhood stones are likely what type
cysteine - will see cysteinuria and hexagon stones
hexagonal stones?
cysteine
which stone types do you treat with potassium citrate?
cysteine and uric acid stones
uric acid stones are radiolucent, and correlate to a pH of less than what?
5.5
these stones form in the presence of upper UTI, and look like a coffin lid
struvite
treatment for struvite stones?
surgical removal - can’t pass
this anatomical structure is an enlargement of the vas deferens and a reservoir for sperm
ampulla (of the vas)
these cells exist outside of the testicular cell and produce testosterone
leydig cells
what is a common autoimmune disease that affects sperm production/fertility?
cystic fibrosis
