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Renal > Norris (UTI, stones, GN, AKI) > Flashcards

Norris (UTI, stones, GN, AKI) Flashcards

1
Q

complicated UTI factors (4)

A
  1. upper UT (pyelonephritis)
  2. structural/functional abnormality
  3. significant infx
  4. young and/or pregnancy
  5. male
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2
Q

Recurrent UTI status

A

> 2 UTIs in 6M

>3 UTIs in 1 Y

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3
Q

Chief UTI bugs

A
  1. E. coli
  2. Staph saprophyticus
  3. Klebsiella, Proteus
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4
Q

Female: male ratio for UTI

A

30:1

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5
Q

most common nosocomial dz due to

A

foli catheters

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6
Q

Women UTI risk factors (3)

A
  1. short urethra
  2. sexual activity
  3. diabetes (2-3X more likely)
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7
Q

Men UTI risk factors (2)

A
  1. uncircumcised

2. enlarged prostate (prostate secretes protective zinc–unless enlarged)

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8
Q

Nitrite on dip stick

A

ENTEROBACTERIACAE convert nitrate –> nitrite –

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9
Q

Dx of cystitis UTI (5)

A 
Dipstick:
1. Nitrite
2. Leukocyte esterase
UA microscope
3. RBCs, WBCs, 
4. some casts
Urine culture
5. Gold standard
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10
Q

Dx of pyelonephritis

A 
Blood culture
1. oder if pt febrile or possibly septic
CBC
2. Leukocytosis w/ left shift
3. Neutrophilia and bands suggest pyelo
UA
4. * ^ protein & WBC casts
Imaging
5. look for structural abs
6. KUB, US, CT (CT is ^ choice)
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11
Q

1st line Tx of UNCOMPLICATED and RECURRENT cystitis

A

Bactrim–TMP–SMX–Sulfa

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12
Q

1st line Tx of COMPLICATED cystits

A

Cipro/ Levaquin–Fluoroquinolone

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13
Q

1st line Tx of OUTPATIENT/ INPATIENT

A

Cipro/Levaquin

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14
Q

Pyelonephritis associated w/ production of gas in renal and perinephric tissues–usually only in DM

A

Emphysematous pyelonephritis

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15
Q

UTI when chronic urinary obstruction, together w/ chronic infx, leads to suppurative destruction of renal tissue

A

xanthogranulomatous pyelonephritis

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16
Q

Indications for hospitalization for UTI ABSOLUTE

A
  1. persistent vomiting
  2. progression of uncomplicated UTI
  3. possible sepsis
  4. uncertain dx
  5. UT obstruction
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17
Q

R/O (2) for cystitis

A
  1. vaginitis

2. STI’s

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18
Q

Pyridium for analgesia will…

A

turn urine orange

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19
Q

pain w/ bladder distention w/ out infection–dx of exclusion

A

interstitial cystits

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20
Q

tx interstitial cystits w/

A
  1. hydrodistension
  2. amitriptyline
  3. CCB
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21
Q

nephro/ ureterlithiasis types (4)

A
  1. calcium oxalate (80%)
  2. other calcium salts (15%)
  3. uric acid (5%)
  4. struvite (5%)
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22
Q

nephrolithiasis Sx

A

usually asymptomatic–possible hematuria

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23
Q

ureterlithiasis Sx

A

severe paroxysmal pain, F/C, Hematuria, frequency

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24
Q

Tx for nephro/ureterlithiasis (6)

A
  1. Flomax (alpha-adrenergic) – relaxes smooth muscle
  2. Analgesia
  3. antiemetics
  4. ABX for infection
  5. hydration
  6. strain urine
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25
Q

Cut-off for spontaneous passage of stone

A

5-7 mm 60%

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26
Q

many stones get “stuck” at

A

UVJ ureterovesical junction

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27
Q

surgery for nephro/ureterlithiasis

A
  1. lithotripsy (US)
  2. ureteroscopy
    laser
    basket retrieval
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28
Q

Relative admission for stones (5)

A
  1. persistent V
  2. associated UTI
  3. unremitting pain
  4. stone >6mm
  5. impaired renal function
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29
Q

Ca+ stone etiologies (4)

A
  1. hypercalciuria
  2. hyperoxaluria–* check oxalate in KIDS w/ stones
  3. hypocitruria
  4. hyperuricosuria–forms core
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30
Q

*uric acid stone risk factors (2)

A
  1. low urine pH (<5.5)

2. Gout

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31
Q

Struvite (staghorn) stone risk factors (2) Tx

A
  1. Recurrent UTIs
  2. urine pH >7.5
    Tx: lithotripsy or surg and ABX
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32
Q

antibody-antigen associated glomerular injury steps (3)

A
  1. antigen-antigen deposition
  2. compliment activation
  3. recruitment of leukocytes
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33
Q

nephrItic

A

Inflammation/ Blood

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34
Q

nephrOtic think

A

pOdocyte , prOtein

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35
Q

mild edema

A

nephritic

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36
Q

generalized/peripheral (anacarca)

A

nephrotic syndrome

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37
Q

oval fat bodies in urine

A

nephrotic

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38
Q

GFR normal at first

A

nephrotic

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39
Q

oliguria, azotemia immediately

A

nephritic

40
Q

hypertension

A

nephritic

41
Q

hematuria, dysmorphic RBC, Casts

A

nephritic

42
Q

Hypoalbuminemia <3g/dL

A

nephrotic

43
Q

60% of ________ cases are in children

A

nephritic

44
Q

primary kidney diseases associated w/ nephritic syndrome (4)

A
  1. postinfection GN (strep)
  2. IgA nephropathy (Berger, HSP)
  3. Membranoproliferative GN
  4. Rapidly progressive GN (CRESCENTIC)
45
Q

anti-GBM GN ex.

A

Goodpasture (systemic kidney disease –> nephritic syndrome)

46
Q

hereditary nephropathy –> nephritic

A

Alport’s

47
Q

systemic diseases which can cause nephritic syndrome

A
  1. Pauci-Immune (Churg, Microscopic Polyangiitis, Wegener’s)
  2. Anti-GBM GN (GP)
  3. Hereditary nephropathy
48
Q

Nephritic syndrome Urinalysis findings (4)

A
  1. RBCs (dysmorphic)
  2. RBC casts
  3. WBCs
  4. Possible mild proteinuria
49
Q

renal bx findings for nephrotic syndrome

A

crescents

50
Q

antinuclear antibodies associated w/

A

Lupus GN

51
Q

Asthma and eosinophilia findings

A

chung-strauss syndrome

52
Q

Tx post strep nephritic syndrome

A
  1. Treat underlying infx or inflammatory agent: ABX
  2. treat HTN: ACEI
  3. don’t use corticosteroids or immunosuppresants unless severe
53
Q

nephrotic syndrome may present w/ hypercoagubility because

A

loss of serum proteins responsible for anti-thrombin

54
Q

*Nephrotic syndrome in children is usually _______ while _____ in adults

A

primary,

secondary

55
Q

serum findings in nephrotic syndrome (4)

A
  1. HYPOalbuminemia
  2. Total serum protein <6 g/dL
  3. HYPERlipidemia
  4. Complement levels
56
Q

UA findings in nephrotic syndrome (3)

A
  1. Proteinuria
  2. Lipiduria (OVAL FAT BODIES)
  3. BLAND URINE
57
Q

Tx nephrotic syndrome

A
  1. dietary (low fat, salt

2. Loop diuretics (Lasix)

58
Q

Angiotensin II ______ ________ glomerular capillary

A

dilates afferent

59
Q

postinfectious GN appears how long after infection

A

1-3 weeks after infx resolves (usually Strep pyogenes–sometimes S. aureus)

60
Q

test for postinfectious GN

A

Anti-streptolysin O (ASO)

61
Q

Pt w/ POSTINFECTIOUS GN may complain of (2)

A
  1. back or flank pain

2. hematuria

62
Q

Tx for postinfectious GN (2)

A
  1. Tx infx–possibly w/ antiinflammatory ABX

2. antihypertensives, salt restriction, diuretics

63
Q

IgA nephropathy aka

A

Berger disease (IgA deposits in MATRIX)

64
Q

most common cause of recurrent hematuria/ most common type of GN in adults

A

Berger disease

65
Q

IgA nephropathy (Berger) dx (3)

A
  1. serum IgA level
  2. hematuria (cola-urine)
  3. immunofluorescence IgA
66
Q

Berger may be a localized variant of

A

Henoch-Schonlein Purpura (

67
Q

Berger pathophys

A

deposition of IgA in mesangium

68
Q

slowly progressive unremitting GN that can initially present as nephrotic syndrome

A

membranoproliferative GN (secondary to chronic infx HCV/lupus or immune cmpx’s)

69
Q

ANCA aka

A

Pauci (small)-immune GN

70
Q

eosinophilia associated w/ asthma, allergic rhinitis, purpura

A

Churg-Strauss (Pauci-immune GN)

71
Q

C-ANCA

P-ANCA

A
  • Wegerner’s (cytoplasmic pattern)

- Microscopic polyangitis (perinuclear pattern)

72
Q

ANCA light microscopy findings (2)

A
  1. necrotizing lesions

2. crescents

73
Q

Anti-GBM GN and Goodpastures differentiation

A

2/3 of GP pt present w/ alveolar hemorrhage (coughing up blood)

74
Q

Anti-GBM GN dx

A
  1. normal compliment levels

2. Anti-GBM antibodies

75
Q

hereditary nephritis

A

Alport syndrome–^males

76
Q

Alport syndrome presentation

A
  1. nerve deafness
  2. various eye disorders (lens dislocation, cataracts, corneal atrophy)
  3. hearing loss
77
Q

plasmophoresis treatment used to

A

get rid of antibodies

78
Q

most common cause of proteinuria in children (80%)

A

minimal change disease (nephrotic syndrome)

79
Q

May follow URI, renal function preserved, insidious development of edema and nephrotic syndrome in otherwise healthy child

A

minimal change disease

80
Q

minimal change disease UA findings + Tx

A
  1. proteinuria
  2. Oval fat bodies
    - -Corticosteroids
81
Q

idiopathic sclerosis of certain segments in some but not all glomeruli

A

focal and segmental Glomerulosclerosis

82
Q

nephrotic syndrome more likely to have nephritic sx (hematuria, HTN)

A

focal & segmental Glomerulosclerosis

83
Q

Tx for focal and segmental glomerulosclerosis (3)

A
  1. low salt/diuretics (tx the edema)
  2. ACEI
  3. statins
84
Q

___% of focal and segmental glomerulosclerosis & membranous glomerulonephritis sufferers develop ESRD

A

50%

85
Q

most common cause of nephrotic syndrome in adults

A

membranous glmerulonephritis (30-50yo)

86
Q

most common cause of ESRD in USA

A

diabetic nephropathy

87
Q

deposition of abnormal proteins that have become insoluble and clumped together in tissue (amyloid)

A

amyloidosis

88
Q

dz largely due to immune complex deposition resulting in mesangial proliferation and GBM abnormalitis

A

systemic Lubus Erythematosus–can present as nephrotic or nephritic syndromes

89
Q

Risk factors for AKI (4)

A
  1. DM
  2. HTN
  3. Dehydration
  4. Age
90
Q

Acute renal failure S and Sx (3)

A
  1. sudden ^BUN
  2. ^creatinine
  3. Oliguria
91
Q

*urine sediment w/ pigmented granular casts and renal tubular epithelial cells

A

acute tubular necrosis (pathogneumonic)

92
Q

85% of intrinsic AKI

A

acute tubular necrosis

93
Q

2 main causes of acute tubular necrosis

A
  1. ischemic–prolonged prerenal state

2. nephrotoxins–(exogenous>endogenous)

94
Q

Acute tubular necrosis UA findings (5)

A
  1. muddy brown sediment (pig. gran. casts)
  2. renal tubular epithelial cells
  3. oliguric
  4. FeNa >1
  5. urine Na>20
95
Q

caused by interstitial inflammatory response (often allergic)

A

acute interstitial nephritis

96
Q

key features of acute interstitial nephritis (4)

A
  1. fever
  2. maculopapular rash
  3. AKI
  4. pyuria, WBC casts, hematuria
97
Q

serum eosinophila findings ^

A

acute interstitial nephritis

Renal (5 decks)

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