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Urology > Quiz 1 real > Flashcards

Quiz 1 real Flashcards

1
Q

What are the 6 functions of the kidneys?

A
  1. Blood Pressure Regulation
  2. Excretion of waste
  3. Maintenance of blood pH
  4. Produce EPO
  5. Vitamin D Synthesis(last 2 steps)
  6. Gluconeogenesis
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2
Q

What is the estimated daily urine output

A

1440-2880mL

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3
Q

What is a normal GFR

A

120/mL/min

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4
Q

What are the functions of the basement membrane?

A

-allows only certain size molecules through and has a charge which repels protein to allow blood to continue down stream

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5
Q

What happens when the basement membrane is damaged?

A

blood and large molecules will pass through and proteins can get spilled leading to proteinuria and hematuria

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6
Q

What is secreted when there is low blood volume? What does this do?

A
  • Renin is secreted

- increased blood pressure

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7
Q

What is intractable blood pressure?

What population is it common in?

A
  • renin increases leading to even higher blood pressure

- Atherosclerosis

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8
Q

When a patient has kidney pain what is causing the pain?

A

Inflammation

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9
Q

What simple urine test reveals the concentration ability of the kidneys?

A

Urinalysis/Specific Gravity

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10
Q

What finding in a patients vitals can help differentiate between simple cystitis and pyelonephritis?

A

Temperature

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11
Q

What type of casts are found in people with renal failure?

A

Waxy Casts

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12
Q

What specific lymph node is palpated when concerned about a testicular condition?

A

Left supraclavicular lymph node

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13
Q

What are common urological ddx’s for fever?

A
  • Acute PN
  • Malignancy
  • Acute Prostatitis
  • Epididymitis
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14
Q

What are common urological ddx’s for No fever?

A
  • Simple Cystitis

- Chronic PN

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15
Q

What are common urological ddx’s for weight loss?

A
  • advcanced
  • renal insufficiency due to obstruction
  • renal insufficiency due to infx
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16
Q

What are common urological ddx’s for failure to thrive?

A

-Children suspect chronic obstruction, UTi or Both

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17
Q

how do you differentiate between nephritic and nephrotic syndrome?

A

24 hour urine test

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18
Q

Constant pain indicates?

A

Infx

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19
Q

Pain that comes and goes indicates?

A

Obstruction

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20
Q

What is normal specific gravity

What level do you start to see diminished renal function?

A
  1. 00-1.030

1. 010

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21
Q

What does Bun indicate

A

Blood urea nitrogen

-indicates GFR, influenced by dietary proteins, hydration, GI bleeding and drugs

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22
Q

What is a normal BUN

A

7-20

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23
Q

What does an elevated Bun indicate

A

decreased kidney function

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24
Q

What is a normal BUN/creatinine ration

A

> 20:1 signifies increased BUN ) indicates something is happening prior to the kidneys

<10:1 signifies renal damage leading to decreased reabsorption of BUN

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25
Q

what is a normal GFR for males and females

A

Males: 56-84
Females: 50-80

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26
Q

Why would you run serum creatinin

A

to estimate glomerular function

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27
Q

Blood and casts think?

A

renal endothelial damage

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28
Q

What are 6 characteristic findings of nephritic syndrome?

A
  • Hematuria
  • HTN
  • Milder
  • Mild proteinuria <3.5
  • RBC casts
  • Mild Edema
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29
Q

What are 7 characteristic findings of nephrotic syndrome?

A
  • Slower development
  • Polyuria
  • Severe Proteinuria >3.5
  • Edema (severe)
  • Dyslipdemia
  • Lipiduria
  • Some HTN
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30
Q

What is the classic presentation of Nephritic syndrome?

A

PHAROH

  • protinuria
  • Hematuria
  • Azotemia
  • RBC casts
  • Oliguria
  • HTN

other sx:
edema, rash, heart murmur

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31
Q

What is glomerular bleeding RBC morphology?

A

Dysmorphic

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32
Q

Treatment for IgA nephropathy

A
  • ACEi
  • ARB
  • Steriod if resistant
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33
Q

What lab is commonly found in goodpastures

A

Anti GBM antibodies

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34
Q

What is a common lab test in RPGN?

A

ANCA

-microscopy shows crescentic GN

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35
Q

What disease does microscopy show diffuse proliferation

A

PSGN

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36
Q

What disease does microscopy show focal proliferation

A

IgA nephropathy

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37
Q

What are the physical exam findings in Neprotic syndrome?

A
  • Pretrial pitting edema
  • Periorbital edema
  • Asess JVD
  • Ascities
  • Terry’s nails
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38
Q

What are the lab findings in nephrotic syndrome?

A
  • Protenuria
  • Microalbumia
  • Hypoalbuminemia
  • Hematuria
  • Azotemia
  • Lipiduria
  • Dyslipidemia
  • Oval Fat bodies
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39
Q

What would a UA for acute tubular necrosis show?

A
  • Mild proteinuria
  • Hematuria
  • RTE
  • RTE Casts
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40
Q

What is normal protein level in the urine?

A

0-2

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41
Q

symptoms of chronic tubulointerstitial disease?

A
  • Nocturia
  • Uremia Sx
  • Small Kidneys
  • Hyperkalemia
  • Reduced SG
  • Hyperchloremic metabolic acidosis
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42
Q

What are symptoms of Intrinsic acute renal failure?

A

-Salient hx of URI
-Diarrhea
-Use of ab or Iv drugs
-Back pain
-Gross hematuria
-Fever
Maculopapular rash
-Dehydrationand shock

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43
Q

What would you expect laboratory tests in patients with Intrinsic acute renal failure to show?

A
  • change in SG
  • High urine sodium
  • RBC Casts
  • Increased BUN
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44
Q

What is the presentation of Postrenal Acute Renal Failure

A
  • renal pain
  • renal tenderness
  • lower abdominal pain
  • post-surgery urine leak
  • over-hydration
  • edema
  • ileus with abdominal distention
  • enlarged prostate
  • distended bladder
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45
Q

What would lab results show that suggest Uremia

A
  • microalbuminuria
  • WBC’s
  • Waxy casts
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46
Q

optimal daily urine volume should be:

A

2500 ml

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47
Q

How much water intake is required to make the optimal amount of daily urine?

A

250 ml qh

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48
Q

Burning pain with voiding felt in suprapubic area may be a sign of what?

A

acute cystitis

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49
Q

Painful suprapubic area may be a sign of what?

A

Acute urinary retention

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50
Q

Is chronic retention painful in the bladder (suprapubic) area

A

No

51
Q

renal pain description

A

Sudden distention of the renal capsule

52
Q

Urethritis sx’s

A
  • Burning Pain throughout urination
  • Frequent, urethral d/c
  • Inflammed urethra
  • Local LA
53
Q

What UA findings suggest urethritis

A
  • Pyuria
  • Bacteriuria
  • Hematuria
  • Suprapubic palpation is painless
  • negative CVA tenderness
54
Q

What are the sx of cystitis

A
  • Burning Midstream/late pain that does not radiate
  • gross hematuria
  • Fatigue
  • mildly positive CVA
55
Q

What UA findings suggest cystitis

A
  • Pyuria
  • Bacteriuria
  • Hematuria
56
Q

Pyelonephritis sx

A
  • timing of pain is variable
  • Pain refers to flank/abdomin
  • fever
  • myalgia, fatigue, weakness
  • N&V
  • suprapubic palpation is painless
  • postive CVA
57
Q

What UA findings suggest pyelonephritis

A
  • Pyuria
  • bacteriuria
  • hematuria
58
Q

Signs and sx of chronic prostatitis

A
  • pelvic dullness
  • pain radiates from testicular pan to general pelvic pain
  • altered libido
  • pain on ejaculation
  • suprapubic palpation is painless
  • most UA show no results
59
Q

Oliguria and Anuria causes

A
  • acute renal failure due to shock or dehyrdation
  • fluid-ion imbalance
  • bilateral uretral obstruction

always refer for immediate treatment

60
Q

Oliguria definition

A

<500ml urine output daily

61
Q

Anuria definition

A

<100 ml urine output daily

62
Q

Gross hematuria is commonly from what source

A

uroepithelial

63
Q

What is the most common cause of hematuria in children without UTI or GN

A

-Hypercalcicuria with microcalculi

64
Q

history of hematuria and first UA is clear when do you repeat?

A

one week

65
Q

history of trauma and exercise induced hematuria when do you repeat?

A

24-48 hours

66
Q

Dip sticks pick up what type of protein?

A

albumin
not globulin
bence jones proteins are misses

67
Q

What level of plasma glucose needed to see positive glucose in the urine?

A

170

68
Q

What test will often be the first indication of viral hepatitis

A

urine urobilinogen

69
Q

What type of cast is pathognomonic for acute GN or vasculitis

A

RBC casts

70
Q

What is endogenous creatinine clearance used for?

A

reliable measure of renal function without need for infusion

71
Q

Gold standard for measuring GFR?

A

Inulin infusion

72
Q

Nephritic syndrome definition

A

glomerular inflammatory process causing renal dysfunction

73
Q

MC cause of (post) infectious nephritic syndrome

A

PSGN

74
Q

Glomerular bleeding characteristics

A
  • Dark red/cola
  • Proteinuria
  • RBC morphology:dysmorphic
  • HTN
  • Edema
  • Back/flank pain
  • Reduced renal function
  • URI/Fever/Rash hx
75
Q

Urologic bleeding characteristics

A
  • Bright red urine
  • Clots
  • RBC morphology
  • Urinary voiding sx
  • Normal renal function
  • RBC morphology : isomorphic
  • positive trauma hx
76
Q

Sx of PSGN

A
  • 1-3weeks post prior strep infection
  • impetigo
  • infx, fever, confusion
  • HTN
  • periorbital edema
  • hematuria
  • Ha
  • N&V
  • malaise
77
Q

Ua results of PSGN

A
  • Cola colored urine
  • Oliguria
  • RBC
  • RBC Casts
  • protenuria <3.5
78
Q

What ua finding is pathognomonic for PSGN

A

RBC Casts

79
Q

What serology is used to dx PSGN

A

Streptozyme test for 5 antibodies

80
Q

What are complement levels like in PSGN

A

Decreased C3 and CH50

Normal C4 and C2

81
Q

PSGN TX

A

1) Treat infection if present (penicillin, erythromycin)
2) Treat any edema or HTN (conventional: loop diuretics)
3) Limit protein (about 1g/kg per day) and sodium
4) Bed rest
5) Botanicals: Curcuma, Echinacea
6) Quercitin, bromelain
7) Vit C to bowel tolerance Vit E 800 IU
8) Constitutional hydrotherapy, skin brushing

82
Q

ANCA associated GN (necrotizing GN) sx

A
  • hematuria
  • proteinuria
  • bleeding respiratory tract nodules (hemoptysis, crackles)
  • asthma
83
Q

Anti-GBM GN and Goodpasture’s syndrome s/sxs

A

Concomitant pulmonary hemorrhage—dyspnea, hemoptysis, crackles—and renal symptoms (edema, HTN). Type II hypersensitivity reaction.

84
Q

MC cause of primary nephritic syndrome

A

Berger’s disease (IgA nephropathy)

85
Q

IgA nephropathy cause

A

Idiopathic

86
Q

IgA nephropathy sx

A

-Episodic gross hematuria <5 days after viral or bacterial URI
-Gastroenteritis
-Microscopic hematuria
-HTN
-Persistent proteinuria
asymptomatic

87
Q

General treatment approach to Nephritic syndromes:

A

1) Avoid sodium, avoid high-potassium foods, low protein diet, low antigen diet (gluten, meat, dairy), Grifola, Withania, Tinospora)
3) diuretics (use with caution)
4) fish oil (12 g/d)
5) treat HTN: goal BP is <125/75 mm Hg in presence of proteinuria >1g/d. Pharmacologic: ACEi
6) remove other allergens (environmental, etc)
7) Conventional approach: corticosteroids, alkyating agents (cyclophosphamide), calcineurin inhibitors, rituximab and ocrelizumab

88
Q

Nephrotic syndrome definition

A

The end result of a variety of diseases that damage (immunological or other assaults) the GBM ⇒protein wasting (from alteration of the negative charge), and increased permeability of glomerular capillaries.

89
Q

What type of casts are the hallmark sign of nephrotic syndrome?

A

broad waxy casts

“Renal Failure casts”

90
Q

Primary glomerular diseases that cause nephrotic syndrome

A

minimal change dz, focal segmental glomerulosclerosis, Membranous nephropathy, Membranoproliferazive
Glomerulonephritis (MPGN)

91
Q

LUPUS NEPHRITIS s/sxs

A

specific “wire loop” lesions, recurrent hematuria, HTN, rash, joint problems

92
Q

systemic diseases that cause nephrotic syndrome

A

LUPUS NEPHRITIS
BACTERIAL ENDOCARDITIS-ASSOCIATED GN
AMYLOIDOSIS
DIABETIC NEPHROPATHY

93
Q

When to order a renal biopsy with a patient with suspected nephrotic syndrome

A

persistent proteinuria with unclear cause!

94
Q

treatment for nephrotic syndrome

A

1) Allopathic: prednisone, cyclophosphamide, Mycophenolate Mofetil (lupus), oral galactose
2) HTN: ACE inhibitors, angiotensin II receptor blockers, Furosemide
3) limit dietary protein and sodium
4) remove allergens
5) FSGS: Ubiquinone and Ganoderma lucidium
6) MPGN: Alpha-lipoic acid, Vitamin E, Rosmarinic acid (Perilla frutescens eg), Rhubarb
7) Membranous nephropathy: Astragalus 15g/d to lower proteinuria
8) Fish oil 12g/day
9) Anti inflammatory herbs (curcumin, boswellia)
10) Anti-oxidants: Gingko
11) Immune amphoteric herbs
12) Constitutional hydro
13) Control diabetes
14) Renal protectives: nettle seed extract, Salvia miltiorrhiza (DanShen)

95
Q

ACUTE INTERSTITIAL NEPHRITIS (AIN), “Hypersensitivity Nephropathy” definition

A

Inflammation of the renal interstitium, from cell-mediated immune response binding to interstitial proteins, leading to a decrease in renal function. Interstitial compartment infiltrated by T-cells, monocytes, and plasma cells

96
Q

MC form of AIN

A

Drug hypersensitivity (75%)

97
Q

s/sxs of AIN

A

Presentation (acute onset of decrease in renal function days to 2 weeks post admin of meds or infx)
Symptoms (variable): fever, rash, hematuria, oliguria, nausea, vomiting, malaise. (uveitis in TINU)
Signs: decreased urine concentration, decreased GFR

98
Q

UA of AIN

A

UA: hematuria, mild to moderate proteinuria, (higher when NSAIDs), high WBCs, WBC casts, NO bacteria Eosinophiluria often present

99
Q

Management of AIN

A

1) Normal renal fxn usu occurs with discontinuation of suspected causative agent
2) Low protein, low K, low Na diet;
3) anti-inflammatories, antioxidants
4) Renafood® (Standard Process)
5) Alternative natural treatments for conditions treated with offending agents
6) Pharmacologic—if no spontaneous recovery, short course prednisone (1mg/kg, rapidly tapering)
7) Some pts may require dialysis

100
Q

CHRONIC INTERSTITIAL NEPHRITIS (CIN) may develop in what conditions?

A

Polycystic KI dz, analgesic nephropathy, sarcoidosis, SLE, multiple myeloma, Lead poisoning ⇒ fibrotic scar tissue replacing cellular infiltrate

101
Q

ACUTE TUBULAR NECROSIS (ATN) definition

A

Damage to renal tubular epithelium (RTE) cells from:
ischemia: shock (sepsis, anaphylaxis, hemorrhage), trauma, surgery, DIC
OR
“Toxic Nephropathy”: aminoglycosides, amphotericin B, lithium, cisplatin, radiographic dyes, bath salts (recreational drug), solvents, heavy metals, toxic mushrooms; also Strep, Legionella, EBV, Toxoplasmosis and others

102
Q

Treatment of ATN

A

1) correct ischemic cause or removal of toxic exposure, manage ARF
2) Chelation treatment may be needed once symptoms managed
3) NAC to prevent radiation nephropathy: 600-1200 mg bid on day prior and day of procedure
4) Cisplatin- induced nephropathy: Lipoic acid, NAC, ginkgo (1:1 ½ tsp bid), Capsaicin, selenium, quercitin
5) General protectives: Silybum marianum, gingko biloba, Cordyceps, Urtica seed, CoQ10, selenium, Vit C

103
Q

Causes of chronic tubulointerstitial disease

A

Prolonged obstructive uropathy, reflux nephropathy, Analgesic nephropathy, Lead nephropathy, Fanconi syndrome

104
Q

MC cause of chronic tubulointerstitial disease

A

bstructive uropathy

105
Q

Tx of chronic tubulointerstitial disease

A

1) Prevent renal scarring (irreversible!) if early stages: Treat the cause!
2) Tubular dysfunction may require K and Ph restriction, Na, Ca and bicarbonate supplementation
3) Chelation therapy for heavy metals
4) Natural analgesics, HP and physical medicines for chronic pain syndromes
5) Anti-inflammatories such as tumeric, boswellia, bromelain (eg, BCQ®)
6) Renal protectives: nettle seed, Salvia miltiorrhiza
7) Renal anti-oxidants: Ginseng, Coptis, Vaccinium, Quercitin, Vit C, Alpha Lipoic acid
8) Fish oil 12 g/d
9) Fanconi: Phosphate supplementation, vit D

106
Q

RTA definition

A

Renal Tubular Acidosis (RTA) results in metabolic acidosis when the kidneys fail to either reabsorb bicarbonate in the proximal tubule or secrete acid into the distal tubule. Presentation includes urinary stone formation, bone demineralization, hypokalemia.
Causes include heredity, autoimmune disease (Sjogren’s, Lupus, RA), drugs/toxins (toluene, lithium, amphotericin B, lead), chronic obstruction.
Along with managing the cause, treatment includes oral bicarbonate

107
Q

ACUTE RENAL FAILURE (ARF)/acute kidney injury (AKI)

A 
GRF abruptly (<48hrs) reduced ⇒sudden retention of normally cleared endogenous and exogenous metabolites (urea, potassium, phosphate, sulfate, creatinine, administered drugs)
Markers: Increase in serum creatinine. Decrease in urine volume output <0.5 ml/kg/hr
108
Q

What might creatinine values do in ARF?

A

Will rise slower than the BUN, better predictor of imminent kidney failure.
Values approaching 5.5 to 6.0 mg/dl = advanced renal failure
Any increase of up to or greater than 1.5 mg/dl within a short period of time (24 to 48 hours) is sign of significant problem

109
Q

What might BUN values do in ARF?

A

will rise faster than creatinine due to its higher rate of production and partial reabsorption

110
Q

MC category of ARF

A

pre-renal failure

111
Q

prerenal renal failure definition

A

inadequate perfusion TO kidneys from inadequate circulation or volume

112
Q

When is pre-renal failure reversible?

A

Reversible (no renal cell damage) if renal blood flow does not fall below 20% of normal

113
Q

tx of prerenal acute renal failure

A

1) TREAT UNDERLYING CAUSE
2) Rapid fluid replacement, IV volume expansion
3) May need vasopressor drugs (dopamine) to elevate BP and increase renal blood flow
4) Discontinue antihypertensives or diuretics

114
Q

INTRARENAL (INTRINSIC) ACUTE RENAL FAILURE definition

A

due to injury IN renal tubules, interstitium, vasculature or glomeruli leading to loss of function

115
Q

MC cause of intrarenal acute renal failure

A

Acute Tubular Necrosis ATN (80% of cases) (ischemic or toxic causes)

116
Q

Other causes of intrarenal acute renal failure

A 
Acute Interstitial Nephritis AIN (10-15% of cases)
Acute glomerulonephritis (eg post-streptococcal--PSGN, RPGN) 
Acute pyelonephritis 
Vascular diseases: vasculitis, polyarteritis nodosa, cortical necrosis/intravascular coagulation 
Nephrotic syndrome (multiple causes)
117
Q

tx of intrarenal acute renal failure

A

1) Depending on cause: Eradication of infection; Removal of antigen, toxins, drugs
2) Suppression of autoimmune mechanisms (immunomodulators)
3) Pharma: Low dose dopamine (transient improvement)
4) Monitor BUN/Creatinine
5) Supportive dialysis if needed

118
Q

POSTRENAL ACUTE RENAL FAILURE definition

A

urinary flow FROM both kidneys obstructed ⇒incr nephron intraluminal back pressure and dec GFR

119
Q

causes of postrenal acute renal failure

A

Obstruction of urine flow: prostatic enlargement, tumors (bladder, prostate, cervix, pelvic area or retroperitoneal area), urolithiasis, renal V stenosis, neurogenic bladder; post-surgical or trauma; medications (acyclovir, sulfonamides, protease inhibitors, anticholinergics)

120
Q

tx of postrenal acute renal failure

A

Rapidly treat the obstruction with catheterization or stent

121
Q

Chronic renal failure definition

A

reduced Ki clearance of certain solutes ⇒the retention of body fluids, progressing over mos to yrs. Difficult to identify its onset and predict its course

122
Q

Common causes of chronic renal failure

A

Glomerulopathies and nephropathies (esp. diabetic nephropathy)
Polycystic kidneys
Obstructive nephropathy
Hypertensive nephropathy

123
Q

s/sxs of chronic renal failure

A

General SX: HTN, edema, osteodystrophy, anemia of chronic disease, UREMIA

Urology (4 decks)

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