Renal

Question 1

Effect of thiazide diuretics

Answer 1

• hyponatremia
• hypokalemia
• hypomagnesemia
• hypercalcemia
• hyperglycemia
• hypercholorosremia/ LDL/triglyceride
• hyperuricemia

Question 2

Oral desmopressin (antidiuretic hormone analogue)

Answer 2

• reduce urine production during sleeping
• first line medication for primary nocturnal enuresis

Question 3

Obstructive sleep apnea in children

Answer 3

signs:
1. Child is irritable & inattentive & hyperactive with tonsillar hypertrophy

Diagnosis:
- nocturnal polysomnography

Treatment: —> lead to resolution of associated enuresis
- adenotonsillectomy
- positive airway pressure

Question 4

Primary vs secondary nocturnal enuresis in children

Answer 4

Primary:
New onset of nighttime wetting without achieving urinary continence
- treatment: reassurance, restrict evening fluid, bedwetting alarm

Secondary:
- new onset of nighttime wetting after achieving urinary continence for > 6 months
- associated with (UTI, Diabetes, stressor)
- treatment: treat underlying condition, behavioral change

Diagnosis:
- urinalysis

Question 5

Benign prostatic hypertrophy associated with

Answer 5

• diabetic kidney disease = with persistent proteinuria in urinalysis
• acute kidney injury due to bladder outlet obstruction = diagnosed with renal ultrasound to assess for hydronephrosis

Question 6

Assessment of patient with lower urinary tract infection
(Urinary urgency, hesitancy, nocturia, weak urinary stream)

Answer 6

1. Urinalysis —> exclude infection or hematuria
2. Serum prostate-specific antigen (PSA) —> Assess risk for prostate cancer
3. Serum creatinine ( only if patient have risk factors for CKD; diabetes or HTN)

Note:
- creatinine can be elevated in bilateral obstruction= severe bladder outlet obstruction due to BPH —> require renal ultrasound —> to assess for hydronephrosis —> placement of urinary catheter in patient with hydronephrosis can provide quick relief

Question 7

Evaluation of red urine

Answer 7

Urinalysis:

0-2 RBC:
- myoglubinuria: rhabdomyolysis, increase creatine kinase

• hemoglobinuria: intravascular hemolysis, decrease hemoglobin & haptoglobin

> 3 RBC:
- hematuria ( can be seen with long-distance running due to traumatic injury to the bladder mucosa)

Question 8

Alpha 1 receptor blockers ( tamsulosin)

Answer 8

• act on the distal ureter (lower muscle tone & reduce reflex ureteral spasm secondary to stone impaction)
• facilitate stone passage + reduce the need for analgesia

Question 9

Urinary tract infection
(Hematuria, dysuria, pyuria)

Answer 9

• hematuria: > 3 RBC
• dysuria: pain when urinating
• pyuria: elevated WBC

—> FIRST STEP MANAGEMENT: antibiotics therapy