renal Flashcards
dx of urothelial carcinoma (including bladder cancer)?
cystoscopy+ CT uragraphy (if high risk) or
cystoscopy+ kidney US (if medium risk)
a quien se le hace US por UTI?
febrile child 2month-24months with proven UTI in cultivo
sx irritativo+obstructivo+tender prostate
feverm malaise
acute prostatitis
renal arter stenosis
increased plasma renin and unilateral atrophy of affected kidney
stress incontinence pato y sx, tx?
urethra hipermobility due to no support from pelvic floor
loss of urine with stress (laugh, cough, sneezing)
tx: kaegel, pesario, sling (sx)
Hyperaldosteronism presents with the following findings:
Hypertension - Hypernatremia - Hypokalemia - Metabolic alkalosis
sx sd nefrOtico? triada y casts
Fatty casts with maltese cross appearance
triada:
- proteinuria (>3,5 g/24h)
- edema
- hipoalbuminuria (<2,5)
-estado protrombotico
-estado proinfeccioso
-estado aterosclerotico
como se esta perdiendo albumina también se estan perdiendo otras proteinas, incluido antitrombina III haciendo de este un estado hipercoagulante y se pierden immunoglobulina haciendolo un estado proinfeccioso.
como se pierden proteinas se pierde también presion oncotica esto aumenta el luquido y hace un estado aterosclerotico
pielonefritis+gross hematuria. dx?
renal papilla necrosis
flank+colicky pain after ingestion of large amounts of diuresis-inducing beverages (e.g., alcohol, coffee). dx?
ureteropelvic junction obstruction
drugs causing Allergic intersitial nephritis?
“SMART NAC” > smart nephrons are crying
Sulfas
Meticilina
Ampicilina/penicilina
Rifampicina
Tiazidas
Nsaids
Allopurinol
Cefalopsporina/Cimetidina
flank pain+diffuse maculopapular rash+eosinophilia
hematuria and sterile pyuria (classically eosinophils)
N gonorrea tx?
Ceftriaxona IM una dosis (se puede usar en embarazo)
diplococo gram -
Creamy, white, purulent discharge
sd nefritico despues de strep infection? dx y patologia y lab?
Poststreptococcal glomerulonephritis
Subepithelial immune complex deposition
“lumpy bumpy” (granular) immunofluorescence pattern due to immune complex deposition
Deposition of immune complexes composed of IgG and C3 complement
Lab: decreased C3 complement levels
clamidia tx? embarazo y no embarazo
doxiciclina (no embarazo)
azitromicina (embarazo)
Muscular invasive bladder cancer tx?
cystectomy (resection) + cicaplastin (no usar si hay sordera)
kid with abdominal mass that DOESNT cross midline
dx, sx? sd asociado?
nefroblastoma
sx: dolor abdominal + hat
WAGR syndrome:
Wiliams tumo (nefroblastoma)
Aniridia: partial or complete absence of the iris
Genitourinary abnormality
Retardo mental
screenings:
abdominal screening ultrasound should be obtained quarterly until at least five years of age por el neuroblastoma
Hipopotasemia que no responde a tratamiento, que otro electrolito le hace falta?
Magnesio
Low serum magnesium interferes with potassium repletion and should be considered in patients with hypokalemia, especially those who are at risk for multiple electrolyte abnormalities due to ongoing gastrointestinal losses (i.e., diarrhea) and a history of heavy alcohol use, as in this patient.
flank pain+rash+increased creatinine?
dx?
Nefritis alergica intersticial
+eosinofilia
+fever
+hematuria
medicamentos asociados a nefritis alergica intesticial ?
RSVP
Rifampicina
Sulfas
5P
Pain killer (NSAIDs)
Pee pill (tiazidicos y loop diuretics)
Penicilina
Proton pump inhibitor
Phenitoina
organismo en long term catheter y como esta el ph de la orina?
Proteus mirabilis asociado a cateter urinario
ph orina >8
asociado a calculo de struvita / coralino aka staghorn
disuria, nocturia + prostata incrementada + ^ creatinine ^ BUN + fatiga y malaise in older man
diagnostico y metodo dx?
posrenal kidney injury caused by hiperplasia prostatica benigna causandomelos hidronefrosis
dx: us renal
Initial hematuria is suggestive of _____?
uretral/prostata bleeding
Membranous nephropathy a que enfermedades se asocia?
como esta el complemento?
sd nefrOtico
Membranus nephropathy se asocia a:
Hep B, Hep C
Malaria, Sifilis
Autoinmunes (lupus)
cancer
medication
Complemento disminuido
Membranous nephropathy is the most common cause of nephrotic syndrome in White adults
Membranous nephropathy. Biopsia y LM?
Biopsia: IgG y C3 subepitheliar depositos “spike and dome appearance”
LM: DIFFUSED thick glomerular basement
patient missed dialysis, como estan los labs?
decir ph,ho3, co2
metabolic acidosis with increased anion gap
ph disminuido+HCO3 disminuido+ anion gap incrementado (>12)
CO2 disminiudo (<33) (el cuerpo respira mas como compensación, por eso baja el co2)
anion gap rango normal 8-12
que electrólitos se pierden en la fase poliruica de acute kidney injury?
Na, K, Mg
Patients with AKI usually regain full glomerular filtration function approx. 2 weeks after the inciting event, while tubular reabsorption remains impaired, which results in increased urine production and consequent polyuria. The polyuric phase of AKI is characterized by the loss of several electrolytes that are normally reabsorbed by the tubules, including potassium, sodium, and magnesium.
incontinencia al incrementar presion intrabdominal? dx y tx?
stress incontinence
tx:
1) kegel / pessaries
2) cx sling
SIADH tx?
1) HIPERtonic solution (3%) (no muy rapido xk puede causar central pontine myelinolysis (demialinizacion de CNS))
2) severe: tolvaptan
3) cronic: , demeclocycline
a quien se le manda cultivo de orina x ITU?
ITU complicada ( and recent catheterization or instrumentation): pt hombre, embarazo, niños, inmunocomprometido, problema anatomico en vias urinarias, and recent catheterization or instrumentation.
ITU que no respondio a tx inicial de primera linea en itu no complicada (nitrofurantoina, tmp sms, fosfomicina)
Disuria/bacteuria asintómatica en mujer embarazada
vericocele que no desaparece en supino. sospechar?
tumor obstruyéndo vena cava inferior o vena renal izquierda
renal carcinoma sx?
flank pain
hematuria
palpable flank mass
hipercalcemia
primer signo de nefropatia diabetica?
microalbumina
dano valvular asociado a autosomal dominant polycystic kidney disease?
prolapso mitral
blunt abdominal trauma + microscopic hematuria + fractured rib. sospechar? dx?
renal injury
dx: tac con contraste de abdomen y pelvis
constant flank pain+BILATERAL hydrnephrosis
diagnostico, metodo diagnostico, asociado a?
fibrosis retroperitoneal
dx: tac con contraste. biopsia (confirmatoria)
asociado a: chronic ergot use (ergotamina), abdominal irradiation, retroperitoneal surgeries, and IgG4-related systemic disease.
