Renal 2 Flashcards by Stephanie Escobar

Acute tubular necrosis/ Renal Tubular Injury

3 MCC:

Hypotension/Hemorrhage
Aminoglycosides
Contrast dye (iodinated)

muddy brown, granular casts

ATN will HACk your kidneys

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Glomerular immune complex deposition resulting in renal injury (rise in Cr & BUN)
can be caused by what type of syndromes?

Nephortic/Nephritic syndromes:

Ex:
- Membranoproliferative glomerulonephritis (HepC)
- Mixed cryoglobulinemia syndrome (an immune complex deposition disorder)

*UA = +/- dysmorphic red cells, red cell casts, or protein.

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Renal Interstitial inflammation commonly caused by (2)

Acute interstitial nephritis (AIN)
(ABxs or rheumatologic disease)
*UA = WBCs and WBC casts +/- eosinophils in the urine
⎯
Chronic interstitial nephritis
-Tubulointerstitial nephritis
-Analgesic nephropathy
s/t chronic use of combo analgesia w/ acetaminophen + aspirin or NSAID.
* UA= urine WBCs and WBC casts

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Tubular Obstruction can be caused by Methotrexate use and (3)

Chemotherapy, Tumor lysis syndrome, Chronic Gout
(Acute urate nephropathy )

Ethylene Glycol poisoning (Anti-Freeze)

Acyclovir (pt w/ recent viral hemorrhagic meningitis)

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Evidence of glomerular damage on urinalysis = dysmorphic red blood cells, red blood cell casts

suggests what general diagnosis?

Glomerulonephritis

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BUN/Cr ratio >20
& largely unremarkable UA/urine sediment

Diagnosis?

Prerenal AKI

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Nodular glomerulosclerosis occurs in diabetic nephropathy;
renal dysfunction typically develops over what time frame?

gradually (rather than over 1 month)

*and significant proteinuria is seen.

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Leukocyte casts on urinalysis + a skin rash = Diagnosis?

acute interstitial nephritis (AIN)

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Typically presents with HTN, hematuria, ↑ Cr

± dysmorphic RBCs on UA

Glomerulonephritis

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Perineal bruising accompanied by blood at the urethral meatus
and a high-riding prostate on digital rectal examination
Diagnosis? NBSIM?

posterior urethral injury
Retrograde urethrography

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Negative Fast Exam + bladder tear
Where is the tear?

Anterior Bladder Wall

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Postive Fast Exam + bladder tear
Where is the tear?

Bladder Dome

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suprapubic fullness and tenderness and gross hematuria in the setting of a pelvic fracture likely s/t a _____.
NBSIM?

bladder injury
Retrograde cystography

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screening for ____ cancer (urinalysis, urine cytology, tumor markers) has not been shown to improve outcomes and is not recommended.

bladder cancer

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40M Smoker presents with painless hematuria throughout micturition
± Irritative voiding symptoms (frequency, urgency, dysuria)
± suprapubic pain

Diagnosis and NBSIM?

Bladder Cancer
Flexible cystoscopy with biopsy

Hematuria can be microscopic

Renal Cancer does not usually have voiding sxs

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Treatment of Bladder Cancer
No muscle invasion: ____
Muscle invasion: ____
Metastatic: ____

TURBT = transurethral resection of bladder tumor
⎯
No muscle invasion → TURBT & intravesical Immunotherapy

Muscle invasion → Cystectomy & Chemotherapy

Metastatic → Immunotherapy & Chemotherapy

Painless hematuria in an adult age >40 must be evaluated urgently with _____.

cystoscopy

Manifestations of renal infarction include
flank pain, nausea, and vomiting

Urinalysis → hematuria and proteinuria w/o casts.

CT scan → wedge-shaped cortical infarction (dark grey triangle)

Renal infarctions can occur s/t ____. (~4)

Cardioembolic disease (A-Fib)
Infectious endocarditis (murmurs)
Polyarteritis nodosa
Fibromuscular dysplasia
Hypercoagulable states (antiphospholipid syndrome, polycythemia vera, factor V Leiden, cancer)
Marfan syndrome

Patient s/p Hysterectomy develops large volume intraabdominal fluid (uroperitoneum), abdominal tenderness, with a normal UA.

Diagnosis?

Ureteral injury (laceration)

can occur during gynecologic surgery due to the proximity of the ureter to the ovarian and uterine vessels.

RCC is sometimes discovered incidentally on abdominal imaging, but patients often have ≥1 the following:

Unintentional weight loss
Abdominal or flank mass (firm, nontender, and mobile)
Hematuria (_______),
anemia
Intermittent fever
Paraneoplastic syndromes (ectopic EPO, hypercalcemia)

Patients with suspected RCC usually require ____ & ____ for further evaluation.

Microscopic (not seen in urine)
or
Gross (Painless red pee)

Abdominal CT scan
Partial/complete nephrectomy

How to tell bladder cancer and Renal Cell Carcinoma apart?

RCC does not have voiding symptoms (frequency, urgency, dysuria) and suprapubic pain. More common in bladder cancer.

Chronic _____ often causes recurrent symptoms of urinary tract infection (dysuria, frequency, urgency) that improve with short courses of antibiotic therapy but then recur.
Urinalysis often shows pyuria and bacteriuria.

bacterial prostatitis

WAGR syndrome/11p deletion syndrome is characterized by a predisposition to W____ and the presence of A____, G_____, and R____.

Consider in a child with 2 or more of the associated conditions.

Wilms tumor (Nephroblastoma)
Aniridia (no Iris)
Genital-Urinary defects/abnormalities
Retardation (Mental)

Unilateral varicoceles that fail to empty when a patient is recumbent raise suspicion for ____

an underlying Tumor

such as renal cell carcinoma (RCC), that obstructs venous flow

Causes of initial hematuria (2)

urethritis Trauma (catheter insertion)

Causes of terminal hematuria (3)

Urethral stone Urethral cancer Prostate cancer

Causes of hematuria throughout urinary stream (6)

Glomerulonephritis Kidney stones UTI Renal Papillary Necrosis **Cancer (Renal, bladder, urethral)** Trauma

Initial hematuria suggests ____ damage, terminal hematuria indicates ___or ___ damage, and total hematuria reflects damage anywhere in the urinary tract.

Urethral (Initial) Bladder/Prostatic (Terminal)

Seen in children, typically presents with an asymptomatic unilateral abdominal mass. ± Abdominal pain, hypertension, hematuria

Wilms tumor (nephroblastoma) most common renal malignancy in children. (Unilateral → Nephrectomy) (Bilateral → Immunosuppresion → Chemo → Radiation)

Individuals with secondary polycythemia (**elevated Hct**) and no evidence of hypoxia (cardiopulmonary disease, obstructive sleep apnea) should undergo abdominal CT scan to evaluate for ____.

renal cell carcinoma (Pheochromacytoma can do this too)

Blunt trauma (eg, direct blow to the flank) can cause renal injury. Concerning clinical findings (eg, flank pain/ecchymosis) require prompt _____, **regardless of whether hematuria is present**.

CT scan of the abdomen and pelvis

A _____ should be suspected in a prepubertal boy with a soft, coiled ("bag of worms"), right-sided scrotal mass that fails to decompress when supine. NBSIM?

secondary **varicocele** **Abdominal ultrasound** (to evaluate for anatomical causes leading to venous compression (such as a renal tumor)

painless, coiled ("bag of worms") scrotal mass or swelling that **does not transilluminate** is most consistent with a ____.

varicocele (a dilation of the pampiniform plexus surrounding the spermatic cord and testis)

Typical presentation of a ___ is an irregular, unilateral **scrotal mass** in an adolescent or adult patient that **increases with standing/Valsalva** maneuver and **reduces when supine**.

primary varicocele

a varicocele s/t **venous thrombus** or extrinsic compression of the inferior vena cava (IVC) by a renal or retroperitoneal **tumor** is rare but should be considered in the following circumstances: Age Group: _____ _____-sided mass Mass that fails to ____

**Prepubertal** boy ** Right** sided mass **decrease in size** when supine