Renal 2 Flashcards
Acute tubular necrosis/ Renal Tubular Injury
3 MCC:
Hypotension/Hemorrhage
Aminoglycosides
Contrast dye (iodinated)
muddy brown, granular casts
ATN will HACk your kidneys
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.
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
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)
Evidence of glomerular damage on urinalysis = dysmorphic red blood cells, red blood cell casts
suggests what general diagnosis?
Glomerulonephritis
BUN/Cr ratio >20
& largely unremarkable UA/urine sediment
Diagnosis?
Prerenal AKI
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.
Leukocyte casts on urinalysis + a skin rash = Diagnosis?
acute interstitial nephritis (AIN)
Typically presents with HTN, hematuria, ↑ Cr
± dysmorphic RBCs on UA
Glomerulonephritis
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
Negative Fast Exam + bladder tear
Where is the tear?
Anterior Bladder Wall
Postive Fast Exam + bladder tear
Where is the tear?
Bladder Dome
suprapubic fullness and tenderness and gross hematuria in the setting of a pelvic fracture likely s/t a _____.
NBSIM?
bladder injury
Retrograde cystography
screening for ____ cancer (urinalysis, urine cytology, tumor markers) has not been shown to improve outcomes and is not recommended.
bladder cancer
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
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
