Renal Flashcards
1
Q
RBC casts
A
Glomerular disease, vasculitis
2
Q
WBC casts
A
interstitial nephritis, pyelonephritis
3
Q
ATN
A
Hypovolemia, urine Osm >300, urine Na >20, FE Na>2% ——-> MUDDY BROWN casts/epithelium
4
Q
CRF casts
A
Broad and waxy
5
Q
EOSINOPHILIURIA, WBC casts, hematuria, rash, arthralgias
A
Drug-induced interstitial nephritis = lymphocytic or eosinophilic infiltration
6
Q
Uncomplicated cystitis tx
A
Nitrofurantoin 5d, TMP-SMX 3d, Fosfomycin
7
Q
Complicated cystitis tx (DM, CKD, obstruction, cath)
A
Fluoroquinolones + culture
8
Q
Gross hematuria
A
Bladder cancer
9
Q
Recurrent hematuria, child, deafness, thick+thin capillary + GBM splitting
A
Alport syndrome
10
Q
Coffin lid shaped crystals
A
Urease producing UTI organisms
11
Q
Most common type in elderly/nursing home
A
Urge
12
Q
Sudden need when walking, drinking, large volume, nocturnal wetting
A
Urge
13
Q
Causes/mech of urge incontinence
A
UTI, stroke, MS, dementia, Parkinson –> uninhibited detrusor contractions
14
Q
Dx & Tx of urge incontinence
A
Urodynamic - timed-voiding/training –> oxybuntin, imipramine
15
Q
Urine leak w/ laughing, sneezing, small PVRV
A
Stress - weak muscles
16
Q
Tx stress incontinence
A
Kegel, estrogen, pessary, urethropexy
17
Q
Urinary incontinence in woman of childbearing age
A
MS - Urge or overflow
18
Q
Incomplete emptying, dribbling, frequency, PVRV >100ml, nocturnal
A
Overflow
19
Q
Causes/mech of overflow incontinence
A
Poor contraction (DM, anti-cholinergics, a-agonist) or obstruction (BPH, CA, constipation)
20
Q
Tx overflow incontinence
A
Intermittent cath, bethanachol, a-blockers
21
Q
Can’t sense need to urinate
A
Reflex incontinence - SC injury»_space; MS, DM, disc, SC compression/tumor
22
Q
Non-inflammatory chronic prostatitis
A
WBC <10
23
Q
Inflammatory chronic prostatitis
A
WBC >10
24
Q
Nocturia, difficulty starting stream, Cr 0.7, smooth firm prostate next step?
A
Urinalysis - hematuria/stones, infection, cancer, obstruction
25
Difficulty starting, nocturia, hesitancy, Cr 1.2 --> 2.1, smooth firm prostate next step?
Abd US --> hydronephrosis --> Foley --> TURP
26
Indication for prostate bx
Elevated PSA or nodule
27
Causes of priapism
Trazodone, prazosin, sickle cell, leukemia, SC, cauda equina, cavernous a ligation
28
Urgency, frequency, NO dysuria, difficulty starting urination, dribbling
BPH --> U/A, Cr
29
Tx for BPH
a-blocker (Tamsulosin), 5-a-reductase inhib (Finasteride), Foley --> TURP
30
Fever, N/V, + urine WBC, bacteria, tender DRE
Bacterial prostatitis --> UA & cx --> Cipro
31
Tx aseptic prostatitis
High dose NSAIDs
32
Sudden testicular pain, NO fever, horizontal testis, high riding
Testicular Torsion --> US or surgery untwist & b/l orchipexy
33
Sudden testicular pain, NO fever, bacturia, vertical, tender cord
Epidimytis --> US --> abx
34
Penis fracture work-up
Retrograde urethrogram + surgical exploration
35
Low urine pH and stone tx
Uric acid = K-citrate, limit protein
36
Hypercalciuric stone tx
HTCZ, hydration
37
Blood at end of urine stream
Bladder or prostate
38
Hematuria for entire stream
Kidney or ureter
39
Urine sodium <10, ascities, cirrhosis
Renal hypoperfusion - Pre-renal failure
40
Indication for cystoscopy
Hematuria suggesting stone, CA, stricture
41
Flank pain, hematuria
Kidney stone --> CT scan, U/S
42
Tx of kidney stone
Small 3cm = surgical; between = lithotripsy
43
Work-up of hematuria
CT scan, cystoscopy
44
Causes of acute urinary retention
anti-histamines, BPH --> cath for 3d --> a-blocker & 5-a reductase inhibitors
45
Pneumaturia work-up
Diverticulitis --> CT, sigmoidoscopy to r/o CA
46
Evaluate RLQ pain + urine crystals
Uric acid stones --> CT or IVP
47
Blood at meatus + scrotal hematoma, high riding prostate next step
Retrograde URETHROGRAM - pelvic fx
48
Hematuria + flank pain + mass
Renal cell carcinoma --> CT, bx --> resection and chemo
49
Hematuria, varicocele not empty supine, anemia + thromboytosis
RCC --> CT abd
50
Hematuria, hydronephrosis, hydroureter, smoking, b-alanine dye
Bladder CA --> US = hydro but 1st step = cystoscopy, best = bx, CT stage
51
Dribbling, urgency, frequency, difficulty starting urination
Prostate CA = 5-DHT (testosterone responsive)
52
When to get PSA
Firm, nodular DRE --> PSA for Dx
53
Work-up for Prostate CA
DRE --> PSA --> Bx rectal > urethral for Gleason score --> tx
54
Tx for prostate CA
Anti-androgens (Flutamide), GnRH analog (Leuprolide), orchiectomy, surgical +/- rads
55
Germ cell, painless mass
Testicular CA --> transilluminate fails --> orchiectomy
56
Seminoma tx
Platinum chemo + rad, follow LDH
57
Non-seminoma (yolk sac, choriocarcinoma, teratoma)
Follow AFP, b-HCG, teratomas are very malignant
58
Dialysis, excessive bleeding mech
Platelet dysfxn d/t uremic coagulopathy
59
Colicky abd pain --> stones Dx and prevention
CT --> NSAIDs --> inc hydration >2L/d, inc Ca, reduce protein, Na and oxalate in diet
60
HypoNa, low serum osmolarity, high urine
SIADH - NASAID use
61
Dehydration, HypoNa, low serum osmolarity
Mineralocorticoid deficiency
62
Indications for dialysis
HyperK, pul edema, pH<7.2, uremic pericarditis or enceph, coagulopathy
63
Associations w/ ADPKD
#1 = hepatic cysts, MVP, MR< diverticula, hernias, berry aneurysm
64
Linear deposits, anti-GBM
Goodpasture's (cytotoxic ab) --> emergency plasmapheresis
65
Contraction alkalosis, inc bicarb
Dehydration from furosemide
66
Prevent contrast induced kidney damage
Non-ionic contrast, NAC, IVFs or pre-tx w/ prednisone if allergic
67
#1 cause of death in dialysis pts
Cardiovascular (#1 overall)
68
Cell mediated injury renal disease
Idiopathic crescentic GN
69
days after strep infection --> nephropathy
10 - pharyngitis, 21 - impetigo + LOW complement
70
Prevent urate crystal neuropathy in lymphoma and leukemia
Pre-tx w/ allopurinol
71
Hematuria, chronic headaches and analgesic use
Analgesic nephropathy --> ischemic vasa recta --> papillary necrosis
72
Primary glomerular damage -->
dec GFR --> pul edema, JVD, anasarca, proteinuria, RBCs, HTN
73
Oliguria w/ inc BUN, Cr - Acyclovir nephrotoxicity mechanism
Renal tubular obstruction - poorly soluble d/t poor hydration
74
Large amount of blood on UA but, 1 RBC on micro, hx seizure, inc Cr
Rhabdo --> myoglobinuria --> Acute RF
75
Chronic DM, HTN, 3+ proteinuria, retinopathy, Dec BUN
Diabetic nephropathy = microangiopathy
76
Recurrent stones, hexagonal crystals, + CN nitroprusside test
Cystinuria --> impaired dibasic a.a. transport
77
Benign renal cyst characteristics --> reassurance
Thin walls, simple, no enhancement, no divisions
78
1 umbilical artery assoc
Renal anomalies
79
#1 newborn abd mass
Hydronephrosis
80
Right flank mass w/ calcification + hemorrhage, weight loss, inc HVA, VMA in urine
Neuroblastoma = neural crest cells, CROSSES midline (vs. nephro)
81
ASx proteinuria only on dipstick
Repeat on 2 subsequent occasions
82
Transient proteinuria causes
Fever, exercise, volume depletion, stress, seizure
83
Nephrotic proteinuria, podocyte effacement
Minimal change --> steroids
84
Inc serum globulin, 3+ proteinuria, edema, hyperlipidemia, periorbital swelling
Minimal change --> steroids
85
Hodgkin lymphoma renal disease
Minimal change, sometimes Focal
86
HIV + HepB renal disease
Membranouns
87
Renal disease assoc w/ cancers
Membranous
88
Nephrotic, HBV infection, sub-EPIthelial deposits
Membranous
89
Nephrotic syndrome, sudden fever, hematuria, abd pain
Renal vein thrombosis = MEMBRANOUS
90
A.A. HIV
FSGS
91
Heavy proteinuria, rapid renal failure, HIV+, sickle, Black, obesity, drugs
FSGS
92
Previous URI, now hematuria, RBC casts, normal complement GN?
IgA - <5d after URI, normal complement
- Berger IgA = days after URI
- PSGN = 1-2 WEEKS after infection
93
LE purpura, abd pain, hematuria, arthralgia, scrotal swelling
HSP --> IgA nephropathy
94
RA, enlarged kidneys, hepatomegaly, proteinuria
Amyloidosis - deposits under polarized light + fat pad Bx
95
Slow diabetic nephropahy
Add ACE
96
1st renal abnormality w/ DM
Glomerular hyperfiltration --> GBM thickening --> mesangial --> nodular sclerosis
97
Kimmelstiel-wilson nodules in GBM
Diabetic nephropathy
98
Etiology of hypercoagulation in nephrotic syndrome
Dec ATIII, dec protein C, S, inc platelet agg --> #1 RV thrombosis
99
Complications of nephrotic syndrome (think about dec proteins/albumin)
Fe resistant anemia d/t transferrin loss
VitD deficiency --> HyperPTH
Dec thyroxine
Inc infection
100
Systemic effects of nephrotic syndrome & hypoalbuminemia
Abn lipid metabolism --> faster atherosclerosis --> hypercoag --> Inc MI & Stroke
101
Low complement GNs
Post-infectious, MPGN, Lupus, Mixed cryglobulinemia
102
Acute bloody urine, edema, HTN
Step GN
103
RBC casts, peri-orbital swelling, oliguria, low C3
PSGN
104
Grannular deposits/immune complexes, low C3
SLE, PSGN
105
Nephrotic 4+ proteinuria, hematuria
MPGN
106
URI, hematuria nephropathy
IgA
107
Dense C3 intramembranous deposits
IgG (C3 nephritic factor) MPGN-II = persistent complement activation
108
Crescent formation
RPGN
109
Rapid onset nephritic, hematuria, renal insufficiency
Crescentric
110
Acidotic, hypoK, urine pH high, fam hx kidney stones
RTA-I
111
RTA I
No H+ secretion in urine = low ammonium production by tubules
112
Dec bicarb reabs, Fanconi
RTA-II
113
RTA II
Defective bicarbonate reabsoprtion, fanconi & carbonic anhydrase inhibitors
114
HyperK, hyperCl acidosis, uropathy, cystic kidneys
RTA-IV
115
Renal insufficiency, hyperK, non-anion gap acidosis w/ low Bicarb
Renal tubular acidosis - 4 = aldosterone deficiency, worse w/ ACEs, DM
116
UTI management
7-14d abx
117
Renal and bladder US indications
<24mo, recurrent febrile, no abx response
118
UTI prophylactic abx indications
Grade III-IV vesicoureteral reflux
119
Indications for voiding cystourethrogram
Hydronephrosis, scarring, high reflux, obstruction, recurrent
120
Chronic UTI, IVUP shows blunted calyces, scarring Dx
Chronic pyelo
