Renal Flashcards
purpose of voiding cystourethrogram?
look for presence of reflux
PUV
post obstructive urpathy
can see hydro and oligohydramnios on prenatal US
after birth: no UOP, distended bladder
tx= VCUG –> cath –> surgery
whast important to know about epi/hypospadias?
DO NOT CIRC! need skin to rebuild
teenager binge drinks and has colicky abd pain that eventually resolves
consider UPJO –> surgery or stent
ectopic ureter
young girl with nl bladder function but is NEVER dry –> looks like a fistula but she’s too young for that
dx test is radionucleotide scan
BUN/cr ratio prerenal vs intrarenal
Pre= >20
Intra= <15, FeNA >2%
utility or Pr/Cr ratio on UA?
will essentially give you 24hour protein but it is easier and more reliable
why doesn’t hemolysis cause hyperuricemia?
no nuclei in RBC
in general, tubular disease is:
acuTe and caused by Toxins.
Think of it like an allergic reaction. Remove the insult, correct hypoperfusion. Do not treat with steroids.
in general, glomerular disease is:
slow, and chronic
-not cause by toxins
tx with steroids but need bx to confirm dx
lab findings in RAS
Cr inc >30% after initiation of ACE/ ARB
Hypokalemia
bug that causes UTI with alkaline pH?
proteus
treatment for MCD?
oral pred x 12 weeks
bonus: if not resolving/immobile sate, consider heparin as loss of ATIII puts pt in hypercoag state
managment of stones: <5mm <7mm >10mm >1.5cm
<5 - hydrate!
<7 - medical expulsive therapy with dilating agents (bb blockers, alpha bockers
> 10 - proximal= lithotripsy, distal/ overweight= ureteroscopy
> 1.5= surgery
patients with untreated VUR at risk for?
renal scarring
complciation of cyclophasphamide?
hemmorhagic cystitis –> tx with MESNA (mercaptopethane sulfonate)
CHOP = chemo combo commonly used in lymphoma
treatment for pyleo/complicated pylo?
IV FQ 7-14 days inpatient
cyanide nitroprusside test
confirmatory test for cyteinuria
cystinuria
AR tubular defect in transpaort of dibasic amino acids (COAL)
- excrete them through urine
- causes acidic urine
- HEXAGONAL crystals
- dx with nitroprusside test
- tx with urine alkalinization
***cysteine stones are one of the few stones that DO NOT show up wel on xray
classic triad of RCC
hematuria –> suggest invasion into collecting sys
flank pain
flank mass
**only 5% of patients present this way, most come in with paraneoplastic complaints
paraneoplastic syndromes of RCC
hypertension
polycythemia –> flushing, head ache
hypercalcemia –> pth-rp
look for NO RBC casts but +RBC to suggests its not a glomerular cause and you need to look elsewhere
chronic tubulointerstitial nephritis
why: chronic analgesia –> NSAIDS inhibit prostacylcins –> restrict renal blood flow –> papillary necrosis
imaging: shrunken kidneys, calcifications from papillary necrosis
**multiple myeloma can also cause this, but instead from xs light chains (bence jones protein)
stones that cause low urine pH?
calc ox
uric acid –> radiolucent!
cysteine
cause of UTIs in pregnancy?
progeserone dilates everything, including ureters, –> urinary stasis
This makes women with asyx bacteruria (>100,000 CFU) at greatest risk for ascending infection, so treat
Use cephalexin, augmentin, nitro
how does management differ in RAS between fibromuscular dysplasia and atherosclerotic etiologies?
fibromuscular dysplasia= PTA w/o stent
athersclerosis= PTA ++++ stent!
both should also be controlled with an ACEi. Just make sure to closely monitor and stop if functoin decreases
e coli vs staph sappro UTI?
ecoli= + nitrites
staph= - nitrites! cannot convert nitrates to nitrites
high blood pressure, pulsatile tinitus, carotid stenosis?
no- cerebrovascular FMD
tx fr pregnant pylo?
iv ceftriaxone 10-14 days
treatment for posterior urethral valves?
VUR?
PUV = ablation!! (vesicostomy if unable to do ablation)
VUR= reimplantation of the ureter
mechanism of AKI with acyclovir
crystal deposition nephropathy –> poorly soluble drug that deposits crystals which obstruct tubules
**side note: immunocompromised pt who develops shingles needs inpt IV acyclovir
DKA gas
metabolic acidosis with attempts towards repiratory compensation (blow ff CO2)
gap acidosis with low bicarb (bicarb becomes rapidly used up to buffer the ketone acids)
RPGN basics
nephritic syndrome
think of: Good pastures (anti GBM), Immune complex ( lupus, PSGN), Wegner’s
treat with steroids
—–> steroids plus plasmapheresis if antiGBM
wilms vs beuroblastoma
neuroblastoma
- crosses midline
- irregular surface
- presents ~age 2
wilms
- does NOT cross midline
- smooth surface
urine of nephrtic syndrome
frothy
fatty casts (maltese cross)
3.5g/day
urinary retention after surgery but everything is normal
don’t forget to check the foley for kinking.
interstitial cystitis (bladder pain syndrome)
noninfectious cause of UTI
- sx inc urgency/frequency > 6 weeks
- relief with voiding
- **dyspaurenia is common too
- **assoc with psych do
tx of urge incont?
oxybutinin (anticholinergic) – decrease detrusor tone
first line is bladder training, pelvic floor excercises
due to urethra HYPERMOBILITY
approach to management of bladder cancer
non muscle invasive
- low risk: TURBT
- high risk: TURBT with chemo
muscle invasive with or without nodes
-radical cystectomy
metastatic
-palliative chemo
med management of BPH
alpha blocker: immediate relief
fin-a5-teride: 5 a reductase inhibitor –> blocks testosterone to dihydrotest which shrinks the prostae
- – takes a few months to work
- –can cause sexual side effects
scleroderma renal crisis
causes MAHA –> dec haptoglobin, inc ldh
stages of ATN
olig/anuric
polyuric
recovery
muddy brown casts
PRINCIPLE cause of AKI in hospitalized patients
AIN
eosinophils!!
think of this like an allergic reaction
PSGN
immune complex deposition
damage to glomerular capilary wall
subepithelial deposits along the basement membrane
membranous nephropathy
“spike and dome”
nephrotic syndrome
most common in white people!
Hep b!
solid malignancies!
assocaitions with ADPKD
bilat flank mass with inc Cr
arterial HTN
berry aneursyms
MVProlapse
**many patients have multiple liver cysts or cysts in other locations
VHL
bilat RCC
pheo
renal/panc cysts
mechanism of incont in NPH?
compression to periventricular white matter leads to central inhibition of detrussor contraction
hep b kidney path?
membranous nephropathy –> subepi deposits
membranoproliferative –> basement membrane thickening/ splitting (tram tracks) from IgG and C3 deposits
urethral hypermobility
most common cause of stress incont
-assoc with post menopause estrogen, childbirth
approach to stress incont:
conservative measures: kegels, alcohol cessation, pessary
surgery: if above fail –> urethral sling
- -> urethropexy (colposuspension) used to be popular but more invase/ more complications –> used when simultaneous repair of prolapsed organ
igA nephropathy
generally presents as otherwise asyx microhematuria
- presents DURING or IMMEDIATELY after mucosal infection
- presents in 2nd/3rd decade
- –> use this info to r/o PSGN which from 10-14 days after strep
diabetic nephropathy
- kimmelstil wilson nodule- eosinophilic nodular glomerulosclerosis
- microvascular damage
repeated UTIs from sex. Rec?
oral bactrim for 6 months
-poistcoital voiding is a sfety measure
causes of renal papillary necrosis
POSTCARDS
PYELO obstruction SICKLE CELL DZ/TRT tb cirhossis ANALGEIA dm
causes of renal papillary necrosis
POSTCARDS
PYELO obstruction SICKLE CELL DZ/TRT tb cirhossis ANALGEIA dm
usu presents with colicky bilat flank pain and mild hemturia
why does good pasture’s attack lung and kidneys?
attacks type IV collagen, which makes up basement membranes
orthostatic proteinuria
overweight, adolescent boys
- increased protein as the day gos on
- resolves with lying down overnight
- benign
alportss
ears
eyes
kidneys
abscence of type IV collagen
4 glass test is for…
chronic prostatitis
ADPKD
presents in adulthood with:
- hypertension
- flank pain
- hematuria
- palpable kidneys
assoc with liver cysts and sometime cysts in other places too
lithium cause….
DI!!!!!!!!!!!!!!!
not siadh
unilateral varicocele that does not resolve with standing, with flank pain and fatigue?
RCC, or mass in the retroperitoneum, can cause a varicocele by compression of pampiniform plexus
*be suspicious of a right sided one because they are more common on the LEFT
OAB after spinal anesthesia, prolonged labor, etc?
Or put another way, oliguria after surgery. What should be the next step?
Overflow incont.
If distended, painful bladder –> put in a cath!
If there is no associated pain or distention, do a quick US to r/o post obstructive (this is if they don’t give you lab values to tell you its prerenal due and they just need IVF)
casts: WBC Pigmented Waxy Fatty Muddy brown Hyaline Fatty
WBC- pyelo Pigmented- rhabdo --> tamm horsefall Waxy- non specific Fatty- nephrotic syndrome Muddy brown - ATN Hyaline - non specific, can be seen in healthy people after vigorous exercise or dehydration, TTP!!
ESRD tx
living donor transplant
better prognosis than cadaver
renal bx with congo red shows apply green bif.
amyloid
*consider in relation to multiple myeloma.
tx for heat stroke?
immediate ice water immersion
PAN
fatigue, myalgia, weight loss, renal involvement, abd pain
-spares lungs!!
effects MEDIUM vessels
microscpic polyangitis
necrotizing vasc with NO granuloma
- effects lungs, kidney, skin
- palpable purpura
- diff from Wegner’s because of no nasal invovlement and lack of granulomas
BUN / Cr effect by orthostatic syncope?
elevated BUN
**elevated Cr after LOC is indicative of postictal state
tx hypovolemic hypernatremia 2/2 to lithium tox
first, correct to euvolemia!! Give NS, then switch to 5% dextrose
if hemodynamically stable: amiloride if lithium cannot be d./c
hyperkalemia that require emergent therapy
EKG changes, >7, rapidly rising
If <7 and on pot sparing diuretics with no EKG change, just swtich them
metformin in AKI?
withhold in hospitalized patient with AKI as first step
rhabdo and renal failure?
ATN due to myoglobin
clue to hepatorenal syndrome?
very low urine sodium, <10, with renal function that doesn’t improve with appropriate fluid resusc
-poor perfusion of kidneys
acute urinary retention risk
post surgical men history of BPH older MCI
dietary recs for renal calculi with calcium oxalate stones
- inc fluids
- dec sodium (helps with Ca reabsorption –> inc sodium causes inc Ca in the urine)
- normal calcium
presentation of barter’s/gittlemans
hypokalemia, normotension, alkalosis, HIGH urine Cl
*contrast to surreptitious vomiting which will have low urine chloride
most common kideny stone pres:
calcium ox with hypercalciuria and normal blood calcium
encourage increased fluids!
