Renal Flashcards
Hematuria where’s the blood coming from
Kidney/ureter = blood the whole time Bladder = blood at the end Urethra = blood at the beginning
Urethral stricture
Obstructive sx slow urine stream, dribbling, spraying, large postvoid residual, NO UTI SX, cause often unknown
Membranous nephropathy
Hep B
Why do we treat pregnant women w asx bacteriuria
Prevent pyelo (ureteral smooth muscle relaxes higher risk asc infx), ARDs preterm labor
Stones
Don’t see on XR: (SUCCX)
- Struvite (urease-prod bact)
- Uric acid (tx K citrate alk urine)
- Ca 1-3mm (envelope crystals)
- Cysteine (SIXteen=hexagonal crystals, genetic, COLA, cyanide nitroprusside test)
- Xanthine
Radiopaque:
- Ca oxalate >3mm
AKI
Def=<600mL/24h, Cr inc >50%
Prerenal BUN/Cr>20, UNa<20 appropriately low (kidneys are working), nl UA:
- hypovolemia (sepsis, DIURETICS)
- maybe CHF
Intrarenal BUN/Cr 10-15, UNa>40:
- acyclovir crystals direct damage to tubules 24-48h
- AIN rx (blactams other abx, PPI >7 days after start the rx) OR systemic dz, WBC casts
- ATN ischemic injury, can be 2/2 hypovolemia, Uosm >300, UNa >20, FeNa >2% (kidneys suck), give fluids MUDDY BROWN CASTS
- Glomerulonephritis RBC CASTS (+/- few WBC)
Postrenal hydronephrosis:
- BPH
- cancer
Blunt abd trauma, pelvic injury PERITONITIS
Bladder dome rupture (ant wall and neck of bladder are extraperitoneal)
W/u for recurrent UTIs in kids
US: <2 yo 2+ UTIs Family hx renal dz Abx don’t work
Voiding cystourethrogram:
Newborn <1 mo
2+ UTIs
Not E. coli
Diabetic glomerulosclerosis course
1 Glomerular hyperfiltration —> intraglom hypertension ACEi reduce htn
2 BM thickening
3 mesangial expansion
4 nodular sclerosis
DM nephropathy Screening check microalbumin (dipstick detects protein >300, in DM have protein 30-300)
Nocturnal enuresis
> 5 yo, lifestyle, alarm, desmopressin
Indications to remove a stone
Time >1mo
Size >1cm
Stuck (complete obstruction)
Sick (AKI, sepsis, PAIN)
Sickle cell TRAIT kidney stuff
Hypostenuria (kidney can’t concentrate the urine)
Renal papillary necrosis (hematuria)
Rhabdo
SSRI
SIADH!
Posterior urethral injury
Pelvic fx, blood in urethral meatus, perineal hematoma, inability to urinate, high-riding prostate, dx retrograde urethrography
Proteinuria in a preggo
Physiologic = trace, dec Cr, hypotens
Diabetic nephropathy = >300 or 1+ protein, inc Cr, hypertension, if <20w likely preexisting
Polycystic kidney disease
AD
B/l masses, berry aneurysms, hepatic cysts, INTERMITTENT recurrent b/l flank pain (w/ gardening) +/- hematuria, early onset HTN
HYPERKALEMIA!! Treatment
IF >7 or EKG changes —> Give calcium gluconate or chloride NOT CARBONATE, insulin + glucose, inhaledB2 agonists
Drug to help pass a kidney stone
Tamsulosin a1 antagonist
Bethanechol cholinergic tx for retention
Oxybutinin antichol tx for OAB
Drugs that cause hyperK
Notoriously Bad Potassium
NSAIDs
BP drugs (ACEi, ARB, amiloride, Bb, spironolactone)
Symptomatic hyponatremia (encephalopathy)
6-8 per 24h, if iatrogenic from hypotonic fluids can give hypertonic
Interstitial cystitis
Clean UA, pain, tx supportive
Mixed acid-base disorders compensatory
Metabolic acidosis, CO2 should be lower to compensate—> CO2=1.5(HCO3) + 8 +-2
Metabolic alkalosis—> CO2 INC 0.7/1 HCO3 >28
Respiratory acidosis—> bicarb INC 1/10 acute, 4/10 chronic
Respiratory alkalosis—> bicarb DEC 2/10 acute, 5/10 chronic
Nephrotic syndrome increases risk of
Atherosclerosis
Renal artery stenosis
ACEi, ARB, no stent
Bladder cancer
Unilateral hydronephrosis w/o a stone
Electrolyte changes w vomiting
Low K, H, Cl
Increased bicarb —> metabolic alkalosis
Calciphylaxis (calcifications uremic arteriolopathy)
ESRD on HD, kidney transplant
Hyperphosphatemia, hyper-PTH, hyper/normal Ca
Calc of arterioles and soft tissue —> ischemia and necrosis
Hypernatremia
IF HYPOVOLEMIC, give NS (0.9%) saline until euvolemic, then hypotonic (0.45% saline or D5)
Dx of pyelonephritis or renal abscess in kids
Abd US (not CT, rad)
RCC
Flank pain, hematuria, abd mass
L sided varicocele that DOES NOT reduce w recumbancy
Paraneoplastic (thrombocytosis, polycythemia/anemia)
Von Hippel-Lindau
RCC, CNS hemangioblastomas (cerebellum, retina), pheo
AD
Main risk factor for UTI in women vs men
Shorter urethra
Hyperventilation acid-base stuff
Low CO2 —> decreased bicarb, decreased H+ in urine —> alkaline urine
Hepatic cyst benign vs malignant
Benign —> homogenous, non-enhancing, non-septated, no loculation, asx, usually incidental, provide reassurance
Coagulopathy in ESRD patients
Platelet dysfxn, prolonged BT, DDAVP inc VIII:vWF multimer release from endothelial cells
SIADH tx
Na <120 = severe, +symptoms —> hypertonic saline (3%)
Not severe —> fluid restriction +/- salt tabs
DM nephropathy, amyloidosis, membranous nephropathy, MCD, membranoproliferative glomerulonephritis, FSGS, IgA
DAMMM you FIne
DM nephropathy: hyalinosis af+ef arterioles
Amyloidosis: abnl proteins/inflamm (RA) vs lambda light chains (MM Waldenstrom) congo red apple green birefringence
MCD: kids>adults NSAIDs Hodgkin lymphoma
MN: cancer (breast, lung) hep B, NSAIDs, SLE
MPGN: Hep B/C, lipodystrophy (type 2=anti-C3 convertase IgG)
FSGS: HIV, heroin, obesity, race AA or Hispanic
IgA: URI granular deposits
Familial hypocalciuric hypercalcemia
High serum Ca, normal-high PTH, low urine Ca/Cr clearance <0.01
Ddx hyperPTH, will have urine Ca >0.02
Tx for recurrent calcium stones
Low sodium, low protein, fluids, NORMAL Ca, thiazide
Tx hypercalcemia
> 14 +/- sx—> NS + calcitonin, if can’t get fluids (CHF, RF) HD, bisphos later (MM, but worry about that LATER)
MC cause of potter sequence
Posterior urethral valves
Ethylene glycol vs methanol
Both: AG gap + osmolal gap met acidosis (2xNa + glucose/18 + BUN/2.8, nl <10), tx fomepizole
Ethylene glycol kidneys (Ca oxalate crystals in UA, hypoCa)
Methanol eyes
Farmer
Organophosphate poisoning
DKA/HHS
Often precipitated by infx (UTI) 30-40%, dehydration 2/2 osmotic diuresis, Na may be normal
IT CAN STILL BE DKA IF GLUCOSE IS 250, iso saline bolus 10mL/kg x 1h, ins + K <5.2 gluc <200
Na correction hyperglycemia
+2 for every 100>100
Hyponatremia
sOsm <275, hypovolemic GI (UNa<40) OR renal (UNa>40), euvolemic psychogenic (uOsm<100) OR SIADH (uOsm>100, UNa>40), hypervolemic CHF
sOsm >295 hyperglycemia, mannitol, lipids
Nephrogenic diabetes insipidus
Criteria: UOsm<300, >50mL/kg/d, urine spec grav <0.01
Etiology: kidneys don’t respond to ADH
Sx: nl-high Na
Renal infarct
wedge-shaped lesion on CT, flank pain, n/v (+/- fever), hematuria + protein no casts
Lithium toxicity
GI, tremor, ataxia, sz, Rx NSAIDs, metronidazole ACEi, tetracyclines HCTZ
Prenatal: Ebstein’s anomaly (enlarged RV, ASD)
Renal vein thrombosis
Pt w cancer, COMPLICATION OF NEPHROTIC SYNDROME enlarged kidney, UA isolated hematuria, LDH, causes hypercoagulability (loss of protein C, S), AC or AKI surg thrombolytics
Kidney stone w/u
US, CT NO CONTRAST
Renal tplant complications
ROCA BUM
rejection, occlusion (vascular, ureteral), cyclosporine, ATN
Bx, US, MRI
tx for rejection = steroids
MUDPILES
Methanol Uremia DKA Propylene glycol Iron/Isoniazid Lactic acidosis Ethylene glycol Salicylate (tinnitus)
Iron poisoning
<6yo GI losses=hypovolemic shock corrosive hematemesis, radiopaque XR tx deferoxamine
Alport syndrome
Type IV collagen, kidney probs + SN hearing loss
PSGN
1-4w, immune complexes (vs IgA during or days after illness)
Normal lactate
<1 (<2 if critically ill)
