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Clin Med II Disease Key Notes > Renal (Exam #3) > Flashcards

Renal (Exam #3) Flashcards

1
Q

GENERALLY for kidney disease, what two values should be low and which one should be high?

A
  • LOW: GFR, UO

- HIGH: Cr

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2
Q

What is a measure of number of functional nephrons? Can this be measured directly?

A

GFR

- NOPE, need MDRD or Cockcroft-Gault formulas

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3
Q

What lab value is used to screen or monitor disease with tx for prostate CA?

A

Prostate-Specific Antigen (PSA)

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4
Q

PSA is seen in all males but high if… (4)?

A
  • Prostate CA
  • BPH
  • Prostatitis
  • AFTER prostate manipulation
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5
Q

What diagnostic test should be used to detect prostate CA in patients with a HIGH PSA?

A

Prostate US/Biopsy transrectally (TRUS)

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6
Q

High ANA is indicative of what?

A

SLE

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7
Q

High C-ANCA/P-ANCA is indicative of what?

A

Granulomatosis with Polyangiitis (GPA)

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8
Q

High Anti-GBM is indicative of what?

A

Goodpasture Syndrome

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9
Q

What UA finding is earliest clinical sign of diabetic nephropathy?

A

Microalbumin

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10
Q

What UA finding is never normal; seen with acute interstitial nephritis?

A

Urine Eosinophils

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11
Q

Bence Jones proteins seen on what diagnostic test is indicative of MM?

A

UPEP

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12
Q

What is the first line radiographic test ordered if renal failure of UO or “abdominal/flank pain”?

A

Renal US

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13
Q

What radiographic test can distinguish renal mass vs. cyst?

A

CT Scan

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14
Q

What is the gold standard test for nephrolithiasis?

A

CT WITHOUT contrast

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15
Q

What is the concern with using Iodine contrast, and what can this lead to?

A

Can be nephrotoxic

- Can cause Contrast-Induced Nephropathy = CNI

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16
Q

What medication should be held for 48 hours prior to performing a CT WITH contrast, and WHY?

A

Metformin

- Avoid lactic acidosis

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17
Q

What is the gold standard test for renal vein thrombosis?

A

MRI

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18
Q

What might Gadolinium contrast may increase risk for?

A

Nephrogenic systemic fibrosis

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19
Q

What radiographic test can show “string of pearls”, and what is this indicative of?

A

Renal Angiography

- Indicates Fibromuscular Dysplasia

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20
Q

What test is x-ray w/ contrast; almost never ordered because other tests available (dye concern)?

A

Intravenous Pyelogram (IVP)

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21
Q

What test is preferred to IVP for bladder-specific conditions?

A

Cystourethrogram

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22
Q

With what test is post-procedural hematuria expected and should clear within 3 voids?

A

Cystoscopy

  • Commonly used by urology
  • Cystoscope inserted into urethra → bladder
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23
Q

If ordering a Testicular US, what other test should always be obtained, and why?

A

Obtain Doppler to evaluate blood flow

- R/O testicular torsion

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24
Q

What involves diseases that present in nephritic spectrum; inflammatory process → renal dysfunction?

A

Glomerulonephritis (GN)

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25
Q

What condition involves hematuria (smoky/cola-colored)?

A

Glomerulonephritis (GN)

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26
Q

What condition involves RBC casts?

A

Glomerulonephritis (GN)

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27
Q

What condition involves dysmorphic RBCs?

A

Glomerulonephritis (GN)

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28
Q

What condition involves proteinuria (<3 g/day)?

A

Glomerulonephritis (GN)

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29
Q

With what condition will you not see clots in hematuria, but may have proteinuria?

A

Glomerulonephritis (GN)

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30
Q

What is the general treatment for Glomerulonephritis (GN)? What medication may be considered?

A

Depends on underlying cause SO JUST nephrology referral

- Consider ACE-I/ARB for renoprotection

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31
Q

With what two conditions should IMMEDIATE hospitalization be considered with Glomerulonephritis (GN)?

A
  • Acute Nephritic Syndrome

- Rapidly Progressive Glomerulonephritis (RPGN)/Crescentic Glomerulonephritis

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32
Q

What condition is due to progressive loss of renal function over short period of time?

A

Rapidly Progressive Glomerulonephritis (RPGN)

- AKA Crescentic Glomerulonephritis

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33
Q

What condition involves crescent formation of glomerular cells?

A

Rapidly Progressive Glomerulonephritis (RPGN)

- AKA Crescentic Glomerulonephritis

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34
Q

What is the most common cause of primary Glomerulonephritis (GN)?

A

IgA Nephropathy

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35
Q

What condition peaks 2nd and 3rd decades of life, often male?

A

IgA Nephropathy

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36
Q

What condition involves gross hematuria 1-2 DAYS after URI?

A

IgA Nephropathy

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37
Q

With IgA Nephropathy, if there is persistent proteinuria >1 g/dL, high Cr/low GFR or HTN, what medication should be considered?

A

ACE-I/ARB +/- steroids

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38
Q

What condition is due to group A beta-hemolytic strep; more common in male children?

A

Poststreptococcal Glomerulonephritis (PSGN)

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39
Q

What condition occurs 1-3 WEEKS after pharyngitis or skin infection (impetigo)?

A

Poststreptococcal Glomerulonephritis (PSGN)

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40
Q

What diagnostic finding is indicative of Poststreptococcal Glomerulonephritis (PSGN)?

A

Recent GAS infection with high ASO or +throat/skin culture

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41
Q

What is the recommended treatment for Poststreptococcal Glomerulonephritis (PSGN)?

A

SUPPORTIVE

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42
Q

Is recurrence of Poststreptococcal Glomerulonephritis (PSGN) common or rare?

A

RARE

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43
Q

What condition involves tetrad of palpable purpura (rash), arthralgias, abdominal pain, renal disease after URI?

A

IgA Vasculitis (IgAV) = Henoch-Schönlein Purpura (HSP)

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44
Q

What tetrad of symptoms is seen with IgA Vasculitis (IgAV) = Henoch-Schönlein Purpura (HSP)?

A
  • Palpable purpura
  • Arthralgias
  • Abdominal pain
  • Renal disease
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45
Q

What is the recommended treatment for IgA Vasculitis (IgAV) = Henoch-Schönlein Purpura (HSP)?

A

SUPPORTIVE

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46
Q

What age group has higher risk of progressive renal disease a few days-1 month after onset of systemic sxs with IgA Vasculitis (IgAV) = Henoch-Schönlein Purpura (HSP)?

A

ADULTS

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47
Q

What two age groups are most affected by Anti-GBM Antibody Disease (Goodpasture Syndrome)?

A
  • Male in 3rd decade (more severe)

- Female in 6th/7th decade

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48
Q

What two conditions/findings are consistent with Anti-GBM Antibody Disease (Goodpasture Syndrome)?

A
  • RPGN

- Alveolar hemorrhage (pulmonary)

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49
Q

What condition involves anti-GBM antibodies in serum or biopsy? What other test may be positive?

A

Anti-GBM Antibody Disease (Goodpasture Syndrome)

+/- positive ANCA

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50
Q

What two medications are recommended for treatment of Anti-GBM Antibody Disease (Goodpasture Syndrome)?

A
  • Prednisone

- Cyclophosphamide

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51
Q

What condition presents with +Anti-ds DNA antibodies?

A

Lupus Nephritis (LN) aka Systemic Lupus Erythematosus Nephritis

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52
Q

What condition is ANCA-associated, where ANCA antibodies produce tissue and vascular damage?

A

Pauci-Immune Glomerulonephritis

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53
Q

What are the three possible causes of Pauci-Immune Glomerulonephritis? How do you treat ALL THREE?

A
  • Granulomatosis with Polyangiitis (GPA)
  • Microscopic Polyangiitis (MPA)
  • Eosinophilic Granulomatosis with Polyangiitis (EGPA)

Tx: referral +/- immunosuppressants

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54
Q

What condition involves necrotizing granulomas, and what is it a possible cause of?

A

Granulomatosis with Polyangiitis (GPA)

- Possible cause of Pauci-Immune Glomerulonephritis

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55
Q

What triad is consistent with Granulomatosis with Polyangiitis (GPA)?

A
  • Upper respiratory sxs
  • Lower respiratory sxs
  • GN
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56
Q

What condition involves nasal/oral inflammation, saddle nose deformity; RPGN common?

A

Granulomatosis with Polyangiitis (GPA)

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57
Q

How can you differentiate Granulomatosis with Polyangiitis (GPA) from Microscopic Polyangiitis (MPA) and Eosinophilic Granulomatosis with Polyangiitis (EGPA)?

A

GPA = C-ANCA

- MPA and EGPA = P-ANCA

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58
Q

What condition involves ONLY lower respiratory sxs and GN? How does this differ from Granulomatosis with Polyangiitis (GPA)?

A

Microscopic Polyangiitis (MPA)

  • NO granulomas
  • NO upper resp. sxs
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59
Q

What two findings/symptoms are associated with Eosinophilic Granulomatosis with Polyangiitis (EGPA)?

A
  • Asthma

- Eosinophilia

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60
Q

What condition involves prodromal (Atopic Triad) → Eosinophilic → Vasculitis (systemic renal sxs)?

A

Eosinophilic Granulomatosis with Polyangiitis (EGPA)

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61
Q

What condition is common; often asymptomatic and found incidentally on US?

A

Simple Renal Cyst

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62
Q

What condition is benign = NO enhancement with contrast, round, sharply demarcated, smooth walls?

A

Simple Renal Cyst

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63
Q

What condition is an inherited disease that causes irreversible decline in kidney function? What are the two types, and what symptom/finding is seen with BOTH?

A

Polycystic Kidney Disease (PKD)

  • Autosomal Dominant PKD (ADPKD)
  • Autosomal Recessive PKD (ARPKD)

BOTH have bilateral marked kidney enlargement

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64
Q

In Autosomal Dominant PKD (ADPKD), which gene is mutated? In Autosomal Recessive PKD (ARPKD), which gene is mutated?

A
  • ADPKD: PKD1 OR PKD2

- ARPKD: PKD1 only

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65
Q

How does the presentation of Autosomal Recessive PKD (ARPKD) differ from ADPKD? What can this lead to (2)?

A

Kidneys AND Liver
- Bilateral marked kidney enlargement AND congenital hepatic fibrosis

Can lead to HTN and portal HTN

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66
Q

What two non-renal conditions are often associated with Autosomal Dominant PKD (ADPKD)?

A
  • HTN

- Liver cysts

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67
Q

What two non-pharmacologic treatments are recommended for Autosomal Dominant PKD (ADPKD)?

A
  • Strict BP control/low-salt diet

- Pain control

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68
Q

What medication can also be prescribed to treat Autosomal Dominant PKD (ADPKD)?

A

Tolvaptan

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69
Q

What condition involves abrupt loss of kidney function resulting in urea retention, dysregulation of volume status and electrolytes?

A

Acute Kidney Injury (AKI)

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70
Q

What are the three aspects of KDIGO Diagnostic Criteria (need 1 of 3)?

A
  • Increase in serum Cr by >0.3 mg/dL within 48 hours
  • Increase in serum Cr to >1.5 times baseline
  • Urine volume <0.5 mL/kg/hour for 6 hours
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71
Q

What renal condition is often common in hospitalized patients, and what are two likely causes?

A

Acute Kidney Injury (AKI)

  • Prerenal disease
  • ATN
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72
Q

What does prerenal etiology of Acute Kidney Injury (AKI) mean?

A

Decreased renal BF

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73
Q

What does intrinsic etiology of Acute Kidney Injury (AKI) mean?

A

Acute tubular necrosis (ATN)

- Pathology of vessels, glomeruli, tubules

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74
Q

What does post renal etiology of Acute Kidney Injury (AKI) mean?

A

Obstruction

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75
Q

What is the most common renal etiology of Acute Kidney Injury (AKI)? What is second most common?

A

MOST common = ATN (intrinsic)

- 2nd most common: prerenal

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76
Q

What are five possible causes of prerenal Acute Kidney Injury (AKI)?

A
  • Volume depletion
  • Hypotension
  • Edema
  • Selective renal ischemia
  • Drugs affecting GFR
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77
Q

What two drug groups can cause prerenal Acute Kidney Injury (AKI)?

A
  • NSAIDs

- ACE-I

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78
Q

What are three possible causes of intrinsic Acute Kidney Injury (AKI)?

A
  • Renal ischemia
  • Sepsis
  • Nephrotoxins (IV contrast)
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79
Q

What are three risk factors for IV contrast toxicity in intrinsic Acute Kidney Injury (AKI)?

A
  • Pre-existing renal disease
  • Volume depletion
  • Repeated doses of contrast
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80
Q

What can cause renal tubular epithelial cell toxicity, renal medullary ischemia?

A

IV contrast toxicity

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81
Q

A reduction in GFR WITHOUT hx of prerenal requires what for posterenal Acute Kidney Injury (AKI)?

A

BILATERAL obstruction

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82
Q

What are two of the most common reasons for posterenal Acute Kidney Injury (AKI)?

A
  • Prostatic disease (BPH, CA)

- Metastatic CA

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83
Q

What condition involves “muddy brown casts”?

A

ATN

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84
Q

What does FENa measure? What does an FENa <1% indicate? What does an FENa >2% indicate?

A

FENa = measures % of Na+ excreted in urine

  • FENa <1% = prerenal
  • FENa >2% = ATN
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85
Q

What test can be used to assess for obstruction, and what can obstruction predispose you for?

A

Renal US

- Obstruction can predispose for UTI → urosepsis → kidney failure

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86
Q

SEVERE Acute Kidney Injury (AKI) can present with what symptom?

A

AMS

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87
Q

What are six possible complications of Acute Kidney Injury (AKI)? What is often the treatment if any of these complications are present?

A
  • Volume imbalance
  • Metabolic acidosis
  • Hyperkalemia
  • Hypocalcemia
  • Hyperphosphatemia
  • Uremia

If complications present, often requires hemodialysis to treat

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88
Q

If volume depleted due to Acute Kidney Injury (AKI), what is the recommended treatment? If the patient does not respond, what is the likely etiology of AKI?

A

1-3 L of IV fluids (isotonic crystalloids)

- Likely ATN or intrinsic AKI (not prerenal)

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89
Q

If volume overloaded due to Acute Kidney Injury (AKI), what is the recommended treatment? What should be considered with this treatment decision?

A

Diuretics temporarily

- STOP diuretics if UO does not increase with diuretic use (NOT for long-term use)

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90
Q

If mild case of metabolic acidosis due to Acute Kidney Injury (AKI), what is the recommended treatment? What symptom especially calls for this treatment?

A

Give bicarbonate

  • Especially if diarrhea
  • If overloaded, no bicarb because → increase Na+ load
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91
Q

If overloaded or severe case of metabolic acidosis due to Acute Kidney Injury (AKI), what is the recommended treatment? Why can’t bicarbonate be used to treat overload AKI?

A

Dialysis

- If overloaded, no bicarb because → increase Na+ load

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92
Q

What can hyperkalemia due to Acute Kidney Injury (AKI) cause symptomatically (2)? How do you treat this (2)?

A

NM issues and/or arrhythmias

- Treat with medicine and dialysis (drive K+ from ECF → ICF and remove excess K+)

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93
Q

What often causes Hypocalcemia due to Acute Kidney Injury (AKI)?

A

Hypocalcemia often occurs because of hyperphosphatemia

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94
Q

If symptomatic hypocalcemia due to Acute Kidney Injury (AKI), what is the recommended treatment? What three symptoms might present as hypocalcemia?

A

Give IV Calcium

  • Trousseau’s sign
  • Chvostek’s sign
  • QT prolongation
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95
Q

If asymptomatic hyperphosphatemia of >5.5 mg/dL present with Acute Kidney Injury (AKI), what is the recommended treatment?

A

Phosphate binders

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96
Q

For hyperphosphatemia + LOW serum Ca2+ with Acute Kidney Injury (AKI), what is the recommended treatment (2)?

A
  • Calcium acetate

- Calcium carbonate

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97
Q

For hyperphosphatemia + HIGH serum Ca2+ with Acute Kidney Injury (AKI), what is the recommended treatment (2)?

A
  • Aluminum hydroxide

- Lanthanum carbonate

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98
Q

What stage is uremia (“urine in blood) more common with, and what is the recommended treatment if severe?

A

More common in CKD

- If severe (neuropathy, pericarditis), start dialysis

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99
Q

What involves diffusion of small molecules down their concentration gradient? What types of molecules CAN diffuse?

A

Dialysis

- Small molecules = waste (urea, Cr, K+ and excess fluid) can cross

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100
Q

What is the general prognosis for Acute Kidney Injury (AKI)?

A

MOST recover renal function with normalized Cr and UO

- BUT MANY have residual renal dysfunction

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101
Q

What two issues are those with an Acute Kidney Injury (AKI) at increased risk for?

A
  • Another AKI

- Develop CKD

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102
Q

What constitutes Chronic Kidney Disease (CKD)?

A
  • Decreased kidney function (GFR <60)
    OR
  • Kidney damage (albuminuria with ACR of 30+)

FOR 3+ MONTHS = chronic

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103
Q

What constitutes Stage 1 kidney disease?

A

Kidney damage with normal GFR (90+)

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104
Q

What constitutes Stage 2 kidney disease?

A

Kidney damage with mildly low GFR (60-89)

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105
Q

What constitutes Stage 3a kidney disease?

A

Mild/moderate GFR of 45-59

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106
Q

What constitutes Stage 3b kidney disease?

A

Moderate/severe GFR of 30-44

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107
Q

What constitutes Stage 4 kidney disease?

A

Severely low GFR (15-29)

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108
Q

What constitutes Stage 5 kidney disease?

A

FAILURE (GFR <15)

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109
Q

What constitutes Stage 1 kidney disease (ACR specifically)?

A

Normal/mild increase of ACR (<30)

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110
Q

What constitutes Stage 2 kidney disease (ACR specifically)?

A

Moderately increased ACR (30-300)

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111
Q

What constitutes Stage 3 kidney disease (ACR specifically)?

A

Severely increased ACR (>300)

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112
Q

What is the hallmark of progressive kidney disease?

A

Declining GFR

113
Q

What condition involves nephron destruction leads to compensatory hypertrophy with supranormal GFR of remaining nephrons → overwork injury of remaining nephrons… What does this lead to?

A

Chronic Kidney Disease (CKD)

- Leads to dlomerular sclerosis and interstitial fibrosis

114
Q

What two hormones are LOW in Chronic Kidney Disease (CKD)?

A
  • Erythropoietin

- Calcitriol (active Vitamin D3)

115
Q

What two conditions are often the cause of Chronic Kidney Disease (CKD)? What is another possible cause we discussed?

What are three other risk factors for CKD?

A
  • DM
  • HTN

Also, chronic tubulointerstitial disease

RF other than DM, HTN: 65+ years, hx of AKI, CVD

116
Q

What condition should be considered with CKD that involves accumulation of metabolic waste or uremic toxins?

A

Uremic Syndrome

117
Q

What condition involves fatigue, malaise, pericarditis, encephalopathy?

A

Uremic Syndrome

- Associated with CKD

118
Q

What four symptoms are associated with Uremic Syndrome?

A
  • Fatigue
  • Malaise
  • Pericarditis
  • Encephalopathy
119
Q

CKD alone is risk factor for developing what disease?

A

CVD

120
Q

What group of diseases involves low GFR → secondary hyperparathyroidism?

A

CKD-Mineral/Bone Disorders (CKD-MBD)

121
Q

CKD-Mineral/Bone Disorders (CKD-MBD) can lead to what condition? What four lab findings are often seen with CKD/MBD?

A

Secondary hyperparathyroidism

  • Hyperkalemia
  • Hyperphosphatemia
  • Hypocalcemia
  • High PTH
122
Q

What medication can be used to treat proteinuric CKD by decreasing albuminuria?

A

ACE-I/ARBs

123
Q

ACE-I/ARBs are considered _____, but CAN be harmful if used with what two conditions?

A

ACE-I/ARBs are renoprotective but CAN be harmful if…

  • AKI
  • Bilateral renal artery stenosis
124
Q

What is the target BP control for CKD WITH proteinuria? What is the target BP control for CKD without proteinuria?

A
  • WITH proteinuria: <130/80

- Without proteinuria: <140/90

125
Q

What are the two types of dialysis, and what is a complication for each?

A
  • Hemodialysis: hypotension

- Peritoneal dialysis: peritonitis

126
Q

What treatment is often used for ESRD? BUT what is the TREATMENT OF CHOICE?

A

Dialysis often used

- Treatment of choice of ESRD is kidney transplant

127
Q

What two improvements are seen with kidney transplant?

A
  • Improve quality of life

- Reduce mortality risk

128
Q

What are the three types of Chronic Tubulointerstitial Disease, and what is this a possible cause of?

A

Chronic Tubulointerstitial Disease can lead to CKD

  • Obstructive Uropathy
  • Reflux Nephropathy
  • Analgesic Nephropathy
129
Q

Which group of diseases involves tubules and interstitium (NOT glomeruli)?

A

Chronic Tubulointerstitial Disease

130
Q

What two findings characterize Chronic Tubulointerstitial Disease?

A
  • Interstitial scarring

- Tubular atrophy

131
Q

What two general symptoms/findings are seen with Chronic Tubulointerstitial Disease?

A
  • Polyuria

- Hyperkalemia

132
Q

What condition involves prolonged/recurrent obstruction of urinary tract → chronic reduction of GFR, and what can this cause/eventually lead to?

A

Obstructive Uropathy

- Causes Chronic Tubulointerstitial Disease → CKD

133
Q

What two tests are used to diagnose Obstructive Uropathy, and what is seen with each?

A
  • UA shows sterile pyuria

- Renal US shows hydronephrosis

134
Q

What condition is a consequence of vesicoureteral reflux (VUR), and what can this cause/eventually lead to?

A

Reflux Nephropathy

- Causes Chronic Tubulointerstitial Disease → CKD

135
Q

In what population is Reflux Nephropathy often diagnosed in?

A

Young children with history of recurrent UTIs +/- HTN

136
Q

What two tests are used to diagnose Reflux Nephropathy?

A
  • Renal US

- Voiding cystourethrogram (VCUG)

137
Q

What condition involves long-term consumption of analgesics, and what can this cause/eventually lead to?

A

Analgesic Nephropathy

- Causes Chronic Tubulointerstitial Disease → CKD

138
Q

How is Analgesic Nephropathy often diagnosed?

A

Incidental finding of high serum Cr

139
Q

What condition involves NON-inflammatory damage to glomerular capillary wall?

A

Nephrotic Syndrome

140
Q

Compare proteinuria of Nephritic Syndrome and Nephrotic Syndrome.

A
  • Nephritic: proteinuria <3 g/dL

- Nephrotic: proteinuria >3.5 g/dL

141
Q

What are the three PRIMARY causes of Nephrotic Syndrome?

A
  • Minimal Change Disease (MCD)
  • Membranous Nephropathy (MN)
  • Focal Segmental Glomerulosclerosis (FSGS)
142
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal Change Disease (MCD)

143
Q

What condition involves sudden onset edema over days/weeks, and what is this a possible cause of?

A

Minimal Change Disease (MCD)

- Can cause Nephrotic Syndrome

144
Q

What condition is seen post-URI; NO changes on light microscopy, primarily effects podocytes? What is this a possible cause of?

A

Minimal Change Disease (MCD)

- Can cause Nephrotic Syndrome

145
Q

What is one of most common causes of nephrotic syndrome in adults?

A

Membranous Nephropathy (MN)

146
Q

What condition involves white males age 40+ years; primary = immune-mediated vs. secondary = HBV, autoimmune diseases? What is this a possible cause of?

A 
Membranous Nephropathy (MN)
-  Can cause Nephrotic Syndrome
147
Q

What are you at higher risk of with Membranous Nephropathy (MN)?

A

Hypercoagulation

148
Q

What is one of most common causes of primary nephrotic syndrome in adults?

A

Focal Segmental Glomerulosclerosis (FSGS)

149
Q

What condition is often seen in middle-aged AA male, and what is this a possible cause of?

A

Focal Segmental Glomerulosclerosis (FSGS)

- Can cause Nephrotic Syndrome

150
Q

What condition involves histologic pattern of kidney injury; sclerosis in parts of 1+ glomerulus (focal)? What is this a possible cause of?

A

Focal Segmental Glomerulosclerosis (FSGS)

- Can cause Nephrotic Syndrome

151
Q

What are the two SECONDARY causes of Nephrotic Syndrome?

A
  • Diabetic Nephropathy

- Amyloidosis

152
Q

What is the most common cause of ESRD in U.S.?

A

Diabetic Nephropathy

153
Q

What two labs findings are often seen with Diabetic Nephropathy?

A
  • Hyperglycemia

- Albuminuria >300 mg/d

154
Q

What other condition is commonly associated with Diabetic Nephropathy?

A

Retinopathy

155
Q

What diagnostic test should be used to diagnose Amyloidosis (causes Nephrotic Syndrome)?

A

SPEP/UPEP

156
Q

What two symptoms are associated with Nephrotic Syndrome?

A
  • “Foamy urine”

- Edema

157
Q

What condition involves “foamy urine”?

A

Nephrotic Syndrome

158
Q

What are two possible complications of Nephrotic Syndrome?

A
  • Hypercoagulability

- Infection

159
Q

What diagnostic finding is associated with Nephrotic Syndrome?

A

Oval fat bodies

160
Q

What two things can cause false negative nitrite for UTI?

A
  • Non-nitrate producing organism

- Frequent urination

161
Q

What two things can cause false positive LE for UTI?

A
  • Vaginal contamination

- Trichomonas infection

162
Q

What is the most common pathogen of UTI?

A

Escherichia coli

163
Q

What condition is an infection confined to bladder, and what types of symptoms are seen?

A

Acute Simple Cystitis

- No systemic sxs or sxs suggestive of upper UTI (“classic sxs” = dysuria, urinary frequency, urgency)

164
Q

What condition is an infection that extends beyond bladder, and what types of symptoms are seen?

A

Acute Complicated UTI

- More systemic sxs like fever, chills, flank pain, CVA tenderness

165
Q

What are the four special populations for UTI?

A
  • Pregnant
  • Males
  • IC
  • Comorbidities
166
Q

What three symptoms are suggestive of Acute Simple Cystitis?

A
  • Dysuria
  • Frequency
  • Urgency
167
Q

What population may present with atypical sxs with Acute Simple Cystitis, and what are two example symptoms?

A

Elderly

- Can present with AMS/confusion, nocturne

168
Q

What four labs are often positive for Acute Simple Cystitis?

A
  • +LE
  • +Nitrites
  • Pyuria
  • Bacteriuria
169
Q

What symptomatic care (medication) can be prescribed to treat Acute Simple Cystitis?

A

Pyridium

170
Q

How long should Pyridium be prescribed, and why (2)?

A

Pyridium for 2 days ONLY

- Can mask sxs, decrease GFR

171
Q

If normal patient (not special population), what three antibiotics can be used to treat Acute Simple Cystitis?

A
  • Nitrofurantoin/Macrobid
  • Bactrim
  • Fosfomycin/Monurol
172
Q

If pregnant, what three antibiotics can be used to treat Acute Simple Cystitis?

A
  • Augmentin
  • Cefpodoxime
  • Fosfomycin/Monurol
173
Q

What antibiotic should be avoided if pregnant?

A

Fluoroquinolones

174
Q

If male (but normal), how does treatment to treat Acute Simple Cystitis change? What three antibiotics are used?

A

Duration is longer (7 days)

  • Nitrofurantoin/Macrobid
  • Bactrim
  • Fosfomycin/Monurol
175
Q

If IC or comorbidites, how does treatment to treat Acute Simple Cystitis change? What three antibiotics are used?

A

Duration is much longer (7-14 days)

  • Nitrofurantoin/Macrobid
  • Bactrim
  • Fosfomycin/Monurol
176
Q

Under what condition should a follow up culture be ordered for Acute Simple Cystitis (2)?

A

ONLY needed if pregnant or symptoms persist post-abx

177
Q

What is an infection of LOWER urinary tract?

A

Acute Simple Cystitis

178
Q

What is an infection of UPPER urinary tract (ascent of bacteria up ureters from bladder)?

A

Acute Pyelonephritis

179
Q

What five additional symptoms are seen with Acute Pyelonephritis (not with Acute Simple Cystitis)?

A
  • Fever
  • Chills
  • Abdominal/flank pain
  • N
  • V
180
Q

What two physical exam findings are seen with Acute Pyelonephritis?

A
  • Fever

- CVA tenderness

181
Q

How can you differentiate Acute Simple Cystitis from Acute Pyelonephritis diagnostically?

A

WBC Casts

182
Q

Is follow up required for Acute Pyelonephritis?

A

MUST FOLLOW UP IN 48-72 HOURS REGARDLESS OF OP TX

183
Q

If mild/moderate Acute Pyelonephritis, what antibiotics can be used?

A

Fluoroquinolones (Ciprofloxacin, Levofloxacin)

184
Q

If severe Acute Pyelonephritis, what antibiotics can be used (4)?

A

IV antibiotics

  • Fluoroquinolone
  • Extended spectrum Cephalosporin
  • Extended spectrum Penicillin
  • Carbapenem
185
Q

What four complications are possible with Acute Pyelonephritis?

A
  • Sepsis with shock
  • Renal failure
  • Scarring/chronic pyelonephritis
  • Renal abscess
186
Q

What condition involves LOWER UTI sxs for 6+ weeks, no obvious infection?

A

Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)

187
Q

What condition often coexists with other chronic pain conditions; more common in women?

A

Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)

188
Q

What is the primary symptoms associated with Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS), and what makes it better AND worse?

A

Chronic, debilitating pain

  • Worse with bladder filling
  • Better with voiding
189
Q

What condition involves chronic, debilitating bladder pain worse with bladder filling, relieved with voiding?

A

Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)

190
Q

What condition involves altered urothelium?

A

Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)

191
Q

What condition involves disruption of GAG layer, mast cell activation, neural hypersensitivity?

A

Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)

192
Q

What renal condition is a diagnosis of exclusion?

A

Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)

193
Q

What diagnostic test should be ordered if smoker/smoking history?

A

Urine cytology

194
Q

What test can be used to support the diagnosis of Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)?

A

Cystoscopy

195
Q

What is the FIRST line treatment for Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)?

A

LIFESTYLE

- Diet modifications, bladder retraining, exercise, psychotherapy, Pyridium

196
Q

What three medications can be considered as SECOND line treatment for Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)?

A
  • Tricyclic Antidepressants (Amitriptyline)
  • Pentosan Polysulfate (Elmiron)
  • Antihistamines (Hydroxyzine)
197
Q

What condition involves risk factors of 65+, women, obese, parity, prolapse, DM, neuro disease?

A

Overactive Bladder (OAB)

198
Q

What causes Overactive Bladder (OAB)?

A

Overactivity of Detrusor muscle

199
Q

What three symptoms are consistent with Overactive Bladder (OAB)?

A
  • Urgency
  • Incontinence
  • Frequency of small
200
Q

What is the first line treatment for Overactive Bladder (OAB) (3)?

A
  • Kegel exercises
  • Lifestyle modifications
  • Bladder training
201
Q

What two medications can be considered as SECOND line treatment for Overactive Bladder (OAB)?

A
  • Antimuscarinics

- Beta3 Agonists

202
Q

What is the most common type of crystal seen with Nephrolithiasis/Ureterolithiasis? What other crystal type is common?

A
  • Calcium oxalate = MOST common

- Calcium phosphate

203
Q

How can you differentiate uric acid crystals vs. calcium crystals for Nephrolithiasis/Ureterolithiasis?

A

Uric acid crystals are usually radiolucent (NOT seen on x-ray)

204
Q

What condition involves pain/“renal colic” (flank radiating to groin); hematuria?

A

Nephrolithiasis/Ureterolithiasis

205
Q

What is the gold standard test for Nephrolithiasis/Ureterolithiasis?

A

LDCT WITHOUT contrast

206
Q

What two medications are recommended for treatment of Nephrolithiasis/Ureterolithiasis?

A
  • NSAIDs (unless surgery)

- Alpha-Blocker (Tamsulosin)

207
Q

What size stone should pass spontaneously with Nephrolithiasis/Ureterolithiasis?

A

Less than or equal to 5 mm

208
Q

Under what five conditions should you refer to urology for Nephrolithiasis/Ureterolithiasis, and which two conditions are URGENT referral?

A
  • > 10 mm
  • Fail to pass
  • Significant obstruction
  • Infection = URGENT
  • Renal involvement = URGENT
209
Q

What two medications can be considered for prophylaxis treatment of Nephrolithiasis/Ureterolithiasis?

A
  • Allopurinol

- HCTZ

210
Q

What is the most common benign tumor in men 40-80 years?

A

Benign Prostatic Hyperplasia (BPH)

211
Q

What condition involves proliferation of tissue in transitional zone?

A

Benign Prostatic Hyperplasia (BPH)

212
Q

What are four risk factors for Benign Prostatic Hyperplasia (BPH)?

A
  • Type II DM (nocturia)
  • Age 60+ years
  • Black
  • History of 3+ months of bothersome urinary sxs
213
Q

What is the FIRST line treatment for Benign Prostatic Hyperplasia (BPH)?

A

Behavior modifications

  • Avoid caffeine/alcohol/meds
  • Fluid restrict before bed or going out
  • Double void
214
Q

What is the SECOND line treatment for Benign Prostatic Hyperplasia (BPH)? Give an example.

A

Alpha-Blockers

  • Tamsulosin
  • Doxazosin
  • Terazosin
215
Q

What is the THIRD line treatment for Benign Prostatic Hyperplasia (BPH)? Give an example.

A

5-Alpha Reductase Inhibitors

- Finasteride

216
Q

What is the most common general etiology of Acute Bacterial Prostatitis? What is the alternative?

A

Often urinary pathogens (i.e. E. coli)

- Can be STI (gonorrhea, chlamydia)

217
Q

What condition presents with DRE = tender, edema (unlike UTI); leukocytosis, elevated PSA and ESR?

A

Acute Bacterial Prostatitis

218
Q

What is the recommended treatment for a stable/reliable patient with Acute Bacterial Prostatitis (2)?

A
  • Fluoroquinolone for 6 weeks
    OR
  • Bactrim for 6 weeks
219
Q

What is the most common cause of Chronic Bacterial Prostatitis?

A

Recurrent UTI

- Especially following acute BP

220
Q

How is Chronic Bacterial Prostatitis often diagnosed? What is the gold standard test?

A 
Often clinical (DRE and labs often normal)
- Prostatic fluid analysis = gold standard
221
Q

What is the recommended treatment for a stable/reliable patient with Chronic Bacterial Prostatitis (2)?

A
  • Fluoroquinolone for at least 6 weeks
    OR
  • Bactrim for at least 6 weeks
222
Q

What condition involves chronic pelvic pain, voiding difficulties, hematospermia for 3+ months?

A

Chronic Prostatitis/Chronic Pelvic Pain Syndrome

223
Q

What urinary condition is a diagnosis of exclusion?

A

Chronic Prostatitis/Chronic Pelvic Pain Syndrome

224
Q

What three medications are considered in treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome?

A
  • Alpha-Blockers
  • Abx
  • 5-Alpha Reductase Inhibitors
225
Q

What is the most common CA in men 60-80 years?

A

Prostate Cancer

226
Q

What is the 2nd leading cause of CA death in men (death still rare)?

A

Prostate Cancer

227
Q

What condition involves slow growing malignant neoplasm of adenomatous cells?

A

Prostate Cancer

228
Q

What scoring system can be used to stage Prostate CA?

A

Gleason score = based on architectural structure of prostate

- Also, TMN

229
Q

What is the recommended follow up for a patient with Prostate CA?

A

Total PSA every 6-12 months for 5 years, then annually

230
Q

What condition involves common in early 40s, increasing with age (worse if meds or comorbidities)?

A

Erectile Dysfunction (ED)

231
Q

What is the FIRST line treatment for Erectile Dysfunction (ED)? Give an example.

A

Phosphodiesterase-5 Inhibitors

  • Sildenafil
  • Vardenafil
232
Q

What are the two types of Urethritis?

A
  • Gonococcal

- Non-gonococcal (Chlamydia, etc.)

233
Q

What condition involves dysuria and urethral discharge; inflamed meatus?

A

Urethritis

234
Q

How can you differentiate gonococcal from non-gonococcal Urethritis?

A

Gonococcal will show polymorphonuclear cells and G- diplococci
- Non-gonococcal does not have the “little balls”

235
Q

What two findings are seen with Gonococcal Urethritis?

A
  • Polymorphonuclear cells

- G- diplococci

236
Q

What is the recommended treatment for Gonococcal Urethritis (__ + __)?

A

Ceftriaxone 250 mg IM + Azithromycin 1000 mg x1 dose

237
Q

What is the recommended treatment for Non-gonococcal Urethritis (2)?

A
  • Azithromycin 1 gram orally
    OR
  • Doxycycline 100mg PO BID x7 days
238
Q

What is often the general etiology of Epididymitis in the young vs. old?

A
  • Young = STI

- Older = urinary pathogens

239
Q

What condition involves acute, unilateral dull-severe scrotal pain radiating to flank?

A

Epididymitis

240
Q

What condition does a +Prehn’s sign indicate?

A

Epididymitis

241
Q

What is the recommended treatment for Epididymitis caused by STI (__ + __)?

A

Ceftriaxone 250mg IM x1 + Doxycycline 100mg BID x10 days

242
Q

What is the recommended treatment for Epididymitis caused by urinary pathogens (2)?

A
  • Levofloxacin 500 mg QID x10 days
    OR
  • Ofloxacin 300mg BID x10 days
243
Q

What condition involves similar to Epididymitis + involvement of testicle (retrograde infection)?

A

Epididymoorchitis

244
Q

What is a common etiology of Epididymoorchitis?

A

MUMPS

245
Q

If Varicocele is seen on the right side, what should be considered?

A

Pelvic/abdominal malignancy

246
Q

What condition involves “bag of worms”?

A

Varicocele

247
Q

What condition involves a increase in size with Valsalva, decrease in size with supine/elevated scrotum?

A

Varicocele

248
Q

What condition has peaks of neonates and post-pubertal boys?

A

Testicular Torsion

249
Q

What condition involves acute onset scrotal pain (severe/worsening); unilateral, hemi-scrotal swelling?

A

Testicular Torsion

250
Q

What condition involves Bell-Clapper deformity?

A

Testicular Torsion

251
Q

What condition involves absent Cremasteric reflex; -Prehn’s sign?

A

Testicular Torsion

252
Q

What type of urinary CA is most common in males 15-35 years?

A

Testicular Cancer

253
Q

What is the most common tumor type seen with Testicular Cancer, and what are the two subtypes?

A

Germ cell tumors

  • Non-seminoma
  • Seminoma
254
Q

What is a major risk factor associated with Testicular Cancer?

A

Personal history of testicular CA

- Also, cryptorchidism

255
Q

What condition involves painless, solid nodule with swelling, inguinal LAD?

A

Testicular Cancer

256
Q

If a patient has advanced Testicular Cancer, what other two systems may be affected?

A
  • Pulmonary

- Neuro

257
Q

What condition involves firm/hard/fixed testicle; check for supraclavicular LAD?

A

Testicular Cancer

258
Q

What three tumor markers may be positive with Testicular Cancer?

A
  • Beta-hCG
  • LDH
  • AFP
259
Q

What is the recommended treatment for Non-seminoma Testicular Cancer? What about for Seminoma Testicular Cancer?

A
  • Non-seminoma: chemotherapy (NOT sensitive to radiation)

- Seminoma: radiation

260
Q

What are the three types of groin hernias?

A
  • Inguinal (direct)
  • Inguinal (indirect)
  • Femoral
261
Q

What type of hernia involves Hesselbach’s triangle?

A

Direct Inguinal Hernia

262
Q

What type of hernia involves int. inguinal ring → inguinal canal → INTO scrotum?

A

Indirect Inguinal Hernia

263
Q

What is the most common type of groin hernia?

A

Indirect Inguinal Hernia

264
Q

What type of groin hernia is most often seen in females?

A

Femoral Hernia

265
Q

What is the definitive treatment for all three types of groin hernias?

A

SURGERY

266
Q

What is the second most common urologic malignancy?

A

Bladder Cancer

267
Q

What is the most common type of Bladder Cancer?

A

Transitional Cell Carcinoma

268
Q

What risk factor is associated with Bladder Cancer?

A

Smoking

- More common in men

269
Q

What condition involves painless hematuria (gross or microscopic)?

A

Bladder Cancer

270
Q

What is the gold standard test for Bladder Cancer?

A

Cystourethroscopy

271
Q

What are the four types of Incontinence?

A
  • Urge
  • Stress
  • Mixed (Urge + Stress)
  • Incomplete Emptying Incontinence (Overflow)
272
Q

What condition involves loss of urine proceeded by strong, unexpected urge to void?

A

Urge Incontinence

273
Q

What condition involves leakage with exertion or Valsalva?

A

Stress Incontinence

274
Q

What condition involves urgency and exertional leakage?

A

Mixed Incontinence

275
Q

What condition involves impaired detrusor contractility +/- obstruction; nocturia?

A

Incomplete Emptying Incontinence (Overflow)

276
Q

What two medications are recommended for treatment of Urge Incontinence? Give an example of each.

A

Antimuscarinics
- Tolterodine

Alpha-Blockers
- Tamsulosin

277
Q

What medication is recommended for treatment of Incomplete Emptying Incontinence (Overflow)? Give an example.

A

Alpha-Blockers

- Tamsulosin

278
Q

What condition might present with glomerulations or Hunner ulcer on cystoscopy?

A

Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)

Clin Med II Disease Key Notes (4 decks)

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