Renal/Genitourinary Flashcards
What is SIADH
TX
Excess increased of ADH from the pituitary gland or ectopic source which leads to increase in free water retention and impaired water excretion
Leads to concentrated urine and hyponatremia
Tx: Restrict Water, Demeclocycline to inhibit ADH in severe cases
What is Epididymitis
Sx
Dx
Tx
In men <35 yrs caused by Chlamydia or Gonorrhea
In men >35 usually E.Coli, Klebsiella
Sx: Gradual onset of scrotal pain, erythema and swelling, dysuria, urgency, frequency, fevers, chills
Positive Prehn’s sign (relief of pain with elevation of testicles), Positive Cremaste Reflex (normal)
Dx: Ultrasound, UA may show pyuria or bacteriuria
Tx: Azithromycin and Ceftriaxone
What is Acute Orchitis
Sx
Dx
Tx
Usually viral, Mumps, Rubella, Coxsackie
Sx: Gradual onset of scrotal pain, erythema and swelling, dysuria, urgency, frequency, fever, chills
What is Prostatitis
Sx
Dx
Tx
Prostate gland inflammation usually secondary to ascending infection
E.Coli, Pseudomonas
Chlamydia/Gonorrhea in young men
Sx: Fevers, Frequency, Urgency, Dysuria, Hesitancy, perineal pain, Tender, Hot, boggy prostate
Dx: UA and Culture (don’t do prostate massage in acute state)
Tx: Fluoroquinolones, Bactrim
If Chlamydia/Gonorrhea Azithromycin and Ceftriaxone
What is a major side effect of Phosphodiesterase-5 (PDE-5).
What is it used for
What drug interaction should be careful with as a result of this SE
Examples of PDE-5
Hypotension
Used for Erectile Dysfunction
Careful with use with Nitrates which also lower BP
Sildenafil, Tadalafil
What is the most common component of kidney stones
Calcium
Why should you correct hyponatremia slowly
At what rate
May lead to osmotic demyelinating syndrome (Central Pontine Myelinolysis)
No more than 0.5 mmol/L
What defines Nephrotic Syndrome
What are Examples of Nephrotic Syndromes
Dx
Tx
Proteinuria, Hypoalbumineuremia, Hyperlipidemia and Edema
Minimal Change Disease: Most common in Children
Focal Segmental Glomerulosclerosis
Membranous Nephropathy
Dx: 24 urine with >3.5g/d GOLD STANDARD, Proteinuria, Hypoalbauminemia
Tx: Steroids in Minimal Change, Diuretics, Ace-I/ARB
What are features of Acute Glomerulonephritis
What are types of Nephrotic Syndromes
Dx
Tx
Protein and blood leakage into urine IGA Nephropathy Post Infectious Membranoproliferative Goodpasture's Vasculitis Sx: Hematuria (cola colored urine), Edema, HTN, Fevers, Oliguria Dx: UA with RBC casts, proteinuria Tx: Ace-I, Diuretics, Steroids
RBC Casts with Hematuria
Acute Glomerulonephritis
Vasculitis
Muddy Brown (Granular) or Epithelial Cell Casts
Acute Tubular Necrosis
White Blood Cell Casts, Pyuria
Acute Interstitial Nephritis
Pyelonephritis
Waxy Casts
End Stage Renal Disease
Chronic Acute Tubular Necrosis
Hyaline Casts
Nonspecific
What is Actue Tubular Necrosis
Sx
Dx
Tx
Neprhon damage due to prolonged prerenal, hypotension, gout, rhabdomyolysis
Dx:Renal Tubular Epithelial cell casts and muddy brown casts, low specific gravity
Tx: Remove offending agents, IV fluids, Furosemide
What is Acute Tublointerstitial Nephritis
Sx
Dx
Tx
Inflammoatry or allergic response in interstitium with sparing of glomeruli and blood vessels, Drug hypersnsitivity
Sx: Fever, Esoinophilia, maculopapular rash
UA: WBC casts, Urine Eosinophils
Tx: Remove offending agent
Gradual onset of scrotal pain, Erythema, Swelling
Positive Prehn’s Sign, Positive Cremasteric Reflex
Pyuria
Epididymitis
Sudden onset of scortal pain, nausea, vomiting
Swollen, tender, Retracted testicle
Negative Prhen’s Sign, Negative Cremasteric Reflex
Testicular Torsion
Painless scrotal swelling
Testicular mass
Dull ache or heavy sensation
Does transilluminate
Hydrocele
Painless mass, may have dull ache or heavy sensation
Bag of Worms
Mass is reduced when supine
Mass enlarges with valsalva
Varicocele
What is the most common Testicular Cancer
Seminoma
What is testicular cancer Risk factor Sx Types/Dx Tx
Found in young men
Cryptorchidism
Seminoma: They are Simple and Sensitive (No tumor markers, and are sensitive to radiation)
Non-Seminoma: High Alpha-Fetoprotein and High Beta-HcG, Radio-resistant
Tx: Nonseminoma: Orchiectomy with lymph node dissection
Seminoma: Orchiectomy followed by radiation, or debulking chemo followed by orchiectomy and radiation
What labs do you see with Cystitis vs. Pyelonephritis
Cystitis: Leukocyte Esterase, Nitrites
Pyelonephritis: WBC Casts, Leukocyte Esterase, Nitrites
What is Phimosis
Inability to retract foreskin over the glans
Not an emergency
Tx is circumcision
