Renal/GU (27) Flashcards
MOA of sildenafil
what type of meds can have adverse hypotensive reaction?
PDE5 inhibitor - Nitric Oxide potentiation
antiretroviral medications can increase PDE4 inhibitor levels.
MOA of BPH treatment (terazosin, tamsulosin, doxazosin)
alpha receptor blockade
DoC class for HTN and tachycardia
beta blockers (metoprolol, labetalol, carvedilol)
Someone is taking nitrate medication (nitroglycerin, isosorbide mononitrate, isosorbide dinitrate) and begins a new drug - get hypoT, syncope, stroke, cardiac arrest. What type of drug was added?
PDE5 inhibitor - a NO potentiator
normal GFR range and decrease after 30y
120-130 mL/min/1.73m2
decr by 1mL/yr
At what stage of CKD is eGFR 30-49mL/min/1.73m2 and complications start to become evident?
stage 3 CKD
At what stage of CKD is eGFR 15-29mL/min/1.73m2 and complications start to become evident? What should clinician and pt begin preparing for here?
stage 4CKD
renal transplant
At what stage of CKD is eGFR less than 15 mL/min/1.73m2?
stage 5
?stage = eGFR >90(to 120) mL/min/1.73m2?
stage 1
?stage = eGFR 60-89mL/min/1.73m2?
stage2
?stage = eGFR45-590mL/min/1.73m2 and start to experience complications
stage 3a
What results from retrograde passage of urine in the prostatic urethra into the spermatic duct. It is common in YA males, MCC Chlamydia and E coli in older.
Inflammation of tightly coiled segment of spermatic duct located adjacent to posterior aspect of testicle.
Epididymitis
What is the Prehn sign in epididymitis?
pain improved when testicle elevated in scrotum
DoC for chlamydia
azithromycin (or doxycycline)
Tx of choice for Chlamydia/gonorrhea
azithro or doxy + ceftriaxone or cefixime
Gross hematuria (RED) with clots in a child - what source does this indicate and what is next step?
indicates extraglomerular bleed source in urinary tract (cystic kidney, stones, tumor)
renal/bladder US
child with painless hematuria with tea/cola urine
glomerular disease
> 3.5g/24hr urine protein collection OR
urine protein/Cr 3.0-3.5 = ___dx
nephrotic syndrome - increased glom permeability to macromolecules like albumin (edema and wt gain)
All five are MC common complications of ___
- Malnutrition (protein wasting in urine and bowel edema)
- Hypovolemia (over-diuresis, esp with albumin levels less than 1.5
- AKI
- Infection (MCC of death)
- Thromboembolism
nephrotic syndrome
classic triad for ___:
hematuria, flank pain, palpable abdominal or flank mass
renal cell carcinoma
hemangioblastomas in cerebellum and SC, retinal angiomas, pheo, neuroendocrine tumors of pancreast, clear cell RCCa, etc
VHL disease
male >40y w/ painless hematuria. dx with cystoscopy and tissue analysis. MCC of bladder cancer
transitional (urothelial) cell Carcinoma
hypoalbuminemia, edema, hyperlipidemia, proteinuria
nephrotic syndrome
MC form of the type of renal dz that presents with hypoalbuminemia, edema, hyperlipidemia, proteinuria in a child
Minimal change disease
what often preceeds minimal change disease in children.
tx of MCD?
respiratory infection
CS
MCC of nephrotic syndrome in adolescents and adults. idiopathic or w/ HIV or IV heroin use.
focal segmental glomerulosclerosis
nephrotic syndrome associated with hep B/C, SLE, malginancy in adults
membranous nephropathy.
hematuria, edema, HTN, group A beta-hemolytic strep infectin(pharyngitis or impetigo) 2wks prior. tea/cola colored urine. HTN possible. C3 decreased non nephrotic levels of proteinuria
post strep glomerulonephritis
Malabsorption of FA and bile salts in gut in pts with Inflammatory bowel dz (CD/UC). Lead to increase of oxalate absorption compared to ___. leads to increased risk of ____
lead to increase of oxalate absorption compared to CALCIUM. leads to increased risk of CALCIUM OXALATE STONE FORMATION
free Ca in intestinal lumen become bound to FA and not absorbed into body –> leads to incr oxalate abs. ENTERIC HYPEROXALURIA
describe the clinical presentation fo a male iwth a congenital malformation of the procesus vaginalis
testicular torsion - male has sudden, severe scrotal pain associated with N/V. tender, edematous, erythematous testicle and scrotum with ABSENCE of cremasteric reflex.
tx for testicualr torsion
surgical repair
urine dipstick positive for heme, but neg for RBC. athlete
rhabdomyolysis
painless testicular mass with hematogenous spread, particularly to brain. 15-34y. US revels hemorrhage and necrotic area.
testicular chorioCa
what do testicular chorioCa secrete?
beta-hCG
AFP found in…
yolk sac tumors
naproxen MOA and AE
COX-inhibitors, so stop already synthesized COX, which stops AA conversion to LT and PGs (PGs responsible for vasodilation of renal vasculature)
possible NSAID induced AKI
MC in 10-30y. Often associated with cirrhosis, celiac, HIV. recurrent episodes of frank hematuria, usually FIVE DAYS after URI or after athletic exertion. Renal biopsy reveals…. ___ dx?
IgA nephropathy (heamturia with RBC casts, mild-moderate proteinuria) . IgA deposits in mesangium.
difference in timing bw hematuria in IgA nephropathy v. post-strep glomerulonephritis
IgA=5days
PSGN = 1-3wks, resolving in 3-6mo
painless, unilateral left sided scrotal swelling in adolescents/YA. bag of worms feel. mass distinct from testicle. disappears when supine. does not transilluminate
varicocele
painless, fluid filled cyst located at head of epididymis. mass distinct from testicle, does not transilluminate
spermatocele.
suspect what?
FHx of kidney disease and intracranial aneurysm who presents with sx of colicky abdominal pain and frank hematuria
ADPKD - evidence of ruptured renal cyst.
first step is renal US
a male infant: grunts and strains while urinating, FTT, urosepsis (fever, tender above pubic symphysis, tachycardia), UTI, distended abdomen, oligohydraminos/lung hypoplasia neonates
dx
posterior urethral valve - membranous fold within posterior urethra that cause urinary obstruction.
voiding cystourethrogram
rate of sodium correction. if exceeded, risk osmotic demyelination syndrome. why?
not exceeding 0.5-1 mEq/L/hr, 8-12 mEq/L/hr, and/or 18 mEq/L in first 48 hrs
bc osmotic pull by rapidly increased sodium around brain cells causes brain volume to shrink quickly. compression of myelin sheath by cellular edema
