Renal/GU Flashcards
Nephrotic syndrome: pathophys?
dx?
loss of negative charge on GBM → proteinuria → edema, hypoalbuminemia, hyperlipidemia
UA shows fatty casts
Nephritic syndrome: pathophys?
dx?
inflammation of glomeruli → hematuria, oliguria, HTN, azotemia
Dx UA shows RBC casts
MCC of death associated with minimal change disease?
tx?
spontaneous bacterial peritonitis
steroids, salt-restriction + diuretics during flares
WAGR syndrome?
∆WT1 on chromosome 11 → Wilms tumor (kidney), Aniridia, GU anomalies, mental Retardation, hemihypertrophy
Neuroblastoma = ?
dx?
N-myc amplification →
proliferation of neural crest cells in adrenal gland →
1. abdominal mass/pain
2. opsoclonus-myoclonus syndrome (muscle + eyelid jerks)
3. ± bone mets (pancytopenia)
Dx urinary ↑HVA/↑VMA
Fanconi syndrome: cause?
s/s?
proximal tubule dysfunction → defective resorption of amino acids, bicarb, glucose, phosphate
polydipsia, polyuria, glucosuria, aminoaciduria, type 2 RTA, hypophosphatemic rickets, etc.
Type 1 RTA: cause?
s/s?
“distal RTA”, collecting duct can’t excrete H+ → metabolic acidosis + urinary alkalosis, hypo-K
Type 2 RTA: cause?
s/s?
“proximal RTA”, proximal tubule can’t resorb bicarb → metabolic acidosis + urinary alkalosis, hypo-K
Type 4 RTA: cause?
s/s?
“hyperkalemic RTA”, ↓aldosterone or ∆aldosterone-R → metabolic acidosis + urinary acidosis, hyper-K
Low implantation of ureter:
boys vs girls?
dx?
- asx in boys
- “wet w/ urine all the time” in girls b/c ureter drips into vagina instead of bladder
Dx IV pyelo
(Tx surgical correction)
Posterior urethral valve:
presentation?
dx?
tx?
presents w/ oliguria + lower abdominal mass (distended bladder) in a neonate
first catheterize to empty bladder, then Dx VCUG
Tx resection
Idiopathic hypercalciuria:
persistent excretion of calcium irritates urinary tract → dysuria, ↑risk of kidney stones, microscopic hematuria w/
recurrent episodes of gross hematuria
Dialysis indications:
AEIOU – Acidosis (severe metabolic acidosis), Electrolytes (severe hyperkalemia), Intoxication, Overload (severe hypervolemia), Uremia (BUN >150, pericarditis)
tx of upper UTI? lower UTI?
upper = ceftriaxone
lower = bactrim > cipro
VCUG indications?
r/o VUR in all males w/ UTIs, girls 5 w/ 2+ UTIs
Vesicoureteral reflux (VUR):
dx?
tx?
ureters implanted into wrong site on bladder → no mechanism for preventing retrograde urine reflux →
recurrent UTIs at young age
Dx VCUG
Tx long-term abx until kid grows out of it (low grade), surgical reimplantation of ureter (high grade)
Inconspicuous penis vs Micropenis
Inconspicuous: normal in fat boys, retract foreskin and measure → refer to urology if <2.5 std dev
Micropenis: GH deficiency
When should you consult urology for phimosis?
> 3 yo
Paraphimosis:
inability to relocate foreskin after retraction; Tx urology consult
Labial adhesions:
benign fusion of labia minora; Tx estrogen cream
Labial adhesions + electrolyte imbalances:
congenital adrenal hyperplasia
Polycystic ovarian syndrome (PCOS): hormone abn?
↑LH, ↓FSH, ↑E/T
PID + pelvic mass:
dx?
tx?
tubo-ovarian abscess
Dx transvaginal U/S
Tx I+D
Omphalocele:
management?
intestines protrude into umbilical cord w/ peritoneal covering, ↑risk of associated cardiac defects
first sterile wrapping, then Dx echo to r/o cardiac defects, then Tx closure if small, silo if large
Gastroschisis:
management?
intestines tear through abdominal wall w/o peritoneal covering
first sterile wrapping, then Tx closure if small, silo if large
Patent urachus:
Vitelline fistula:
PU: failure of urachus to obliterate → urination from umbilical cord
VF: failure of vitelline duct to obliterate → meconium from umbilical cord
