Renal/GU Flashcards
Rate of correction of chronic hyponatremia and hypernatreima and consequence
Hypernatremia correction-> cerebral edema
Hyponatremia correction-> central pontine myelinolysis
0.5meq/L
Presents with thirst, neuro sx, doughy skin
hypernatremia
presents with confusion, lethargy, muscle cramp, hyporeflexia, nausea
hyponatremia
presents with n/v, intestinal colic, areflexia, weakness, flaccid paralsis, arrythmia paresthesia
hyperkalemia
presents with fatigue, muscle weaknes, ileus, hypotension, yporeflexia, rhabdo, asc paralysis
hypokalemia
EKG for hypokalemia
T wave flattening, U waves, ST-segm depr
treatment hypercalcemia
IV hydration + furosemide, avoid thiazide diuretics
Type I vs II vs IV RTA: Defect, K+, urine pH, tx
Type I: H+ secr (distal), urine ph >5.3, replace HCO3
Type II: HCO3 reabs (proximal), urine ph 5.3 initially, thiazides and volume depletion
Type IV: aldost def (distal), high K, urine ph
indications of pre renal AKI (FeNa, UNa, Spec grav, BUN/Cr)
FeNa 1.02, BUN/Cr >20
Consequences of AKI
metabolic acidosis, hyperkalemia–> arrythmia
HTN, volume overload
Definition CKD (time and GFR); when symptomatic?
> 3mo, GFR
Consequences and tx of CKD
Metabolic derangement: azotemia, metabolic acidosis, hyperkalemia, ACD, hypocalcemia, hyperphosphatemia, impaired coag
Tx: ACEi/ARB, DDAVP for abn bleeding, low fluid/Na/K/PO diet, PO4/calcitriol, EPO
Nephritic syndrome: sx and workup
hematuria, mild proteinemia
Complement, ANA, ANCA, anti-GBM
Ca levels loop vs thiazide diuretcs
Loop: decr Ca
Thiazide: Incr Ca
Nephrotic syndrome: sx and workup
proteinuria (>3.5), edema, hypoalb, hyperlip
Low serum C3, lumpy-bumpy immunofluorescence: dx and tx
PSGN, nephritic; supportive/diuretics
microscopic hematuria following resp or GI infxn; normal C3: dx and tx
IgA nephropathy; Tx: glucocort, ACEIs
cANCA+, segmental necrotizing glomerulonephritis: dx and tx
Wegener’s, high-dose corticosteroids, cytotoxic agents
linear anti-GBM deposid, hemosiderin-filled macrophages in sputum
Good pasture
plastma exchange + steroids
GBM splitting on EM: dx and tx
Alport’s, progresses to renal failure
microscopic hematuria, bx shows sclerosis in capillary tufts; hx HIV/ IVDU: dx and tx
dx: FSGS
Tx: prednisone, cytotoxic, ACE/ARB
renal bx: spike and dome appearance, HBV/ syphilis: tx and dx
dx: membranous nephropathy
tx: prednisone and cytotoxic
thickened GBM and mesangial matrix: dx and tx
diabetic nephropathy
Type 1: ACEi
Type 2: ARB
Mesangial prolif, subendothel/epithl IC deposition: dx and tx
lupus nephritis
prednisone and cytotoxic
nodular glomerulosclerosis, apple-green birefringence with Congo red stain
renal amyloidosis
prednisone melphalan
tram track appearance, hx of HCV, SLE, endocarditis
membranoproliferative nephropathy
corticosteroids and cytotoxic
Stones: square shape, radio opaque: dx and tx
calcium oxalate/PO4
hydration, Na, thiazide diuretic
Stones: staghorn calculi, assoc with infxn, rectangle crystal, radioopaque
dx: struvite
tx: treat infxn, surgical removal, hydration
stones: diamond shape crystal , radiolucent, hx gout
uric acid crystal
hydration, alkalinize with citrate, purine restriction
Stones: hexagon, radioopaque: dx, workup, tx
cystine
+cyanide nitroprusside
hydration, alk urine, pnicillamine
When treat kidney stone?
> 0.5cm
Other sites of cyst in PKD
spleen, liver, pancreas
male infant with distended, palpable bladder and low UOP
posterior urethral valves
Recurrent UTIs in children: dx and tx
voiding cystourethrogram
daily prophylactic abx (amoxicillin for
hydrocele vs varicocele: sx, tx
hydrocele: transluminaes, treat for hernia or >12-18mo
varicocele: “bag of worms”, may disappear when supine, does not transluminate, treat if symptomatic, varicocelectomy or ligation or embolization
dx with ultrasound
Painful scrotal swelling: dx if pain improves with scrotal elevation vs no
improves with elevation: epididymitis tx with abx (tetracyclines, flouroquinolones)
Does not improve: testicular torsion: immediate surgery within 6hr, orchipexy of both testes to prevent torsion
Tx options for BPH
terazosin, finasteride, TURP or open prostatectomy
workup for prostate cancer
dx with ultrasound-guided transrectal bx
CXR and bone scan for mets (osteoblastic lesion)
Dx and tx for bladder cancer
Dx: cystoscopy with bx, UA, cytology, MRI, CT, bone scan
Tx: intravesicular chemo, complete transurethral resection, mitomycin C or BCG, radical cystectomy or radiotherapy
workup and tx: testicular mas
Dx: testuclar ultrasound, CXR, tumor markers (Bhcg- choriocarcinoma, AFP- nonseminomatous GCT)
Tx: radical orchiectomy, seminoma: radiosens, pt based chemo for seminomaotus GCT
