Renal/GU Flashcards
RTA associated w/ abnormal HCO3 and rickets
RTA type II (proximal)
RTA associated w/ aldosterone defect
RTA type IV (distal)
“doughy” skin
hypernatremia
differential of hypervolemic hyponatremia
cirrhosis, CHF, nephritic syndrome
chvostek’s sign - facial twitch upon tapping the facial nerve
trousseau’s sign - spasm of the hand induced by inflating BP cuff
signs of?
hypocalcemia
most common causes of hypercalcemia
malignancy and hyperparathyroidism
t-wave flattening and u waves
hypokalemia
peak t-waves and widened QRS
hyperkalemia
first line tx for moderate hypercalcemia
IV hydration and loop diuretics (furosemide)
type of acute renal failure in a pt w/ FeNa
prerenal
pt presents w/ acute-onset flank pain and hematuria
nephrolithiasis
most common type of nephrolithasis
calcium oxalate
20 yo male presents w/ palpable flank mass and hematuria; US shows bilateral enlargement of the kidneys w/ cysts. name associations to this dz?
AD-PKD - associated w/ berry aneurysms, mitral valve prolapse, benign hepatic cysts
hematuria, HTN, and oliguria
nephritic syndrome
proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, and edema
nephrotic syndrome
most common form of nephritic syndrome
membranous glomerulonephritis
most common form of glomerulonephritis
IgA nephropathy (berger’s dz)
glomerulonephritis w/ deafness
alport’s syndrome
glomerulonephritis w/ hemoptysis
goodpasture’s syndrome and wegner’s granulomatosis
presence of red cell casts in urine sediment
glomerulonephritis/nephritic syndrome
eosinophils in urine sediment
allergic interstitial nephritis
waxy casts in urine sediment and maltese crosses (seen w/ lipiduria)
nephrotic syndrome
drowsiness, asterixis, nausea, and pericardial friction rub
uremic syndrome seen in pts w/ renal failure
55 yo male diagnosed w/ prostate cancer. tx options?
wait, surgical resection, radiation, and/or androgen suppression
low urine specific gravity in the presence of high serum osmolality
DI
tx of SIADH
fluid restriction or demeclocycline
hematuria, flank pain, and palpable mass
renal cell carcinoma
testicular cancer associated w/ b-hCG and AFP
choriocarcinoma
most common type of testicular cancer
seminoma (type of germ cell tumor)
most common histology of bladder cancer
transitional cell carcinoma
complication of overly rapid correction of hyponatremia
central pontine myelinolysis
salicylate ingestion occurs in what type of acid-base disorder?
anion gap acidosis and primary respiratory alkalosis due to central respiratory stimulation
acid-base disturbance commonly seen in prego women
respiratory alkalosis
three systemic dz that lead to nephrotic syndrome
DM, SLE, and amyloidosis
elevated EPO levels, elevated hematocrit, and normal O2 sat suggests?
RCC or other EPO-producing tumor; evaluate w/ CT scan
55 yo man presents w/ irritative and obstructive urinary symptoms. tx options?
likely BPH - tx includes none, terazosin, finasterid, or surgical intervention (TURP)
RTA associated w/ abnormal H+ secretion and nephrolithiasis
RTA type I (distal)
medications (7) that cause hyperkalemia
- non-selective beta-blockers - interferes w/ beta-2-mediated intracellular K uptake
- ACE-I/ARB/K sparing diuretics - inhibition of aldosterone or the ENaC channel
- digitalis - inhibition of the Na-K-ATPase pump
- cyclosporine - blocks aldosterone activity
- heparin - blocks aldosterone production
- NSAIDs - decreases renal perfusion resulting in decreased K delivery to the collecting ducts
- succinylcholine - causes extracellular leakage of K through acetylcholine receptors
mgmt of hyperkalemia
initial mgmt should include an ECG to evaluate conduction abnormalities. acute therapy (i.e. calcium gluconate, insulin w/ glucose, etc) is typically reserved for pts w/ ECG changes, K ≥ 7.0 w/o ECG changes, or rapidly rising K due to tissue breakdown
tx for acute hyperkalemia (4)
calcium gluconate (given first to stabilize cardiac cell membranes), insulin w/ glucose (quick way to shift K into the cells), beta-2 adrenergic agonists/albuterol (promotes cellular reuptake of K), and sodium bicarbonate (also shifts K into the cells); can also use dialysis is symptomatic and refractory * note in non-acute hyperkalemia can also use Kayexalate (sodium polystryrene sulfonate) which blocks K absorption
indications for urgent dialysis
AEIOU:
acidosis - metabolic acidosis w/ pH 6.5 that is refractory to medical therapy)
ingestion - toxic alcohols (methanol, ethylene glycol), salicylate, lithium, sodium valproate, carbamazepine
overload - volume overload refractory to diuretics
uremia - symptomatic (encephalpathy, pericarditis, bleeding)
differentiate IgA nephropathy from postinfectious glomerulonephritis
IgA nephropathy has earlier onset post-URI/GI infection (usually w/in 5 days) and has normal serum complement levels (normal C3) vs postinfectious glomerulonephritis follows recent GAS infection (usually 2-6 weeks later) and has low serum complement (low C3) and ASO titer
causes of anion-gap metabolic acidosis
MUDPILERS: methanol uremia DKA paraldehyde or phenformin iron, INH lactic acidosis ethylene glycol rhabdomyolysis salicylates, sepsis
muddy brown casts
acute tubular necrosis (ATN)
white cell casts
pyelonephritis
etiology of acute tubular necrosis (ATN)
ischemia or nephrotoxic agents
dz associated w/ focal segmental glomerulosclerosis
HIV, heroin/IV drug use
dz associated w/ membranous nephropathy
Hepatits B
bacteria associated w/ staghorn calculi
urease producing organisms such as proteus
only kidney stone that is radiolucent. associated w/?
uric acid stones. associated w/ gout, xanthine oxidase def, and high purine turnover states (chemo)
kidney stone that has + urinary cyanide nitroprusside test
cystine stones
painless causes vs painful causes of scrotal swelling
painless = hydrocele (asymptomatic and transilluminates) and varicocele (vague pain, L more than R, bag of worms, does not transilluminate) painful = epididymitis (pain may decrease w/ scrotal elevation = + prehn's sign) and testicular torsion (acute onset pain w/ N/V, - prehn's sign, loss of cremasteric reflex)
which drugs are an absolute contraindication to sildenafil
nitrates
differentiate mixed germ cell tumors vs seminoma based on b-hCG and AFP
mixed germ cell tumors - elevated b-hCG and AFP
seminoma - elevated b-hCG, but normal AFP
normal urine output in adults vs children
adults = 0.5 mL/kg/hr children = 1.0 mL/kg/hr
urine loss - after increased intra-abdominal pressure (coughing, sneezing, lifting)
stress incontinence
urine loss - strong, unexpected urge to void that is unrelated to position or activity
urge incontinence
urine loss - chronic urinary retention
overflow incontinence
mechanism of stress incontinence
urethral sphincter insufficiency due to laxity of pelvic floor musculature (common in multi-parous women or after pelvic surgery)
mechanism of urge incontinence
detrusor hyperreflexia or sphincter dysfunction due to inflammatory conditions or neurogenic disorders of the bladder
mechanism of overflow incontinence
chronically distended bladder w/ increased intravesical pressure that just exceeds the outlet resistance, allowing a small amount of urine to dribble out
electrolyte imbalances seen in vomiting
prolonged and excessive vomiting depletes the body of water (dehydration), and may alter the electrolyte status. gastric vomiting leads to the loss of acid (protons) and chloride directly –> alkaline tide –> hypochloremic, hypokalemic metabolic alkalosis
decreased Cl, decreased K, increased HCO3
most common cause of chronic renal insufficiency/failure in male children only
posterior urethral valves
most common cause of recurrent UTIs in infants and children
VUR
dietary recommendations for pts w/ renal calculi?
- decreased dietary protein and oxalate
- decreased sodium intake
- increased fluid intake
- increased dietary calcium
pt w/ personal and family hx of recurrent kidney stones that are hard and radiopaque. UA may show typical hexagonal crystals. urinary cyanide nitroprusside test is positive
cystinuria
