Renal/GU Flashcards
IgA Nephropathy / Berger Dz
- overview
- immunoglobulin A and C3 deposits in the mesangium
- MC glomerular dz worldwide, esp Asia
- M > F
IgA Nephropathy / Berger Dz
- clinical
- gross hematuria 1-2 days after viral URI
- normal complement
- elevated Cr and BUN
- urine: severe proteinuria and hematuria
IgA Nephropathy / Berger Dz
- mgmt
- low risk of progression: monitor
- high risk progression: ACE/ARB to reduce proteinuria and HTN
Hypomg
- clinical
- Neuro: tremor, tetany, seizure, weakness
- CV: prolonged QTc, wide QRS
- Hypokalemia
- Abnl calcium metab
Chancroid vs. Chancre vs. Lymphogranuloma venerum
- Chancroid: painful ulcer, painful inguinal LAD
- syphilis/chancre: painless ulcer, painless LAD
- LV: Painless ulcer, painful LAD
Renal Artery stenosis
- MCC (2)
- clinical
- atherosclerosis, fibromuscular dysplasia (MC in young F)
- usu asx
- recalcitrant HTN
Renal artery stenosis
- dx
- duplex doppler (1st line)
- CT angiography
- MR angiography
- renal arteriography: after other tests are nonconclusive and still high suspicion
Renal artery stenosis
- mgmt
- ACE/ARB for HTN
AKI
- criteria
- serum Cr inc ≥ 0.3 or ≥ 50% in 48 hours
- serum Cr inc 1.5 x known baseline
- Urine output <0.5 mL/kg/hour >6 hours
Cryptorchidism
- when descend
- 3-4 months of life
- descent after 6 months is rare
- sx orchiopexy recommended ASAP after 4 months and def before 2 years
Chronic bacterial prostatitis
- bugs
- E. coli MC
- proteus
- e. faecalis
- klebsiella
- pseudomonas
Chronic bacterial prostatitis
- clinical
- recurrent UTI
- low back / perineal pain
- urinary retention
- tender, boggy prostate (or normal!)
Chronic bacterial prostatitis
- dx
- Urine culture prior to and after prostatic massage
Chronic bacterial prostatitis
- mgmt
- bactrim
- FQ
X 6 weeks
Prostate cancer screening
- high risk pts
- when start screening
- AA
- fam hx
- BRCA mutations
- screen age 40
Prostate cancer screening
- normal risk
50-70
Acute Interstitial Nephritis
- overview
- inflammation or allergic response in interstitial of kidney
Acute Interstitial Nephritis
- clinical
- Pyuria
- WBC casts***
- hematuria
- fever
- rash
- arthralgia
Acute Interstitial Nephritis
- common drugs
- common illness
- PCN & cephalosporins
- NSAIDS
- RMSF
- CMV
- Sarcoid, Sjogren, Lupus
Overflow incontinence
- causes
- blockage of urethra: BPH, stricture
- Detrusor under activity from nerve damage
Acute prostatitis
- clinical
- fever chills
- malaise
- pelvic pain
- perineal pain
- cloudy urine
- irritative and obstructive sx
- firm, edematous, exquisitely tender prostate on DRE
Acute prostatitis
- dx
- clinical
- labs: pyuria, bacteriuria, elevated acute phase reactants (ESR, CRP)
- pos blood cultures
Acute prostatitis
- mgmt
- 1st: bactrim, cipro, levofloxacin X 6 weeks
- Inpt: IV cipro +/- aminoglycoside
Balanitis
- overview
- RF
- inflammation glans penis, MC in uncircumcised with poor hygiene
- RF: DM, genial trauma, obesity, edematous dz (CHF, cirrhosis, etc)
Balanitis
- clinical
- red
- swelling
- DC: curdlike or purulent
Balanitis
- mgmt
- hygiene
- anti fungal if no response
Chancroid
- bug
- clinical
- dx
- Haemophilus ducreyi
- painful genital ulcer, regional LAD
- clinical- no good tests (r/o syphilis and herpes)
Chancroid
- mgmt
- Ceftriaxone 250 mg IM
- Azithromycin 1 g PO
Prerenal AKI
- Bun:Cr
- Urine Na
- FENa
- > 20:1
- < 20
- < 1%
ATN (intrinsic) AKI
- BUN:Cr
- Urine Na
- FENa
- <20:1
- > 40
- > 2%
When to treat patient with CKD with EPO
- hgb <10
- adequate iron
- epoetin or darbepoetin
BPH
- mgmt
- alpha-1-adrenergic antagonists (tamsulosin)
- 5-alpha-reductase inhibitors (finasteride)
- TURP
Urge incontinence
- mgmt
- antimuscarinics (oxybutynin)
- beta-adrenergic agonists (Mirabegron)
Hypokalemia
- EKG
- ST segment depression
- T wave decreased amplitude
- U wave amplitude increased
- Prolonged QT
Vesicoureteral Reflux
- cause congenital/primary
- cause secondary
- congenital: short intravesical ureter
- secondary: due to high voiding pressure in bladder
Vesicoureteral Reflux
- primary: dx
- hydronephrosis on prenatal US
- febrile UTI in child > renal US
Vesicoureteral Reflux
- dx
- renal US
- contrast voiding cystourethrogram: better
MCC CKD
- DM!
- HTN second
Penile Carcinoma
- MC type
squamous cell
Penile Carcinoma
- RF
- uncircumcised
- poor local hygiene
- HPV (16, 18)
- Age >60
Penile Carcinoma
- clincial
- small red lesion,
- non-healing ulcer
- purulent or warty growth
- pain uncommon
Penile Carcinoma
- dx
- biopsy of lesion
- MRI to stage
Penile Carcinoma
- mgmt
surgical excision
Urethral stricture
- etiology
- idiopathic
- injuries
Urethral stricture
- clinical
- decr stream
- hx recurrent UTI
- incomplete bladder emptying
- urinary spraying
Urethral stricture
- dx
retrograde urethrogram: IDs location and length of stricture
Urethral stricture
- mgmt
- urethral dilation
- urethrotomy
- sx reconstruction
MCC nephrotic syndrome in children
minimal change disease
Minimal change disease
- dx
- severe proteinuria >3.5 g/24 hours
- hypoalbuminemia
- hyperlipidemia
- podocyte foot process effacement
Minimal change disease
- clinical
- periorbital edema, weight gain, diarrhea, abd pain, decr urinary output
Minimal change disease
- mgmt
- prednisone
Bladder cancer
- classic presentation
painless hematuria - gross or microscopic
Bladder cancer
- dx
- cystourethroscopy
- urinary cytology
- XR upper GI tract
- CT with and without
