Renal/GU JB Flashcards
acute prostatitis MCC
<35yo: chlamydia and gonorrhea
>35yo: E. coli
Acute prostatitis dx
DRE
UA/culture (+ in acute)
transrectal US
ATN labs
epithelial cell casts
muddy brown casts
waxy/granular casts
low specific gravity
hyperK, hyperP
ATN tx
Volume depletion: IV fluids
Volume overload: diuretics (furosemide)
metabolic acidosis, hyperP: dialysis if pH <7.1
Postrenal azotemia lab
elevated BUN/Cr
pre-renal azotemia labs
elevated BUN/Cr
hypovolemia
BPH lab
DRE
increased PSA
urine cytology
BPH monitor
mild: monitor annually
avoid antihistamine/anticholinergics
BPH tx
5 a reductase: finasteride, dutasteride
a 1 blocker: tamsulosin, doxazosin –> sx relief
MC type of bladder cancer
transitional cell carcinoma
bladder cancer highest risk factor
smoking
bladder cancer dx
cystoscopy w/ bx
bladder injury dx
ureteral contrast study w/ pelvic fx
bladder outlet obstruction tx
BPH: tamsulosin
Detrusal muscle atony: cholinergic (bethanechol)
chronic renal failure labs
proteinuria
broad waxy casts
small kidneys on US
MCC ESRD
DM
give before surgical procedures for chronic renal insufficiency patients
desmopressin
cystitis tx
uncomplicated: Macrobid, FQ, bactrim
complicated: FQ, amino glycoside, gentamicin
Pyridium AE
turns urine orange, do not use more than 48h
mannitol AE
pulmonary edema
acetazolamide AE
hyperchloremic metabolic acidosis
sulfa allergy
kidney stones
Loop diuretics AE
hypoK, hypoCa
hyperglycemia
sulfa allergy
thiazide AE
hypoNa, hypoK, hyperCa, hyperlipidemia
hyperuricemia, hyperglycemia
sulfa allergies
metabolic alkalosis
K sparing AE
hyperK
metabolic acidosis
gynecomastia
Enuresis childhood nocturnal tx
DDAVP
TCA (imipramine)
anticholinergics
glomerulonephritis hallmark
azotemia
glomerulonephritis dx
UA: RBC casts, dysmorphic RBC, proteinuria, high SG, increased BUN Cr, hematuria
renal bx: gold standard
goodpastures dz dx
Bx: crescent formation
+ anti-GBM ab (kidney and alveoli)
linear IgG deposits
goodpastures dz tx
high dose CS + cyclophosphamide + plasmapheresis
HUS tx
hemodialysis
HUS sx
triad: thrombocytopenia, microangiopathic hemolytic anemia, kidney failure
kid w/ renal failure and diarrhea prodrome
HUS tx
observation and IV fluids
plasmapheresis
hydronephrosis dx
UA
CBC
BUN/Cr
Bladder catheter
Renal US –> CT
hyperkalemia tx
EKG changes: calcium to protect heart (calcium gluconate)
bicarb/insulin/dextrose
kayexalate/dialysis
hypocalcemia labs
increased P
decreased Mg
hypovolemic shock sx
pale cool mottled skin
decreased CO
prolonged capillary refill, decreased turgor
no severe respiratory depression
IgA nephropathy lab
+ IgA mesangial deposits on immunostaining
impotence tx
PDE5: sildenafil, tadalafil, vardenafil
PGE1 injection
vacuum pump, revascularization, prosthetics
testosterone if low
interstitial nephritis sx
AKI w/ increased eosinophils
F, maculopapular rash, arthralgia
WBC casts pathognomonic
urine eosinophils
simple kidney cyst dx
US: echoic round mass w/ smooth and sharply demarcated wall
CT
Lactic acidosis labs
increased RR/K/anion gap
decreased pH, CO2, and bicarb
metabolic alkalosis labs
prolonged vomiting
increased bicarb/pH/CO2
Minimal change disease dx
MC in nephrotic syndrome in kids
no visible cellular changes in simple light microscopy
minimal change dz tx
prednisone TOC
cytotoxic therapy w/ cyclosporine if refractory
nephrolithiasis labs
US: hematuria, nitrites if infectious
non contrast CT abd/pelvis BIT
renal US if CT CI
IV pyelography gold standard
pH of stones in nephrolithiasis (calcium oxalate, phosphate, uric acid, cystine, struvite)
pH 5.5-6.8: calcium oxalate/phosphate
pH <5: uric acid, cystine
pH >7.2: struvite
stones seen on radiograph (radiopaque)
calcium and struvite
nephrolithiasis tx
<7mm pass on its own
shock wave lithotripsy
proximal: ureteroscopy + stents
distal: percutaneous nephrolithotomy (usually for >10mm stones)
nephrotic syndrome sx
proteinuria, hypoalbuminemia, hyperlipidemia, edema
MCC nephrotic syndrome in adults
DM
nephrotic syndrome dx
24h urine protein collection gold standard
UA: proteinuria, oval fat bodies “Maltese cross shaped”
hypoalbuminemia, hyperlipidemia
renal bx
nongonococcal urethritis dx
chlamydia
nucleic acid amplification: for chlamydia and gonorrhea
paraphimosis tx
emergency
manual reduction, cool compress
granulated sugar, hyaluronidase injection
dorsal slit
Peyronie associated w/
vitamin E deficiency, BBs, increased serotonin levels
Dupuytren contracture and HLA-B27
Peyronie tx
Vit E and potassium aminobenzoate
colchicine
injection
surgery
phimosis tx
circumcision
PKD sx
abdominal/flank pain, palpable flank mass
HTN, hematuria
berry aneurisms, MVP
colonic diverticula
PKD dx
renal US 1st line
genetic testing
CT/MRI more sensitive
PKD tx
simple cyst: observe, reevaluation. ACE for HTN
multiple cyst: supportive, increase fluid intake, ACE for HTN
postop hypovolemia tx
IV fluids or blood products
premature ejaculation tx
topical desensitizing agents (lidocaine, benzocaine, prilocaine)
SSRI
PDE5 inhibitor (sildenafil, tadalafil)
pindolol, tramadol
priapism tx
low flow (ischemic): phenylephrine intracavernous injection 1st line. Turbutaline PO/SQ if <4h, needle aspiration if >4h. Shunt surgery if not responsive to other tx
high flow: observation
Prostatitis tx
Acute: >35yo FQ or bactrim outpt, IV FQ +/- aminoglycoside or ampicillin +/- gentamicin if inpt
<35yo: ceftriaxone + doxycycline or azithromycin
chronic: FQ, bactrim, TURP
pyelonephritis dx
UA: pyuria, leukocyte esterase, WBC casts (hallmark), nitrites
urine culture definitive
pyelonephritis tx
FQ (PO/IV), amino glycoside (gent), bactrim, cephalosporin
admit for IV fluids + IV abx if severe/complicated
pyelonephritis sx
F, tachycardia, back/flank pain
+ CVA tenderness, N/V
renal calculi tx
pain control (NSAIDS)
antiemetics
alpha blocker (tamsulosin) for large stones
renal cell carcinoma sx
triad: hematuria, flank/abd pain, palpable mass
malaise, L sided varicocele, HTN, hypercalcemia
renal cell carcinoma dx
CT 1st line
renal US
MRI
renal cell carcinoma tx
Stage 1-3: nephrectomy, IL2 therapy. usually resistant to chemo/rad
bilateral or pt w/ one kidney: partial nephrectomy
respiratory alkalosis labs
from hyperventilation
increased pH
decreased PCO2
Testicular torsion PE
negative preens sign
absent cremasteric reflex
blue dot sign
MCC UTI
E. coli
varicocele PE
bag of worms
dilation decreases if supine or testicular elevation
worse w/ upright or valsalva
varicocele tx
observation
surgery
wilms tumor (nephroblastoma) sx
painless palpable abdominal mass, does not cross midline
hematuria, HTN, anemia
wilms tumor (nephroblastoma) dx
abdominal US BIT
CT w/ contrast or MRI more accurate