Renal step Up Flashcards
adverse of acetazolamide
mild metabolic acidosis, hypoK
nephrolithiasis
adverse of osmotic diuretics
no effect on Na excretion, hyponatremia followed by hyper
side effects of loops
ototoxicity, hyperuricemia, hypoK and hypoCa
side effects thiazides
hypoK
hypoNa
hyperuricemia
hypercalcemia
side effects K sparind diuretics
hyperkalemia, gynecomastia, menstrual irregularty
what scenarios do you use aldosterone antagonists
hyperaldosteronism, CHF
post MI
cirrhosis
acne and PCOS(spironolactone only)
cause of calcium oxalate stones
idiopathic hypercalciuria
cause of struvite stones
UTI(urease + bacteria)
more common in women
staghorn
what cuases Ca phosphate kidney stones
hyper PTH and RTA
what causes uric acid stones
chemo drugs, gout
what causes cystine kidney stones
cystinuria and aa transport defects
what are the radiolucent stones
uric acid
what occurs in those with polycystic kidney disease
subarachnoid
Tx ADPKD
ADH antagonists, amiloride
Tx HTN
pain control’dialysis or transplant
complications of polyscystic kidney disease
ESRD, heptic cysts, intracranial aneurysms, subarachnoid hemorrhage, MVP
What malignancies cause increased EPO
RCC
hepatocellular carcinoma
pheo
hemangioblastoma
what is risk factor for RCC
tobacco smoking, cadmium exposure and asbestos exposure
labs in renal cell carcinoma
polycytehmia from increased EPO
UA shows hematuris
Tx RCC
surgicallyr esect
Acute interstitial nephritis
damage to renal tubules or parenchyma
what meds can cause acute interstitial nephritis
beta lactams, sulfonamides, aminoglycosides, NSAIDs, allopurinol, PPIs, diuretics
signs Sx for acute interstitial nephritis
nausea, vomitnig, malaise and fever and rash
labs in acute interstitial nephritis
increased Cr. UA show granular or epithelial casts.
What is Acute tubular necrosis
progressive damage or renal tubules, acute or chronic renal failure, renal papillary necrosis, eSRD
Post infectious glomerulonephritis cause and Sx
GAS
recent infection, oligouria, edema, brown urine and HTN
labs for POst strep glomerulonephritis
hematuria, proteinuria
high ASO
subepithelial humps of IgG and C3 on BM
Tx psot strep gloemrulonephritis
supportive. dec edema and HTN
Sx IgA nephropathy
hematuria, flank pain, low grade fever
labs in AgA nephropathy
increased IgA, mesangial cell prolifeation
Tx IgA nephroapthy
ACEI and statins for proteinuria
corticosteroid if have nephrotic syndrome
signs goodpastures
dyspnea, hemopthysis, myalgias, hematuria
labs in goodpastures
serum IgG anti BM Ab, anemia, pulm infiltrates
linear IgG Ab on glomeruli
Tx goodpastures
plasmapheresis, corticosteroids, immunosuppressants
signs of alport syndrome
hematuria, Sx renal failure, hearing los s(high freq)
cataracts, lenticonus
labs in alport
RBC casts, hematuria, proteinuria and pyuria
split basement membrane
Sx of rapidly progressive crescenteric glomerulonephrtiis
sudden renal failure, weakness, nausea, weight loss, dyspnea, hemoptysis, myalgias, fever, oliguria
labs in RPGN
inflammatory cells deposition and fibrous material in bowman capsule
crescent formation
ANCA +
Sx lupus nephritis
HTN, renal failure
nephrotic syndrome
labs in lupus nephritis
ANA, anti DNA Ab
hematuria and possible proteinuria
cANCA
wegeners
minimal change disease Sx
HTN, increased infections.
in children
labs in minimal change
hyperlipidemia, hypoalbuminemia, proteinuria
flattening BM from loss of foot processes
Tx minmal change
corticosteroids and cytotoxic agents
Sx focal segmental glomerular sclerosis
HTN
common in blacks and latinos in US(most common cause of nephrotic syndrome)
labs in FSGS
hyperlipidemia, hypoalbuminemia, hematuria, high proteinuria
sclerotic changes
Sx membranous nephropathy
edema, dyspnea Hx infection or medication use
assoc with Hep B and C
labs in membranous nephropathy
hyperlipidemia, hypoalbuminemia, proteinuria
spike and dome on BM thickening
which renal pathology requires anticoagulation sometimes
membranous nephropathy when cause renal vein thrombosis
what are Sx membranoproliferative GN
edema
HTN
Hx infeciton or autoimmune
gradual prgression to renal failure
labs in MPGN
hyperlipidemia, hypoalbuminemia, hypoclomentemia, proteinuria and hematuria
IgG deposits
BM with train track double layer
labs in diabetic nephropathy
kimmelstiel wilson nodules (in nodular type)
labs of amyloidosis causing renal issues
elevated Cr
proteinuria
congo red stain show apple green birefringence
Fractional excretion Na
prerenal
BUN/Cr >20
pre renal
Sx signs of chronic kidney disease
gradual development or peripheral neuropathy, brownish skin
changes in mental status, HTN, pericarditis, anorexia, nausea vomiting, GI bleeding
labs in chronic kidney disease
increased K low Na increased phosphate decreased Ca anemia metabolic acidosis increased BUN and Cr urine osmolality similar to serum
complications CKD
ESRD
renal osteodystrophy from low serum Ca
encephalopathy
severe anemia (dec epo)
indications for dialysis
severe hyperK, severe metabolic acidosis, fluid overload
uremic syndrome
Cr>12 and BUN >100
Renal tubular acidosis has what anion gap
no anion gap!!! trick question
type I RTA
distal
impaired H secretion causing secondayr hyperaldosteronisms
what causes type I RTA
idiopathic, autoimmune, drugs, chronic infeciton, nephrocalcinosis, cirrhosis, SLE, obstructive nephropathy
labs in type I RTA
urine pH >5.3
low K in serum with variable HCO3
possible stones
type II RTA
HCO reabsorption problem in proximal tubule
cause of type II RTA
idiopathic, MM, fanconi, wilson, amyloid, vit D def, autoimmune
labs in type II RTA
Type IV RTA
low renin/aldosterone from primary or secondary hypoaldosteronism
cause of type IV RTA
primary renin or aldosterone deficiency, DM, addison, sickle cell
interstitial disease
labs in IV RTA
Tx type IV RTA
fludrocortisone, K restriction
normal anion gap
8-12
normal anion gap suggests what
HCO3 loss
increased anion gap acidosis
H+ excess
causes of high anion gap acidosis
Methanol, Uremia, Diabetic Ketoacidosis Propylene glycol Isoniazid/Iron Lactic acidosis Ethylene glycol salicylates
Sx hypernatremia
oliguria, thirst, weakness, lethargy, decreased consciousness, mental status changes, seizures
tx hypernatremia
gradual hydration with normal saline
how to rehydrate in hypernatremia
half of water deficit in first 24 hours and second half over 24-48 hours
rapid hydration of hypernatremia leads to
cerebral edema
What can cuase central DI
failure of post pituitary to release ADH
can be from idiopathic cause, cerebral trauma, pituitary tumors, hypoxic encephalopathy or anorexia nervosa
causes of nephrogenic DI
hereditary renal disease
lithium toxicity
hyperCa
hypoK
what causes psuedohyponatremia
artificat of hyperlipidemia
What causes hyponatremia
renal H2O retention from CHF, SIADH, thiazide diuretics, hyperglycemia or high fluid intake
signs hypoNa
confusion, nausea, weakness, decreased consciousness
complications hypoNa
CNS damage
what occurs if you correct hypoNa to quickly
central pontine myelinolysis
Tx hypoNa
salt administration, H2O restriction
what can cause SIADH
CNS pathology, sarcoid, paraneoplastic syndromes, psychiatric drugs, major surgery, pneumonia, HIV
what causes pseudohyperK
RBC hemolysis from blood collection
so measure K immediately after transfusion
what can cause hyper K
metabolic acidosis, aldosterone def, tissue breakdown, insulin deficiency, adrenal insufficiency, renal failure, K sparing diuretics
Sx hyperkalemia
weakness, nausea, vomiting, arrhythmias, paralysis or paresthesia in severe cases
ECK hyperkalemia
tall peaked T waves
Tx hyperkalemia
Ca gluconate
NaHCO3, glucose with insulin to encourage K uptake
Na polystyrene sulfonate binds K
what can cause hypokalemia
metabolic respiratory alkalosis, hypothermia, vomiting, diarrhea, hyperaldosteronism, insuline excess, K wasting diuretics, RTA I II
signs hypoK
fatigue, weakness, paresthesias or paralysis, hyporeflexia, arrhythmias
EKG hypoK
T wave flattening, ST depression, U waves
which Vitamins can cause hyperCa
Vit A overload and Vit D overload
EKG with hyperCa
shortened QT interval
familial hypocalciuric hypercalcemia
disorder of Ca sensing R
EKG hypoCa
prolonged QT
effect of thiazides on Ca
Ca sparing
next step in man with suspected UTI
perform workup for STIs
urge incontinence is from
detrusor overactivity
Tx urge incontinence
antimuscarinics like oxybutynin or tolterodine or solifenacin and bladder training
cause of stress incontinence
inc abdominal P and decrease anatomic support and funciton of sphincter
cause of overflow incontinence
incomplete bladder emptying
more commin in men
from impaired detrusor, BPH, neurogenic bladder
Tx overflow incontinence
decompress bladder with foley
common bladder CA
transitional cell
risk factors for bladder cancer
tobaccon, schistosomiasis, cyclophosphamide, aniline dyes, petroleum byproducts, recurrent UTI
male >female
signs Sx bladder cancer
painless gross hematuria, suprapubic pain, frequency, dysuria and urgency
cause of urethritis
N gonn
C tracho
signs of urethritis
burning, purulent discharge, dysuria, frequency and urgency
Tx urethritis
single dose ceftriaxone with doxy or azithromycin
treat sexual partners
Tx prostatitis
TMP SMX for 4-6 weeks
where does BPH occur in prostate
central area
signs Sx BPH
urinary hesitancy, straining, weak or intermittent stream, dribbling, frequency, urgency, nocturia and overflow incontinence
Tx for BPH
a1 blockers(terazosin)
5alpha reductase inhibitors like finasteride
TURP
where does prostate cancer arise
adenocarcinoma in peripheral zone
risk factors prostate CA
increased age, FMH, high fat diet and prostatitis
supporting the scotrum relieves pain in what
epididymitis
what causes epididymitis
prostatitis, STDs(chlamydia), urinary reflux
Tx epididymitis
ceftriaxone and doxy or fluoroquinolone, NSAIDs
what twists in testicular torsion
spermatic cord
testes displaced superiorly
testicular torsion
Tx testicular torsion
emergen surgical reduction
complications of testicular torsion
testicular ischemia or infarction
types of testicular cancer
germ cell (seminomatous, nonseminomatous) or stromal cell (leydig, sertolie or granulosa cell)
signs of testicular cancer
painless testicular mass, gynecomastia, low abdomen pain
GI or pulm Sx
labs for testicular CA
increased bhCG, and increased alpha fetoprotein in germ cell tumors, increased estrogen in stromal cells
Tx for seminoma
radical orchiectomy
Tx nonseminomas
radical orchiectomy
most common CA in men between 15 and 35
testicular CA
labs in impotence
dec testosterone sometimes
dec LH sometimes
increased prolactin possible
wilms tumor
renal malignant tumor in children
signs wilms tumor
weight loss, nausea, vomiting, dysuria, polyuria, palpable abdominal or flank mass, HTN, fever
Tx wilms tumor
resection, chemo and possible radiation
Tx cryptorchidism
exogenous hCG, orchioplexy before age 5 to reduce risk CA
