Renal: structural, congenital and neoplasms Flashcards
severity of UTO basd on
- location
- completeness
- uni or bilateral uretuers
- duration
- nature/cause
main differences b/w upper UTO and lower
UPPER -bladder NOT distended on US -(+) Hematuria \+flank pain \+N/v CAUSES -stones, mass
LOWER
-bladder distended on US
-urgency, frequencyk, hesitency, nocturia
CAUSES: BPH, prostate CA, urethral stricture,
complications of upper UTO
- hydroureter: dlation of ureters
- hydronephrosis: dilatino of renal pelvis and calyces
- uretro-hydronephrosis: dilation of ureters and renal pelvis and calyces
- tubulointerstitial fibrosis: deposition of excess amt of extracellular matrix
- leads to excess cell destruction and death of neprhons
Hydronephrosis
-obstruction of urine flow from the kidneys–>distention and dilation of the pyelocaliceal system
-etiologies
INTRINSIC: stones, clot, congenital, CA
Iatrogenic causes
Lower UTO
-involves
-
bladder, urethra, urinary sprinchter and prostate
***neurogenic bladder
Neurogenic Bladder
- define
- causes
- CM
dysfunction 2nd to neurologic disorders which interrupt innervation
- UMN–>overactive bladder function
- LMN–>underactive bladder function
CAUSES
- prostate enlargement
- urethral stricture
- severe pelvic organ prolapse
- low bladder wall compliance
CM
- frequent DAYTIME voiding >every 2 hours while awake
- Nocturia
- urgency + hesitency
- dysuria
- poor force of stream, intermittent urinary stream
- feelings of incomplete bladder emptying, despite micturation
define Asymptomatic microhematuria
> 3 RBCs/HPF without a known benign cause
MCC of hematuria in PT <40
- inflammatin
- infection
- prostate, blader
-nephrolithiasis
mc causes of hematuria in pt >40
- kidney or urinary tract CA
- BPH
what is MCC of microscopic hematuria in men
BPH
systemic s/s of fever, chills, n/v and UTI s/s
pyelonephritis
Pyelonephritis
- RF
- CM
- PE
- DX–labs, UA, CBC
- complications
- TX —who gets admitted
- who gets a CT scan —finding?
- DM
- hx of recurrent UTIs or kidney stons
- pregnancy
- congenital urinary tract malformations
CM
- upper track s/s: fever, chills, back or flank pain, N/V (not common but suggestive)
- lower s/s: dysuria, urgency and frequency
PE
*+ CVA tenderness
Fever
Tachycardia
DX *UA-->pyuria >10 WBC + leuk esterase + nitrites + hematuria + cloudy color + bacteriuria *****WBC CASTS= pathognmonic *incr PH with Proteus sp. CBC: leukocytosis with left shift DDX=urine culture
COMPS
- **papillary necrosis
- *absces
- septic shock
- renal failure
TX
ADMIT= unstable, elderly, pregnant, complicated med hx or not able to tolerate PO
*OUTPT: PO abx 5-7 days–> FLUOROS first line–>CIPRO 500 mg BID 5-7 days or LEVO 750 mg qd 5-7
*PREG: IV Ceftriaxone first line
*INPT: third or fourth gen cephalopsorin, fluoro, aminoglycocidses or extended spectrum PCN
- **CT scan for PT not improving after 72 hours after tx
- *findings= perinephritic fat stranding
Nephrolithiasis -mcc and others rf -cm -dx--ua, imagignt est of choic? -tx
MCC=genetics
OTHERS: dietary*, systemic dz (hyperparathyroidims), drugs
RF M>W hx of stones fam hx increased oxalate absoprtion-->GI bypass, Crohn's dz -acidic urine hypercaluricemia -decr fluid intake
CM
- RENAL COLIC: sudden, constant upper lateral back or flan pain over the costrovertebral angle—RAD to groin or anteriorly (testicle in men.. labia to women)
- N
- V
- frequency, hesitency, hematuria
PE
+CVA tenderness
fever chills
DX
UA= microscopic or gross H/U
*
TOC= noncontast abd and pelvic CT
TX
if under 5mm—–80% spontaneous passage
-iv fluids
-analgeiscs
-tamsulosin—alpha blocker can help with passage
-
which stone is radio-opaquw
ca-oxalate and ca-phosphate
struvite
which stone is radiolucent
uric acid
which stone is a/w infections
struvite–a/w urease producing bacteria causing UTI
which stone is a/w inheritence
cysteine
most preventable cause of stones
dehydration and low urine output
which stone causes acididc urine and whch causes alkaline
acidic=uric acid and cystein
alkaline=struvite
what location does making a stone harder to pass
ureterovesicular junction bc its the narrowest part of the urinary tract
and
ureteropelbiv junction
horseshoe kidney
- define
- what can be entrapped
- complications
MC type of fusion
1:400
occurs at lower poles
**possible entrapment of inferior renal artery
A/W
- **tri 18
- *turners syndrome
COMPS
- stasis due to shape leads to–>infections, pyelonephritis, kidney stone formation
- incr risk of renal CA—-renal cell CA MC
CM
*most are asympto
when would you develp s/s for
-autosomal rec vs dom PKD
dom=30-40YO
rec=early mo of life
CM for PKD
- abd pain
- flank pain
- back pain
- ***MC complaint=back
sense of heaviness
dullness
HTN
HA—–watch out for berry aneurysm!!!!
Ultrasonographic diagnostic criteria for ADPKD1
At least 2 cysts in 1 kidney or 1 cyst in each kidney in an at-risk patient younger than 30 y/o
At least 2 cysts in each kidney in an at-risk pt 30-59 y/o
At least 4 cysts in each kidney for at-risk pt 60 y/o or older
What is one of the most common early findings of PKD
HTN
incr DBP **
RF for Renal cell cA
-smoking ***strongest
-fam hx
-obesity >30 BMI
-meds—diureitcs
-Male > female 2: 1
-age >55
AA and native americans
dialysis
HTN
adv kidney dz and cystic dz
