Renal/Urinary Flashcards
What drugs are most commonly implicated in interstitial nephritis?
Antibiotics, particularly penicillins, cephalosporins, and sulfonamides.
What is the target hemoglobin level for a patient with chronic kidney disease with a low hemoglobin?
10-12 g/dL. The TREAT trial showed that patients with hemoglobin levels increased to the normal range had worse outcomes.
What imaging study is best for assessing renal colic?
CT
What pain medication is preferred for severe pain associated with end-stage renal disease?
Fentanyl - metabolized by the liver and has no active metabolites that may accumulate with decreased renal excretion (other opioids may accumulate)
What BPH medication may artificially decrease PSA?
Finasteride
What are some methods for reducing contrast-induced nephropathy in at risk patients?
Low-osmolar or iso-osmolar contrast media should be used. The volume of contrast medium should be as low as possible. Evidence also supports hydration before the procedure, preferably with isotonic saline or isotonic sodium bicarbonate solution.
What is orthostatic proteinuria and how is it diagnosed?
Benign condition that occurs in 3%–5% of adolescents and young adults. It is characterized by increased protein excretion in the upright position, but normal protein excretion when the patient is supine. It is diagnosed using split urine collections (16 hour daytime urine collection and 8 hour night time urine collection to screen for protein in the urine). Increased protein during the day but not at night helps confirm diagnosis.
What is the appropriate work up for all patients with hematuria, with the exception of those with generalized renal parenchymal disease, young women with hemorrhagic cystitis, children, and pregnant females?
Cystoscopy AND CT urography or intravenous pyelography
What is the treatment for neurogenic bladder (marked by constant leakage of small amounts of urine. Can be caused by diabetes mellitus, multiple sclerosis, or spinal cord injury)?
Usually initially treated with a strict voluntary urination schedule, which may be coupled with Crede’s maneuver. It can be treated further by adding bethanechol to the regimen.
What are ways to mitigate renal failure in at risk patients when contrast dye is needed for imaging studies?
Current methods for reducing the risk of renal failure induced by contrast material include adequate hydration and the use of N-acetylcysteine.
What is the preferred imaging study for the diagnosis of kidney stones?
An unenhanced helical CT scan of the abdomen and pelvis.
What type of renal stones are improved through acidification of the urine?
Urine should be acidified for prevention of calcium phosphate and struvite stones. Cranberry juice or betaine can lower urine pH.
What are the guidelines surrounding bisphosphonate vs denosumab in relation to renal function?
Bisphosphonates should not be used in patients with a creatinine clearance <35 mL/min, but denosumab is not cleared by the kidneys and is safe in patients with chronic kidney disease.
What is the workup for an adult with microscopic hematuria?
Patients with microscopic hematuria should initially be assessed for benign causes such as urinary tract infection, vigorous exercise, menstruation, and recent urologic procedures. If none of these is found, the next step would be assessing for renal disease using urine microscopy to look for casts or dysmorphic blood cells, and checking renal function. If the results are negative, CT urography and cystoscopy should be performed. CT evaluates the upper urinary tract for nephrolithiasis and renal cancer, while cystoscopy evaluates the bladder for bladder cancer, urethral strictures, and prostatic problems.
What are the indications for using finasteride (or other 5-α-reductase inhibitor) in BPH?
If there is evidence of prostatic enlargement or a PSA level >1.5 ng/mL
