Renal/Urinary Flashcards
Benign Prostatic Hyperplasia cause
age, cancer
Benign Prostatic Hyperplasia s/s
urinary hesitancy, weak stream, stream intermittency, post-void dribbling, nocturia
Benign Prostatic Hyperplasia dx
rectal exam; PSA, UA
Benign Prostatic Hyperplasia tx
lifestyle modifications; phytotherapy, a-blockers (tamsulosin), 5-a-reductase inhibitors (finasteride), PDE5-inhibitors (tadalafil)
Erectile Dysfunction cause
hypertension, diabetes mellitus, hyperlipidemia, cardiovascular disease; obstructed arterial inflow, inadequate venous constriction; poor hormones; psych disorder; medications (b-blockers); drugs
Erectile Dysfunction s/s
unable to have/sustain an erection; need info on timing/frequency of sexual relations, partners, morning erections, ejaculation, ability to masturbate; look for deformities (peyronie disease, testicular atrophy, etc)
Erectile Dysfunction dx
CBC, UA, lipid profile, TSH, testosterone, glucose, prolactin, FSH/LH; nocturnal penile tumescence testing (organic vs psychogenic); direct injection of vasoactive substance
Erectile Dysfunction tx
therapy (psych); testosterone replacement (hypogonadism); Phosphodiesterase-5 inhibitors (Sildenafil, tadalafil); vacuum constriction, injected/inserted vasoactive substances, penile prosthesis
Incontinence cause
uncontrolled bladder contractions (urge); dysfunction of urethral sphincter (stress); urinary retention leading to bladder distention and overflow (overflow); untimely urination by physical/cognitive disability (functional); neurologic disease (parkinson, stroke, dementia); metabolic (hypoxemia, diabetic neuropathy); pelvic disorders (uterine prolapse)
Incontinence s/s
strong desire to void, loss of urine (urge); frequency, urgency, nocturia (overactive); leakage of urine w/ abdominal pressure (stress); hydronephrosis, obstructive nephropathy
Incontinence dx
postvoid residual urine volume; UA (UTI vs glucosuria); cystometry, stress test, US, cystoscopy
Incontinence tx
pelvic floor muscle training (Kegel exercises); electrical stimulation, biofeedback, bladder straining; pessaries/implants; anticholinergics (oxybutynin, tolterodine); catheterization
Nephrolithiasis cause
elevated calcium, uric acid, bacteria; diet w/ salt and protein
Nephrolithiasis s/s
sudden onset of severe CVA tenderness; N/V; lower abdominal pain radiating to groin; pt cannot sit still
Nephrolithiasis dx
CT abd/pel WO contrast; CBC, BMP (BUN/Cr, UA (blood)
Nephrolithiasis tx
IV ketorolac/IV morphine; IV hydration, antiemetics; surgery >7mm (lithotripsy, stent, etc)
Cystitis cause
infection of the bladder (E. coli, enterococci)
Cystitis s/s
frequency, urgency, dysuria, suprapubic discomfort
Cystitis dx
UA (pyuria, bacteriuria, hematuria); positive urine culture; imaging for pyelo
Cystitis tx
Nitrofurantoin 100 mg BID x 5 days, TMP-SMX BID x 3 days, Cipro 500 mg BID x 3 days; nitrofurantoin/augmentin for pregnancy; phenazopyridine (symptom relief)
Epididymitis cause
Behcet’s disease, amiodarone excess, tumor, bacterial infection (gonorrhea <35yo, e.coli >35yo)
Epididymitis s/s
gradual onset; testicular pain, urethral discharge, urethral sx if STD; edematous tender testicle, epididymis, and spermatic cord
Epididymitis dx
clinical; scrotal doppler US (r/o torsion); urine culture
Epididymitis tx
scrotal support; analgesia, antibiotics (cef, doxy, levoflox for no STD)
Orchitis cause
ascending bacterial infection from urinary tract
Orchitis s/s
unilateral swelling and tenderness; fever, tachycardia
Orchitis dx
US; UA, culture
Orchitis tx
antibiotics (cef, azithromycin, doxy)
Prostatitis cause
bacterial (E. coli, pseudomonas, proteus; chlamydia/gonorrhea in younger men); chronic pelvic pain syndrome; nonbacterial, granulomatous
Prostatitis s/s
perineal/prostate pain; dysuria, obstructive uropathy symptoms; low back/abdominal pain; fever, chills, myalgias
Prostatitis dx
tender, nodular, boggy prostate; CBC, BMP, blood cultures, UA
Prostatitis tx
fluoroquinolones vs TMP-SMX; admission if bad
Pyelonephritis cause
infection of the kidney and renal pelvis by bacteria (E. coli)
Pyelonephritis s/s
fever, flank pain, shaking chills (rigors), irritative voiding symptoms
Pyelonephritis dx
CVA tenderness, fever, tachycardia; CBC (leukocytosis w/ left shift); UA (pyuria, bacteriuria, hematuria); urine culture; US abd
Pyelonephritis tx
Fluoroquinolone or TMP-SMX x 1-2 weeks (outpatient); IV fluoroquinolones or gentamicin x 1-2 days, then 2 weeks oral therapy (inpatient); ampicillin (pregnancy)
Urethritis cause
noninfectious (trauma, retiers, stones); infectious (gonococcal, nongonoccocal
Urethritis s/s
dysuria, urethral discharge, urethral pruritus
Urethritis dx
voiding UA (leukocyte esterase, >10 WBC/hpf); gram stain of urethral discharge (>5 WBC/oil immersion field)
Urethritis tx
Ceftriaxone 250mg IM x 1 dose (gonorrhea), Azithromycin 1g PO x 1 dose OR Doxycycline 100mg PO BID x7d (chlamydia)
Acute Renal Failure cause
prerenal, intrinsic, postrenal
■ Prerenal: hypovolemia, hypotension, CHF, cirrhosis, nephrotic syndrome, early sepsis, aortic aneurysm, renal artery stenosis, renal artery embolus
■ Intrinsic: acute tubular necrosis, NSAIDs, aminoglycosides, radiologic contrast, acute interstitial nephritis, SLE, infection, glomerulonephritis, vascular disease
■ Postrenal: tubular obstruction, urolithiasis, BPH, bladder outlet obstruction
Acute Renal Failure s/s
: N/V/D, pruritus, drowsiness, dizziness, hiccups, SOB, anorexia, hematochezia; tachycardia, hypotension (prerenal); distended bladder, CVA tenderness, enlarged prostate (postrenal); anuria/oliguria, weight change, AMS, edema, weakness, dehydration, rashes, JVD, urine odor, ecchymosis
Acute Renal Failure dx
GFR <90% (injury <50%); BUN/Cr ratio (20:1 [pre], <15:1 [intrinsic]); UA (hyaline casts [pre/post]; granular casts, WBC w/ casts, RBC w/ cast, protein, tubular epithelial cells [intrinsic]); US/CT
Acute Renal Failure tx
IV fluids, improve cardiac output (prerenal); adjustments/avoidance of meds (intrinsic); ureteral stents, urethral catheter, etc (postrenal); short term dialysis Cr >5-10
Chronic Renal Failure cause
GFR <60 w kidney damage (proteinuria, glomerulonephritis, structural damage) >3 months; DM, HTN, glomerulonephritis, polycystic kidney disease
Chronic Renal Failure s/s
fatigue, malaise, anorexia, N/V, metallic taste, hiccups, SOB, orthopnea, impaired mentation, insomnia, irritability, muscle cramps, restless legs, weakness, pruritus, easy bruising; cachexia, weight loss, muscle wasting, pallor, HTN, ecchymosis, sensory deficits, asterixis, Kussmaul breathing
Chronic Renal Failure dx
GFR (<60); proteinuria, microalbuminemia, BUN/Cr (elevated); H&H, electrolytes, UA (abnormal); cystatin C (elevated)
Chronic Renal Failure tx
ACE/ARBs; manage comorbid condition, tobacco cessation, control sugars, weight loss; limit water, Na, K, Ph; hemodialysis, peritoneal dialysis, kidney transplant
Glomerulonephritis cause
HSP, postinfectious GN, IgA nephropathy, hereditary (focal); postinfectious GN, membranoproliferative GN (diffuse) [children]; IgA nephropathy, hereditary, SLE (focal); SLE, membranoproliferative GN, rapidly progressive GN, postinfectious, vasculitis (diffuse) [adult]
Glomerulonephritis s/s
hematuria (tea/cola colored); oliguria/anuria, edema of face/eyes and feet/ankles; HTN
Glomerulonephritis dx
Antistreptolysin-O titer (r/o postinfectious); UA (hematuria >3 RBC, proteinuria, RBC casts); serum complement C3 decreased; renal biopsy
Glomerulonephritis tx
steroids, immunosuppressive drugs; decrease salt and fluid intake; dialysis (azotemia); ACE inhibitors
Nephrotic Syndrome cause
GN, glomerulosclerosis, IgA nephropathy, membranoproliferative GN, minimal change disease, congenital, drugs, cancer, SLE, postinfectious
Nephrotic Syndrome s/s
malaise, abdominal distention, anorexia, facial edema/puffy eyelids, oliguria, scrotal swelling, SOB, weight gain; ascites, edema, HTN, orthostatic hypotension, retinal sheen, skin striae
Nephrotic Syndrome dx
> 3.5 g protein in 24 hrs; UA (proteinuria, lipiduria, glycosuria, hematuria, foamy, RBC casts, granular casts, hyaline casts, fatty casts); CMP (hypoalbuminemia, azotemia, hyperlipidemia)
Nephrotic Syndrome tx
ACE inhibitors and diuretics; monitor salt, water, protein, and potassium intake; anticoagulants
Polycystic Kidney Disease cause
autosomal dominant and recessive PKD; acquired PKD from ESRD
Polycystic Kidney Disease s/s
back/flank pain, headaches, nocturia; hematuria, HTN, recurrent UTIs, weight loss, renal colic, N/V; palpable nodular/tender kidney
Polycystic Kidney Disease dx
US (fluid free cysts); UA (proteinuria, hematuria, pyuria, bacteriuria); CBC (anemia); CT
Polycystic Kidney Disease tx
pain control, HTN control, high intake of fluids, low protein; infectious w/ abx (bactrim, cipro, vancomycin); dialysis and transplant
Renal Artery Stenosis cause
HTN, DM, renal insufficiency, atherosclerosis, smoking
Renal Artery Stenosis s/s
HTN, swelling, azotemia (prerenal ARF)
Renal Artery Stenosis dx
angiogram; UA, CMP
Renal Artery Stenosis tx
bypass/revascularization depending on degree of stenosis; ACEs/ARBs to control HTN/provide renal support, control cholesterol
Bladder Neoplasm cause
tobacco, occupational carcinogens, schistosomiasis, cyclophosphamide, chronic infections
Bladder Neoplasm s/s
painless hematuria; bladder irritability and infection
Bladder Neoplasm dx
cystoscopy w/ biopsy (definitive); CBC/CMP (r/o infection and renal function); IV urogram, CT abd/pel, bone scan, retrograde pyelography (staging)
Bladder Neoplasm tx
endoscopic resection/fulguration, repeat cystoscopy q3mos (superficial); intravesical instillation of thiotepa, mitomycin C, bacillus calmette-guerin (recurrent, multiple lesions); radical cystectomy (recurrent, diffuse TCC, invaded muscle); chemo/radiation
Prostate Neoplasm cause
unknown; genetic, hormonal, diet, environmental, infectious
Prostate Neoplasm s/s
urinary obstruction, irritative voiding; enlarged, nodular, asymmetric prostate; bone pain from mets, spinal cord impingement (advanced)
Prostate Neoplasm dx
PSA (elevated); biopsy (diagnostic); transrectal US (hypoechoic lesions); CT/MRI (staging)
Prostate Neoplasm tx
radical retropubic prostatectomy, brachytherapy, external beam radiation (stage A/B/C); hormonal manipulation w/ orchiectomy, antiandrogens, LH agonists, estrogens (stage D)
Renal Cell Carcinoma cause
smoking, hereditary (Hippel-Lindau, hereditary papillary renal carcinoma)
Renal Cell Carcinoma s/s
gross/microscopic hematuria, flank pain, palpable mass (classic triad); paraneoplastic syndrome (erythrocytosis, hypercalcemia, HTN, hepatic dysfunction)
Renal Cell Carcinoma dx
CT with and without contrast; US/MRI w/ contrast and arteriography
Renal Cell Carcinoma tx
radical nephrectomy; radiation, medications (interferon-a and interleukin)
Wilms Tumor (nephroblastoma) cause
unknown, common childhood tumor
Wilms Tumor (nephroblastoma) s/s
asymptomatic abdominal mass; anorexia, N/V, fever, abdominal pain, hematuria, HTN
Wilms Tumor (nephroblastoma) dx
US (initial); CT/MRI (to access extension); UA (hematuria, anemia)
Wilms Tumor (nephroblastoma) tx
radical nephrectomy w/ lymph node sampling, chemo (dactinomycin, vincristine, doxorubicin), radiation (resectable); biopsy and chemo (unresectable)
Testicular Neoplasm cause
cryptorchidism, previous testicular cancer
Testicular Neoplasm s/s
painless, solid testicular swelling; heaviness in testicle (can be painful), para-aortic LAD, abdominal complaints
Testicular Neoplasm dx
scrotal US; CT (staging); elevated a-fetoprotein, b-HCG (nonseminomatous
Testicular Neoplasm tx
orchiectomy; surveillance (S1), surgery/chemo (S2), surgery and chemo (S3) [nonseminomatous]; radiation (S1), increased radiation (S2), chemo (S3) [seminomatous]
Metabolic Acidosis cause
MUDPILES; lactic acidosis, ketoacidosis, ethylene glycol, methanol, salicylate intoxication, renal tubular acidosis, renal insufficiency, adrenal insufficiency, diarrhea, pancreatic drainage, ureteral diversion
Metabolic Acidosis s/s
hyperventilation, ventricular arrhythmia, neurologic symptoms (lethargy, coma); N/V/D; kussmaul breathing
Metabolic Acidosis dx
ABG (pH <7.38, bicarb <22, PO2 dec (compensation))
Metabolic Acidosis tx
remove primary cause; insulin therapy, volume repletion; bicarbonate therapy
Metabolic Alkalosis cause
hypovolemia, vomiting, hyperalimentation therapy, diarrhea, NG tube suctioning, villous adenoma, diuretics, hypercalcemia, milk-alkali syndrome, mineralocorticoid excessive steroids causing Cl/K depletion
Metabolic Alkalosis s/s
paresthesias, carpopedal spasm, light-headedness, confusion, stupor, coma; weakness, muscle cramps, postural dizziness; polyuria, polydipsia, muscle weakness
Metabolic Alkalosis dx
ABG (pH >7.42, bicarb >26, PO2 inc (compensation))
Metabolic Alkalosis tx
sodium chloride solutions; interventions to increase excretion of bicarb; remove adenoma or add spironolactone (aldosterone antagonist)
Respiratory Acidosis cause
COPD, neuromuscular disease (myasthenia gravis), CNS dysfunction (brain stem injury), drug induced hypoventilation; high carbs/parenteral nutrition
Respiratory Acidosis s/s
hypercapnic encephalopathy, headache, drowsiness; stupor, coma
Respiratory Acidosis dx
ABG (pH <7.38, PCO2 >45)
Respiratory Acidosis tx
ventilation, treat underlying disorder
Respiratory Alkalosis cause
anxiety hyperventilation, salicylate intoxication, hypoxia, intrathoracic disorders, CNS dysfunction, gram-negative septicemia, liver insufficiency, pregnancy
Respiratory Alkalosis s/s
hyperventilation (frequent, deep, sighing respirations and obvious rapid, deep breathing); tetany-like syndrome (paresthesia of extremities, chest discomfort, lightheadedness, confusion)
Respiratory Alkalosis dx
ABG (pH >7.42, PCO2 <35)
Respiratory Alkalosis tx
correct underlying disorder; breathing into paper bag, light sedation vs antianxiety; ventilation (severe >7.6
Hyperkalemia cause
potassium retention, impaired excretion, increased tissue breakdown, hemolysis, thrombocytosis
Hyperkalemia s/s
dysrhythmias, cardiac arrest; numbness, tingling, weakness, flaccid paralysis
Hyperkalemia dx
CMP (K >5.0); EKG (peaked T waves >6.5, flat p wave w/ prolonged PR, wide QRS >7.0, cardiac arrest 8.0-10.0)
Hyperkalemia tx
sodium gluconate IV (severe); sodium bicarb, glucose D50, and insulin; low potassium diet; remove potassium sparing drugs; sodium polystyrene sulfonate
Hypokalemia cause
diuretics, renal tubular acidosis, GI losses (V/D)
Hypokalemia s/s
ventricular arrhythmias, hypotension, cardiac arrest; malaise, skeletal muscle weakness, cramps, smooth muscle involvement, ileus, constipation; polyuria, nocturia, hyperglycemia, rhabdomyolysis
Hypokalemia dx
CMP (K <3.5); EKG (flattened/inverted T waves, increased U waves, ST depression, ventricular ectopy)
Hypokalemia tx
oral potassium (potassium chloride, 100meq per 1 point); IV potassium (severe <2.5 or arrhythmias)
Hypercalcemia cause
vitamin D intoxication, hyperparathyroidism, sarcoidosis, hospitalized pts w/ malignancy
Hypercalcemia s/s
anorexia, nausea, constipation, polyuria, polydipsia, dehydration, lethargy, stupor, coma, volume depletion, orthostatic hypotension, tachycardia
Hypercalcemia dx
Ca > 10.5 (Ca + [0.8 x (4-albumin)]; 24hr urine (elevated Ca malignancy, paraneoplastic, hyperparathyroidism; decreased Ca hyperparathyroidism) CXR (mass), UA (hematuria, RCC), ESR
Hypercalcemia tx
isotonic saline, loop diuretics, bisphosphonates, manage underlying cause
Hypocalcemia cause
CKD, hypoparathyroidism, cardiovascular collapse, chronically ill, low albumin (correct)
Hypocalcemia s/s
dry skin, brittle nails, pruritus, muscle cramping, SOB, numbness, syncope, angina; wheezing, bradycardia, crackles; Trousseau sign (carpal tunnel spasm after BP), Chvostek sign (spasm of facial muscle), irritability, confusion, dementia, seizures
Hypocalcemia dx
Ca <8.5; ionized calcium, magnesium, phosphate, albumin, LFTs, BUN/Cr
Hypocalcemia tx
treat emergent cardiovascular states; IV calcium gluconate, calcium chloride; oral calcium or vitamin D supplements
Hyperphosphatemia cause
CKD, phosphate containing laxatives/enemas
Hyperphosphatemia s/s
fatigue, SOB, anorexia, N/V, sleep disturbance, Trousseau’s sign, Chvostek’s sign, hyperreflexia, seizure
Hyperphosphatemia dx
Phosphate >4.5, hypocalcemia
Hyperphosphatemia tx
dietary phosphorous restriction, oral phosphate binders; Calcium carbonate tablets
Hypophosphatemia cause
diminished supply/absorption, increased urinary losses, redistribution; vitamin D deficiency, respiratory alkalosis, burns, hyperparathyroidism
Hypophosphatemia s/s
asymptomatic; disorientation, muscle pain, seizures; rhabdomyolysis, paresthesia, encephalopathy
Hypophosphatemia dx
Phosphate <2.5, hypercalcemia
Hypophosphatemia tx
oral phosphate repletion
Hypermagnesemia cause
renal failure, excessive intake, lithium therapy, hypothyroidism, addison disease, familial, milk-alkali syndrome, depression
Hypermagnesemia s/s
reduced deep tendon reflexes, muscle weakness, hypotension, respiratory depression, cardiac arrest, N/V, flushing
Hypermagnesemia dx
Mg > 2.2; EKG (wide QRS, prolonged PR, prolonged QT); bleeding/clotting times increased
Hypermagnesemia tx
10-20mL IV calcium gluconate over 10 min; saline diuresis and IV furosemide; dialysis (severe)
Hypomagnesemia cause
chronic alcoholism, diarrhea, hypoparathyroidism, hyperaldosteronism, diuretic therapy, osmotic diuresis, nutritional deficiencies (malnutrition, parenteral feeding)
Hypomagnesemia s/s
lethargy, anorexia, N/V, weakness, tetany, seizures
Hypomagnesemia dx
Mg <1.8; hypokalemia, hypocalcemia, hypocalciuria; EKG (prolonged PR/QT, wide QRS)
Hypomagnesemia tx
oral magnesium oxide; magnesium sulfate solution (severe) w/ IV infusion w/ fluids
