Renal, Urinary Systems, and Electrolytes Flashcards
Glomerular versus nonglomerular hematuria
- Type of hematuria
- Common etiologies
- Clinical presentation
- Urinalysis


Red cell casts

Granular, muddy-brown casts
Renal osteodystrophy pathway

Differential diagnosis of urinary incontinence
- Etiology
- Symptoms

Neuroanatomy of urinary voiding

Hypovolemic hyponatremia
- Extrenal losses
- Renal losses
- Decreased effective circulating volume

- Calculating serum osmolality
- Normal serum osmolality
- (2 x Na) + (BUN/2.8) + (Glucose/18)
- 275-295 mOsm/kg H2O
Nephrotic syndrome classic features
Edema
Proteinuria (>3.5 g/day)
Hypoalbuminemia
Most common cause of nephrotic syndrome in adults
Focal segmental glomerulosclerosis
Risks associated with nephrotic syndrome
Infection (loss of immunoglobulins)
Thrombosis (loss of antithrombin and plasminogen)
Protein malnutrition
IgA nephropathy
Can present with nephrotic or nephritic symptoms
Gross hematuria following an upper respiratory tract infection
Rapidly progressive glomerulonephritis (RPGN)
Nephritic syndrome
Rapidly worsening renal function
Primary renal causes of nephrotic syndrome
- Etiology
- Clinical Associations

Treaments for urge incontinence
Bladder training (first line): Delaying micturition and resisting the urge to void
Antimuscarinic: Oxybutynin
Beta 3 adrenergic agonist: Mirabegron
Natural history of diabetic nephropathy

Single most effective intervention for slowing the progression of diabetic nephropathy
Tight blood pressure control
- Drug therapy to lower blood pressure <140/90 mm Hg
- Additional lifestyle measures (weight loss, sodium restriction)
First-line medications: ACE inhibitors, ARBs
JNC 8 recommendations for treatment hypertension

False positive dipstick test for blood
Tests for hemoglobin, which is structurally similar to myoglobin
Will be falsely positive in a patient with myoglobinuria (secondary to rhabdomyolysis)
Bladder catheterization in patients with traumatic spinal cord injuries
Urinary catheter placement can assess for urinary retention and prevent acute bladder distension and damage.
Palpable purpura
Proteinuria
Hematuria
HCV
Low complement
Mixed cryoglobulinemia
Potter sequence


Posterior urethral valves
Most common cause of urinary tract obstruction in newborn boys
Iga Nephropathy versus Postinfectious Glomerulonephritis
- Clinical presentation
- Diagnosis
- Prognosis
IgA nephropathy is the most common cause of glomerulonephritis in adults

Initial treatment for severe hypovolemic hyponatremia
0.9% Saline
The most common cause of hypernatremia is hypovolemia. Mild cases can be treated with 5% dextrose in 0.45% saline.
Treatment for euvolemic hypernatremia
5% dextrose in water (D5W)
Dietary recommendations for patients with renal calculi
- Increased fluid intake
- Decreased sodium intake
- Normal dietary calcium intake
Sickle cell trait
- Clinical features
- Laboratory findings
- Complications

Differential diagnosis of metabolic alkalosis


Simple renal cyst
Characteristics of renal cysts
- Simple renal cyst
- Malignant cystic mass


Hydronephrosis
Cause of refractory hypokalemia (difficult to correct with potassium replacement) in alcoholics
Hypomagnesemia
Diagnostic tests in urinary tract infections
- Serum BUN and creatinine
- Urine dipstick
- Urinalysis
- Urine culture
Patients in diapers should undergo straight catheterization to obtain a steril specimen and avoid contamination with stool or skin flora

Cystinuria
Inherited disease causing recurrent renal stone formation
Group of disorders characterized by impaired amino acid transport – Defective transport of dibasic amino acids
Stones are hard and radioopaque with hexagonal crystals
Urinary cyanide nitroprusside test is used to screen
Side effects of loop diuretics in cirrhotic patients with volume overload and ascites
Hypokalemia
Metabolic alkalosis
Prerenal kidney injury
Loop diuretics inhibit Na-K-2Cl carrier in the loop of Henle, increasing sodium delivery to distal tubule, producing elevated hydrogen and potassium secretion in the urine.
Management of hypercalcemia
- Severe
- Moderate
- Asymptomatic or mild

Most important intervention for preventing contast nephropathy
Adequate pre-CT hydration
Contrast-induced nephropathy presents as a transient spike in creatinine within 24 hours of contrast administration, with a return to normal renal function within 5-7 days
Treatment of acute cystitis and pyelonephritis in nonpregnant women
- Uncomplicated cystitis
- Complicated cystitis
- Pyelonephritis
Uncomplicated cystitis has a low chance of treatment failure and can be treated without a culture

Management of acute oliguria

Cause of coagulopathy in chronic kidney disease
Platelet dysfunction
PT, PTT, and platelet count are normal
Bleeding time is prolonged
DDAVP is the treatment of choice, if needed: Increases release of factor VIII: von Willebrand factor multimers from endothelial storage sites.
Platelet transfusion not indicated bc transfused platelets become inactive.
Aminoglycosides
E.g. Amikacin
Used to treat serious (multi-drug resistant) gram negative infections.
Potentially nephrotoxic
Pre-renal azotemia
BUN: creatinine ratio > 20:1
Due to volume depletion with hypoperfusion to kidneys
Clinical features of crystal-induced acute kidney injury
1. Common etiologies
- Clinical presentation
- Treatment
Drug precipitates in renal tubules, causing intratubular obstruction and direct renal tubular toxicity

Acute interstitial nephritis
- Common etiologies
- Timing
- Clinical presentation
- Associated with beta lactams and proton pump inhibitors
- 7-10 days after drug exposure
- Skin rash, eosinophilia, eosinophiluria, and pyruria
Nephrotic versus nephritis syndrome
- Clinical features
- Pediatric etiologies
- Adult etiologies

Symptoms consistent with typical renal colic but no stones identified on conventional X rays.
- Radiolucent stones (uric acid stones, xanthine stones)
- Calcium stones <1-3 mm diameter
- Non-stone ureteral obstruction (e.g., blood clot, tumor)
Treatment for uric acid kidney stones
Highly soluble in alkaline urine
Alkalinization of the urine to pH 6.0-6.5 with potassium citrate
Radiolucent but may be seen on US or CT
Diuretic used in managment of recurrent hypercalciuric renal stones
Hydrochlorothiazide
Decreases urinary calcium
Muddy brown granular cast
Acute tubular necrosis
RBC casts
Glomerulonephritis
WBC casts
Interstitial nephritis and pyelonephritis
Fatty casts
Nephrotic syndrome
Broad and waxy casts
Chronic renal failure
Acute interstitial nephritis
Presentation:
Caused by:
Treatment:
Presentation: Fever, rash, arthralgias
Peripheral eosinophilia, hematuria, sterile pyuria, eosinophiluria
Caused by:
Cephalosporins
Penicillins
Sulfonamides
Sulfonamide-containing diuretics
NSAIDs
Rifampin
Phenytoin
Allopurinol
Treatment: discontinue offending agent
Clinical clues to renovascular disease (renal artery stenosis)
- HTN-related symptoms
- Supporting evidence

Management of patients with hypertension and renal artery stenosis
ACE or ARB
Renal artery stenting or surgical revascularization is reserved for patients with resistant hypertension or recurrent flash pulmonary edema and/or refractory heart failure due to severe hypertension.
Sodium nitroprusside
Potent arterial and venous vasodilator often used for hypertensive emergencies.
Prolonged influsion can lead to cyanide toxicity, especially in patients with CKD.
Treatment includes sodium thiosulfate
Manifestations of cyanide accumulation & toxicity
Skin:
CNS:
Cadiovascular:
Respiratory:
GI:
Renal:
Combustion of carbon and nitrogen contaning compounds (wool, silk)
Industrial exposure (metal extraction in mining)
Medications (sodium nitroprusside)

Site of bladder rupture causing peritonitis
Bladder dome (only peritoneal structure)
WIll cause referred shoulder pain

Clinical features of analgesic nephropathy
- Clinical presentation
- Diagnosis

Asymptomatic bacteriuria
- Risk factors
- Common pathogens
- First-line treatment
Associated with an increased risk of preterm labor and low birth weight

Metformin in acutely ill patients
Metforming should not be given to acutely ill patients with acute renal failure, liver failure, or sepsis, as these conditions increase the risk of lactic acidosis.
Effect of hypovolemia on the renin-angiotensin-aldosterone system

Prerenal acute kidney injury
- Etiology
- Clinical features
- Treatment

Stimuli for secretion of antidiuretic hormone
- Osmotic
- Nonosmotic

Acid Base Disorders (Primary disorder, appropriate compensation)
- Metabolic acidosis
- Metabolic alkalosis
- Acute respiratory acidosis
- Acute respiratory alkalosis

Most common type of kidney stone
Calcium oxalate
(70-95% of kidney stones)
Alport’s syndrome
Recurrent episodes of hematuria
Sensorineural deafness
Family hx of renal failure
Medications that can cause hyperkalemia
- Medication
- Mechanism
