Renal & Urology 🍆 Flashcards
Lactic acidosis following tonic clonic seizure…. tx
Since it is usually transient, observe and repeat labs in 2 hours
Managment for patient with posterior urethral injury
Retrograde urethrography first. Then catheterise etc.
Septic shock Tx overview
Focus on finding and treating cause. But do fluid resus, then pressors if that doesn’t work out
Renin and Aldo levels in hypovolemia. And ADH Levels
All elevated. Recall why?? This also means we get low Na in hypovolemia often
Signs that a hematuria is glomerular origin, not lower UT
Proetineuria, brown (rather than pink red), Cr elevation etc.
How to confirm a Dx of renal veing thrombosis
CTA or MRS
How to treat renal vein thrombosis. Given if AKI present or not
AKI present: thrombolysis
No AKI: anticoag
Hyponatremia due to SIADH Tx
Initially do fluid restriction with or without salt tabs. Can give demeclocycline if it doesn’t work. If very severe and have neuro signs…. Give hypertonic saline
PUV dx
Do US first, then voiding cystourethrogram, then cystoscope to confirm and ablate the PUV
Rhabdomyolysis can be due to electrical injury? Why? Tx to prevent?
Bone electrical resistance is high, meaning heat is generated internally, killing muscle. Give IV fluid aggressively
When dealing with hypercalcemia in the setting of potential malignancy, order what mainly
PTHrP, CXR, whole body bone scan
Why is pregnancy a risk for pyeloneph
increased progesterone levels cause smooth muscle relaxation and ureteral dilation. Because
of these physiologic changes, pregnant women with untreated ASB are at increased risk for acute pyelonephritis
When tx’ing UTI in preg, what do we do after
As a test of cure, a repeat urine culture is performed after antibiotic treatment due to the risk of persistent or recurrent bacteriuria.
Membranous nephropathy vs minimal change…
Minimal change is more a acute
1° vs 2° membranous nephropathy… which is more adult and which is children
Primary more in adults… so if a child has it, assume secondary causes
Cause of edema in nephritic vs nephrotic. MoA, which causes pulmonary edema
Nephrotic is due low albumin, and doesn’t cause pulmonary edema (since fenestrations are large enough to allow albumin equil across the vessels). Where as nephritic will cause pulmonary edema and is due decreased GFR causing huge hydrostatic pressure
When do you reassure in bed wetting in paeds
No other abnormalities, less than 5years old
Extrarenal issues of PCKD
Cerebral aneurysms
• Hepatic & pancreatic cysts
• Mitral valve prolapse, aortic regurgitation
• Colonic diverticulosis
• Ventral & inguinal hernias
Risk factors for renal veing thrombosis
Hypercoagulability
• Nephrotic syndrome
o Malignancy (particularly renal)
• OCP
• Volume depletion (infants)
Trauma
Dx of renal vein thrombosis and Tx?
CT or MR angiography
• Renal venography
Anticoagulation
• Thrombolysis/thrombectomy (if AKI present)
We all know the main CVD risk factors, but what other aspects of chronic kidney disease/dialysis increases risk. Name 3
Anemia of chronic kidney disease
• Vascular calcifications (1 phosphorus, 1 calcium)
Oxidative stress related to uremia and dialysis
3 differentials for renal colic not identifying anything on US OR X-ray
- Radiolucent stones (uric acid stones, xanthine stones)
- Small calcium stones (<1-3 mm in diameter)
- Nonstone ureteral obstruction (eg, blood clot, tumor)
Other than UTI, what can cause positive leuk esterase on urinalysis’s
Interstitial nephritis
Dx sign of posterior urethral injury, on which modality? Why before catheter
Extravasation of contrast
om the urethra is diagnostic of urethral injury. Urethrography should precede any attempts at urethral (eg, Foley)
atheterization because it can worsen the injury, potentially converting a partial urethral tear into a complete urethral
Iceration
Main causes of….
anterior urethral injury
posterior urethral injury
straddle-type falls or direct blows
anterior urethral injury
pelvic fractures
most often from motor vehicle accidents
posterior urethral injury
Post void residuals limits (for men and women)
, ≤150 mL in women, ≤50 mL in men).
Main three bac causing interstitial nephritis
Legionella, Mycobacterium tuberculosis, Streptococcus).
ECG changes for hyperkalemia…. Name as much as poss
If uti presents with blood, do we need to do anything extra in followup?
Urinalysis should be repeated a few weeks after completion of antibiotics for patients initially presenting with blood in the urine to ensure resolution of hematuria after UTI treatment; a UTI without initial hematuria can typically be followed clinically for resolution of symptoms
What med can be given to treat hypervolemia and met alk
Acetazolamide, a diuretic that inhibits proximal renal bicarbonate reabsorption, may be used in patients with hypervolemia
and metabolic alkalosis.
Why is IV fluids very helpful for vomiting
In vom, we get met alk and BP drop (which worsens the contraction alkalosis). intravenous fluids (such as normal saline) removes the stimulus for RAAS activation so helps the BP and the alkalosis
What can happen to the diurnal variation in blood pressure in DM
IT can disappear
Waxy casts and broad casts are seen in which disease
CKD
Can transplanted kidneys have RAS
it can occur in patients with a transplanted kidney, and is commonly associated with operative abnormalities (eg, trauma during organ procurement, abnormal suture placement), occurring within two years
Three main symptoms of renal A stenosis
Abdominal bruit, HTN, flash pulmonary edema
Most common occult infx location cause in infants
UTI, So do urine tests
If need to do urine tests on infants prior to toilet training… do what
Catheterise to get urine sample
initial treatment of symptomatic hypovolemic hypernatremia
s restore circulatory volume and
tissue perfusion by emergency fluid resuscitation. NS
How does PCKD cAUSE HTN
Hypertension is a typical early disease manifestation
that results from localized renal ischemia with increased renin secretion.
Can you explain the link between ADH and PCKD
In effect, a mild nephrogenic diabetes insipidus is created in PCKD, with resulting increased circulating vasopressin levels. So vaptans can help reduce cyct growth
What ocular issue do we see in alports
Anterior lenticonus (lens protrusion)
Vit C good or bad for calcium stones
Increased vitamin C intake also promotes hyperoxaluria.
High potassium good or bad for calcium stones
A high-potassium diet decreases urinary calcium excretion. Foods rich in potassium enhance urinary citrate excretion (likely from urinary alkalization), forming soluble calcium citrate and thereby preventing stone formation.
How does low sodium diet help Ca stones
Increased sodium intake enhances calcium excretion (hypercalciuria), and low sodium intake promotes sodium and calcium reabsorption through its effect on the medullary
concentration gradient.
Risk factors for post partum urine retention
Primiparity
• Regional neuraxial anesthesia
• Operative vaginal delivery
• Perineal injury
• Cesarean delivery
Generally when to do suprapubic catheter
If need to catheter and it’s CI to do urethral.
What would be considered normal urine outPut for neonates
1 or more wet diaper in 24hr
Neonatal AKI sus, first invx?
Renal and UT US. need to rule out intra or post renal causes before giving fluid bolus
Most commons symptom in FMD
Recurrent headache
Recall strange symptom in FMD
SUBAURICULAR bruit (pulsatile tinnitus ). Due to involvement of internal carotid
Difference in carotid involvement in carotid artery stenosis from atherosclerosis, and FMD
Atherosclerosis involves carotid bulb, FMD involves internal carotid
Analgesic nephropathy, what is it caused by, who is it high in, and how does it present
Analgesic nephropathy is the most common form of drug-induced chronic renal failure. It accounts for 3-5% of end stage renal disease in the USA, and is most commonly seen in females (peak at age 50-55 years) who habitually use combined analgesics (eg, aspirin and naproxen).
Can present as renal papillary necrosis or chronic tubointerstitial nephritis
Why is Cl high in NAGMA
Because HCO3 and chloride (CI-) are the predominant anions in the body, the loss of HCO3, increases serum CI to maintain an electronegative balance. Due to this relationship, NAGMA is also referred to as hyperchloremic acidosis.
If suspect glomerular hematuria… what invx are good
Compliment, FBC, Cr
General mx of asymptomatic hematuria microscopic
asymptomatic microscopic hematuria may be followed by serial urinalyses
Can Cr be high or low In DM NEPHROPATHY
For example, creatinine clearance can be elevated in early DN (due to glomerular hyperfiltration), it can also be normal even in the setting of MIA. Then clearance can be low later on.
Recall strange diagram of diabetic nephropathy… in the different stages.
What kind of voiding and almost UTI symptoms can bladder cancer cause and why?
• Voiding symptoms:
Tumors often protrude into the bladder and reduce bladder volume or cause detrusor
overactivity, leading to subacute/chronic voiding symptoms such as dysuria, frequency, and urgency. Although bladder cancer is often associated with painless hematuria (no pain during micturition), some patients with bladder cancer have dysuria as part of their voiding symptoms.
• Suprapubic pain:
This usually indicates a more advanced tumor that has penetrated the muscle and invaded the
surrounding soft tissue or nerves. Urinalysis is generally the first test of choice to rule out UTI in these cases
Drugs causing rhabdo
Direct myotoxicity
Statins, fibrates
• Colchicine
• Ethanol
• Cocaine
Vasoconstrictiveischemia
• Cocaine
• Amphetamines
Prolonged immobilization
(compression ischemia)
• Ethanol
• Opioids
• Benzodiazepines
When treating rhabdomyolusis with fluids…. Must be careful of what?
Causing compartment syndrome
How many protein urine grams a day will Dx nephrotic
urinary protein excretion of >3.5 g/day meets all of the major
criteria for nephrotic syndrome.
Advice to give parent of minimal change syndrome
Very responsive to Tx, However, relapse is common and typically requires repeat
corticosteroid courses.
Indications for cystoscopy
Gross hematuria with no evidence of glomerular disease or infection
• Microscopic hematuria with no evidence of glomerular disease or infection but increased risk for
malignancy
• Recurrent urinary tract infections
• Obstructive symptoms with suspicion for stricture, stone
• Irritative symptoms without urinary infection
Abnormal bladder imaging or urine cytology
Triad of dialysis related amyloidosis
Scapulohumeral periarthritis
Bone cyst
Carpal tunnel
Why does low cortisol mean low Na
The hypovolemia provides nonosmotic stimulus
for antidiuretic hormone (ADH) secretion, with consequent water retention and hyponatremia.
When is gastrostomy tube needed
Percutaneous gastrostomy tube placement is indicated in patients with severe dysphagia or those who are unable to maintain adequate nutrition with oral intake alone.
Mg tox Tx
Calcium gluconate
What is pemphigoid gestationis? How is it Txd
pemphigoid gestationis, also known as herpes gestationis, is an autoimmune bullous dermatosis that occurs during the second or third trimester of pregnancy, or in the immediate postpartum period
treatment is usually oral corticosteroids
Invx of choice if sus bladder rupture
Retrograde cystography
Symptoms of bladder rupture
Tender pubis area. Potential pelvic fracture. FAST shows intraP free fluid. Difficulty voiding. hematuria
Renal condition treated, remaining proteinuria only… patient is diabetic
Diabetic nephropathy
Acute vs chronic hyponatremia signs. Relate this to Tx.
Acute usually causes cerebral edema. So patients get headache, nausea etc. and even even coma. In chronic the patient adapts better, so we don’t see these signs. In acute we usually do hypertonics and the risk of ODS is usually low (neurones haven’t adapted to Na change). Chronic only do hypertonic if <120. ODS risk is higher.
Desmopressin use for primary nocturnal enuresis
Considered a first line for immediate results. Tell kids not to drink much in evening to avoid low Na. But patients relapse easily if discontinue
Can constipation cause urine retention
Yes!
Child with UTI. Given Abx. But fever persists and maybe even abscess pyelo signs.
Do US. If abnormal, do voiding cystourthrogram.
Risk factors for UTIs in kids
Female, non circumsized, constipation, VUR etc.
Do we need biopsy for minimal change
Only if atypical case. Otherwise no
Pathophys of minimal change
Dodgy T cells, secrete CKs, causing podocyte damage and loss of negative charge of the GMB
What is hyposethuria.
Inability of the kidney to concentrate urine. Usually seen in SCD or SCT. Low urine gravity, normal serum Na and no increased thirst usually (DI has more serum sodium issue and increase thirst)
