STEP 2 renal/GU Flashcards
Causes of nephritic syndrome? (5)
PSGN IgA GPA (Wegener's) Alport Goodpasture's (MPGN (I & II))
PSGN - pathophys, clinical features, labs/histology, TX
- subendothelial and subepithelial deposits of IgG and complement lead to glomerular injury (type III)
- hematuria, edema, HTN - resolves in 6-8 wks - skin or throat infections with GAS 2-6 wks prior
- granular IF staining, low C3 levels, ASO+, anti-DNAseB+
- TX - supportive w/ diuretics - most recover
IgA nephropathy - pathophys, clinical features, labs/histology, TX
- mesangial deposits of IgA and complement (type III)
- asymptomatic RPGN picture, h/o viral URI or GI infx 48-72 hrs previously, +- HSP
- nl C3, granular IF pattern
- steroids for some pts; ACEI for proteinuria; 20% progress to ESRD
GPA nephritis (Wegener’s) - pathophys, clinical features, labs/histology, TX
- pauci-immune GN cell-mediated damage (type IV)
- fever, weight loss, hearing, sinus, +hemoptysis - northern euro male 35-55
- c-ANCA+, nl C3, scant IF staining
- corticosteroids, cytotoxins, relapsing course
Goodpasture syndrome - pathophys, clinical features, labs/histology, TX
- anti-GBM vs type IV collagen (type II rxn)
- RPGN with pulm hemorrhage, males in mid 20’s
- linear IF
- PLEX, pulse steroids, -> ?ESRD
Alport syndrome - pathophys, clinical features, labs/histology, TX
- collagen IV mutations - X-linked
- hematuria, hearing loss, +- eye problems
- GBM splitting on EM
- -> ESRD, may recur after transplant
Causes of nephrotic syndrome? (7)
MCD FSGS Membranous nephropathy SLE DM Amyloidosis (MPN)
MP(G)N - pathophys, clinical features, labs/histology, TX
- type I - subendothelial and mesangial immune complexes - HCV, cryo, SLE, SBE
- type II - dense deposit disease, C3 nephritic factor
- children/young adults, idiopathic
- low C3, tram-track GBM
- steroids & cytotoxics, -> ESRD
ADPKD associations? RCC risk?
tx?
berry aneurysm -> subarachnoid hem, MVP/AR hepatic/pancreatic cyst hernias diverticulosis HTN, CKD, proteinuria no increased RCC risk tx: ACE/ARB
urine test for cystinosis?
cyanide nitroprusside, hexagonal crystals
Children 2 yrs and under with febrile UTI workup?
U/S -> VCUG if scarring, hydronephrosis, high grade VUR
Does orchiopexy decrease risk of testicular cancer?
No. So if cryptoorchidism discovered post 12mo, ectomy.
Painless scrotal swelling workup
transluminate (varicocele opaque vs hydrocele)
U/S, CXR, CTAP, betaHCG, AFP for testicular ca w/up
Painful scrotal swelling workup
Prehn’s sign (relief upon nutsack elevation), surgery if high suspicion for torsion, vascular U/S
Urge incontinence: defn and tx?
Defn: sudden urge w/o incr IAP
Tx: Kegels, bladder training, oxybutinin
Overflow incontinence: defn and tx?
involuntary continuous leakage (impaired bladder emptying)
alpha-blockers (doxazosin eg) and bethanechol
hypercalcemia tx?
severe (>14 or symptomatic): hydration, calcitonin, loop D if vol overloaded
long term: bisphosphonates
hyperkalemia associated meds?
beta-blockers: shift out dig: NaK atpase inhibition succinylcholine: leak ACEI/ARB/antialdos/anti-ENAC heparin: blocks aldo production cyclosporine: blocks aldo TMP: blocks ENAc NSAIDs: decreases renal perfusion
nephrotic syndrome and sudden flank pain, fever, gross hematuria = ?
tx?
renal vein thrombosis, due to loss of ATIII in nephrotic syndrome
tx: heparin -> warfarin. no data for thrombolysis.
hypocalcemia - check which serum levels?
albumin - 0.8 factor
Mg - esp in alcoholics
finally, PTH
ADPKD vs amyloidosis?
ADPKD: flank pain, hematuria, HTN, big kidneys
Amyloidosis: edema, proteinuria, HTN, big kidneys, inflammatory condition (for AA)
hematuria - beginning of urination, end of urination, whole cycle? from where? clots?
beginning of urination: suggests urethra (urethritis)
end of urination: suggests bladder or prostate origin (cancer)
whole cycle: suggests kidney or ureters - clots not seen
hypomagnesemia - effects on calcium and K?
causes PTH resistance and decreased PTH secretion resulting in low Ca (and low-nl Phos levels)
interferes with kidney retention of K+
associations for: MCD Membranous Nephropathy FSGS MPGN IgA Nephropathy
MCD - lymphoma (hodgkins!), NSAIDs Membranous Nephropathy - hep B, adenocarcinoma, SLE MPGN - hep B, hep C, cryoglobulinemia FSGS - african american, HIV, heroin IgA - URI
AV block with wheezing - what toxicity?
tx?
beta blocker
1st line - IVF and atropine
refractory hypotension - glucagon
what is trihexyphenidyl?
anticholinergic parkinson’s drug (like benztropine)
congenital hypothyroidism etiology?
thyroid dysgenesis
toxicities of: cyclosporine, tacrolimus, mycophenolate, azathioprine?
cyclosporine: renal failure, hyperkalemia, hypertension, gum hyperplasia, hirsutism
tacrolimus: renal failure, hypertension, neurotoxicity, glucose intolerance, diarrhea
mycophenolate: bone marrow suppression
azathioprine: diarrhea, leukopenia, hepatotoxicity, pancreatitis
