Treatment - Renal & GU Flashcards
minimal change disease (nephrotic syndrome)
prednisone/corticosteroids
+/- diuretics for edema and ACE/ARB to reduce pressure on kidneys
acute glomerulonephritis (nephritic syndrome)
corticosteroids +/- ACE
+ cyclophosphamide if rapidly progressing
acute tubular necrosis (ATN)
remove offending agents, IV fluids (restore BP), +/- furosemide if euvolemic and not urinating
adult polycystic kidney disease
-increased fluid intake (to decrease vasopressin/ADH)
-control HTN
+/- dialysis or transplant
chronic kidney disease
prevent progression; HTN, low protein diet, DM control
SIADH
tx underlying, H2O restriction (<800/d)
-demeclocycline in severe cases (inhibits ADH)
diabetes insipidus
- central: desmopressin/DDAVP (synthetic ADH) +/- carbamazepine (inc ADH)
- nephrogenic: Na/protein restrict, hydroclorothiazide (causes mild hypovolemia to promote retention), indomethacin (potentiates effect of ADH)
hyponatremia and hypernatremia fluid rate
correct <0.5 mEq/L/h to prevent demyelination (hypo) or cerebral edema (hyper)
hypovolemic hyponatremia
normal saline (correct volume)
critical hyponatremia
hypertonic saline + loop diuretic (furosemide)
-with neurologic symptoms require treatment with hypertonic (3%) saline.
euvolemic hyponatremia
water restriction (<1500mL/d)
hypervolemic hyponatremia
water and salt restriction
hypomagnesemia
oral magnesium oxide
severe - IV mag sulfate (also w/ TORSADES de POINTES)
hypokalemia
KCl oral (IV if severe) *use non-dextrose IV bc dextrose induced insulin release will shift K into cells)
- replace Mg
- hypoK associated w/ increased risk of digoxin toxicity
hyperkalemia
-repeat blood draw to verify not from venipuncture error
- IV calcium gluconate - stabilizes cardiac membrane if significant lab (>6.5) and ECG findings
- insulin w/ glucose to shift K intracellularly
- kayexalate (sodium polystyrene sulfonate) to enhance GI excretion
- beta-2 agonists (albuterol helps move K intracellular)
- lasix to rid extra through kidneys
- sodium bicarb
corrected serum sodium (high glucose) calculation
1.6 mEq/L to the sodium value for every 100 mg/dL of glucose above 100 mg/dL
corrected serum potassium in acidosis
subtracting 0.6 mEq/L from the initial potassium value for every 0.1 decrease in pH from 7.4.
chlamydia
doxy 100mg x 10d
alt: azithro
gonorrhea
ceftriaxone (250 mg IM)
chronic epididymitis (enteric cause)
fluoroquinolones
children - cephalexin or amoxicillin
testicular torsion
detorsion + orchiopexy (testicle fixation in scrotum)
-orchiectomy if testicle not salvageable
cryptorchidism
orchiopexy (ideal btw 6 mo and 1 yr)
-observation if <6 mo - most descend by 3 mo
testicular cancer
low-grade nonseminoma –> orchiectomy w/ retroperitoneal lymph node dissection
low-grade seminoma –> orchiectomy –> radiation
high-grade seminoma –> debulking chemo –> orchiectomy + radiation
hydrocele
infants: no tx needed, most resolve by 1 yo
adults: sx if communicating (elective) or complications
uncomplicated cystitis
nitrofurantoin (macrobid) - not if pyelo suspected
fluoroquinolones
bactrim double strength
complicated cystitis or pyelo
fluoroquinolones, aminoglycosides
pregnant + cystitis
AMOXICILLIN, augmentin, cephalexin
nitrofurantoin
acute prostatitis
> 35 yo - fluoroquinolones or bactrim 4-6 weeks
<35 yo - ceftriaxone plus doxy (or azithro)
chronic prostatitis
fluoroquinolones or bactrim 6-12 wks or TURP if refractory (transurethral resection)
BPH
5-a-reductase inhibitors (suppress growth, reduce obstx)
a-1-blockers (sx relief but not course of BPH)
TURP
prostate cancer
local - radical prostatectomy
advanced - external beam radiation, androgen deprivation (orchiectomy + GnRH agonists)
bladder cancer
local/superficial: transurethral resection (elecrocautery)
invasive: radical cystecomty, +/- chemo, radiation
recurrent: Bacillus Calmette-Guerin vaccine intravesicular (immune rx stim cross-rx w/ tumor antigens) dont use if immunosuppressed
renal cell carcinoma
stage 1-3 –> radical nephrectomy, immune therapy
usually resistant to chemo and radiation
wilms tumor / nephroblastoma
nephrectomy followed by chemo (80-90% cure rate)
-radiation if extends beyond renal capsule or lung mets
ischemic priapism
phenylephrine (intracavernous injection) alpha-agonist
C/I –> cardiac or cerebrovascular hx
(non ischemic - observation)
renal artery stenosis
angioplasty w/ stent (if Cr >4 or >80% stenosis)
+ACE/ARB (unless bilateral or one kidney)
enuresis
bedwetting
- behavioral: motivational tx, education and reassurance, bladder training (most resolve spontaneously)
- alarm: if fail bx tx, sensor
- DESMOPRESSIN - better for short-term use (synthetic ADH)
- TCAs (stim ADH secretion, detrusor muscle relax) i.e. imipramine
stress incontinence
laugh, sneeze
- pelvic floor exercises
- alpha agonists: midodrine, pseudoephedrine (increase urethral sphincter tone)
- surgery, anti-incontinent devices, estrogen
urge incontinence
overactive bladder
- bladder training (time void, dec fluid intake)
- ANTICHOLINERGICS: oxybutynin/ditropan, tolterodine
- TCAs
- Mirabergon
- avoid spicy foods, citrus fruit, chocolate, caffiene
overflow incontinence
intermittent or indwelling catheter 1st line
-cholinergics (bethanacol)
BPH –> a-1-blockers tamsulosin
Haemophilus ducreyi (painful ulcers + enlarged lymph nodes in groin)
ceftriaxone 250 mg or one gram of oral azithromycin
