Urinary Tract and Renal Flashcards
Anion gap
AG = Na - (Cl + HCO3)
Normal ABG ph
7.35 to 7.45
Normal bicarb
22-26
Normal PCO2
35-45
In metabolic alkalosis there is excess
HCO3
In metabolic acidosis there is decrease in
HCO3
In respiratory acidosis there is increase in
CO2
In respiratory alkalosis there is decrease in
CO2
If HCO3 is high as in metabolic alkalosis, CO2 should compensate by
Increasing by 0.6 for every 1
If PCO2 decreases as in respiratory alkalosis, what should bicarb do?
Decreased by 2 if acute, 6 if chronic
If the CO2 increases as in respiratory acidosis, the bicarb should compensate by
Increasing by 1 for acute, 4-5 for chronic
DDX prerenal acute kidney injury
Hypovolemia, low effective circulating volume, NSAIDs
Renal causes of AKI
Renal vascular disease, glomerular disease, tubulointerstital disease
Post renal cause of AKI
Obstructive uropathy
Most common cause of urinary tract obstruction in newborn male
Posterior urethral valves
In utero, impaired fetal urination can lead to
Oligohydramnois and subsequent lung hypoplasia
US findings consistent with PUV
Dilated bladder with bilateral hydroureters and hydronephrosis
Newborn boy wth bladder distension, decreased urine output, and respiratory distress should be evaluated for
Posterior uterthral valves
Recurrent cystitis in women is defined as
2+ infections in 6m, 3+ infections in a year
Prevention of recurrent cystitis in women
Daily antibiotic prophylaxis or postcoital prophylaxis
When would cystoscopy be performed?
For suspected bladder cancer or urinary tract injury
Does cranberry juice help UTIs
No, but increased fluid does
Urodynamic testing is used to evaluate
Bladder function and urinary incontinence
What age do symptoms of ADPKD usually arise
30-40
Clinical presentation of ADPKD
Flank pain, hematuria, hypertension, bilateral kidney masses
Management of ADPKD
Controlling risk factors, ACE inhibitors for hypertension, hemodialysis and renal transplant for ESRD
Elevated creatinine is a sign of
Kidney dysfunction
Low specific gravity on urinalysis
Urinary concentrating issue
Most sensitive test for early elevations in albumin excretion is
Random urine albumin to creatinine ratio testing
Which nodes are commonly affected in testicular cancer
Retroperitoneal lymph nodes
Painless testicular mass, retroperitoneal nodes, low back pain
Testicular cancer
Hypertension cause in a patient with autosomal dominant polycystic kidney disease (ADPKD)
Cyst expansion leading to localized renal ischemia, and consequent increased renin release. Increased RAAS leads to secondary hyperaldosteronism
Drug of choice for hypertension in ADPKD
ACE inhibitors
Renal dysfunction in patients with advanced liver disease that is due to altered renal blood flow, nor intrinsic kidney disease
Hepatorenal syndrome
Recurrent uti is defined as
2 or more in 6m, 3 or more in 1yr
Preventing recurrent uti
Postcoital or daily ABX prophylaxis, topical vaginal estrogen post menopausal
Treating vulvar lichen planus or lichen sclerosis
Topical corticosteroids
Male patient presenting with soft irregular “bag of worms”, directly above testis, increasing with valsalva and not transilluminating
Varicocele
Treating varicocele win boys and young men
Gonadal vein ligation
Treating varicocele in older men do dont want more children
Scrotal support and NSAIDs
Retrograde blood flow to testes and dilatation of the pampiniform plexus
Varicocele
Fluid filled cyst of the head of the epididymis that transilluminates
Spermatocele
Peritoneal fluid collections between the parietal and visceral layers of the tunica vaginalis
Hydroceles
Firm testicular mass that doesnt change with positioning
Testicular neoplasia
