Uro New Flashcards
what is normal GFR (stage 1)?
> 90
what GFR is stage 2 renal failure ?
60-89
What GFR is stage 3b (moderate renal failure )?
30-44
What GFR is stage 3a (moderate renal failure)?
45-59
What is number one cause of renal vascular disease?
Diabetic kidney disease #1
and HTN, smoking, renal artery stenosis
What sGFR is stage 4 (severe renal failure)?
15-29
What is the typical presentation of apatient with acute kidney injury>?
An abrupt or rapid decline in renal filtration function
Elevated serum creatinine
Azotemia a rise in blood urea nitrogen (BUN) concentration
decrease GFR
What common causes of prerenal kidney injury?
(hypovolemia) volume loss, heart failure, sepsis. anethesia
Prerenal (before the kidneys) - perfusion (50%) – kidney working fine but the things that perfuse it aren’t
A 72-year-old man presents to the emergency department with confusion and decreased urine output over the past two days. He reports poor oral intake due to recent gastrointestinal illness. Physical examination reveals dry mucous membranes and orthostatic hypotension. Laboratory studies are obtained.
Which of the following lab findings is most consistent with a prerenal cause of his acute kidney injury (AKI)?
A) BUN:Creatinine ratio < 10:1, urine sodium > 40 mEq/L
B) BUN:Creatinine ratio > 20:1, urine sodium < 20 mEq/L
C) BUN:Creatinine ratio ~15:1, urine sodium > 40 mEq/L
D) BUN:Creatinine ratio < 10:1, urine sodium < 20 mEq/L
B) BUN:Creatinine ratio > 20:1, urine sodium < 20 mEq/L
note U; rine specific gravity > 1.030,
What are common causes of intrinsic kidney injury?
glomerular, tubular, interstitial damagd
( direct damage to the kidney)
think of
Nephrotoxic drugs= aminoglycosides (gentamicin), cyclosporine
Tumor lysis syndrome
Vasculitis (SLE, Sarcoidosis)
Crystals from gout
Myoglobin from rhabdomyolysis
What cast in urine is considered normal
Hylaine casts
A 55-year-old woman is admitted for worsening weakness and dark-colored urine. She was recently treated with gentamicin for a urinary tract infection. Laboratory studies are obtained, and urinalysis shows muddy brown granular casts.
Which of the following lab findings is most consistent with an intrinsic (intrarenal) cause of acute kidney injury?
A) BUN:Creatinine ratio > 20:1, urine sodium < 20 mEq/L
B) BUN:Creatinine ratio ~15:1, urine sodium > 40 mEq/L
C) BUN:Creatinine ratio > 30:1, urine sodium < 10 mEq/L
D) BUN:Creatinine ratio < 10:1, urine sodium < 20 mEq/L
B) BUN:Creatinine ratio ~15:1, urine sodium > 40 mEq/L
WBC cast in urine should make you think of ____
Pyelonephritis
RBC cast in urine should make you think of ___
glomerulonephritis
Muddy brown cast in urine should make you think of
Acute tubular necrosis
What do waxy cast on urinaylsis indicate?
Chronic renal disease
what is the treament of choice prerenal kidney injury?
fluids, cardiac support, treat shock
what is the treatment of choice intrinsic kidney injury
IV Fluids remove drugs if present and sometimes Lasix to get the kidneys moving
What common causes of kidney injury?
obstructive - most likely
prostate, kidney stone, tumor
What is th MC infectious cause of glomerulonephritis?
Post-Strep glomerulonephritis (either from strep pharyngitis or strep skin infection (impetigo)
-Group A strep, IGA, anti-GBM, ANCA
How is the diagnoses of Glomerulonephritis made ?
proteinuria + RBC in urine; usually caused by group A beta-hemolytic strep
What UA findings are consistent withInterstitial nephritis ?
WBC cast + eos + hematuria
Preform renal biopsy, discontinue offending drug, steroids, dialysis if needed, usually self-limiting
what stage of chronic kidney disease can begin treatment with dialysis?
Stage 4
How to treat acute interstitial nephritis?
Causes of Acute intersitial Nephritis
treat by discontinuing the offending drug, corticosteroids, diaylsis if needed, usually self limiting if caught early
What are signs and symptoms of BPH?
Decreased force of urinary stream, hesitancy (stop and start) and straining, postvoid dribbling, incomplete emptying, frequency, nocturia, urgency, recurrent UTIs
What Digital rectal exam findings are associated with BPH?
enlarged rubbery prostate
A 68-year-old man presents with urinary hesitancy and increased frequency, especially at night. He wishes to avoid surgery. Which of the following is the most appropriate initial recommendation?
A. Immediate referral for TURP
B. Begin finasteride therapy
C. Reduce evening fluid intake and avoid caffeine and alcohol
D. Start tadalafil for symptom control
C. Reduce evening fluid intake and avoid caffeine and alcohol
PSA (prostate-specific antigen) is a protein made by prostate cells.In benign prostatic hyperplasia (BPH), the prostate grows larger (but it’s not cancer).When the prostate gets bigger, more prostate cells are present → more PSA gets produced and can leak into the blood, raising PSA levels. What level of PSA is suspious of BPH?
Elevated > 4 → Electrolytes, blood urea nitrogen (BUN), and creatinine to evaluate for renal impairment (postrenal kidney injurys)
Fraction excretion of sodium >2% + muddy, pigmented granular casts + high urine osm is consitent with what condition
Acute tubular necrosis
Which medication class works by relaxing smooth muscle tone in the bladder neck and prostate to relieve urinary obstruction symptoms in BPH?
A. 5-alpha reductase inhibitors
B. Alpha-adrenergic receptor blockers
C.Phosphodiesterase-5 enzyme inhibitors
D. Beta-blockers
B. Alpha-adrenergic receptor blockers
A 72-year-old male is prescribed finasteride for symptomatic BPH. What is the primary mechanism of action of this medication?
C. Inhibition of dihydrotestosterone (DHT) synthesis
What is the gold standard for inital diagnsois of bladder cancer?
Cystoscopy with biopsy
What is the most common type of bladder cancer?
Transitional cell carcinoma
What is the typical presentation of a patient with bladder cancer?
Cigarette smoker; presents with painless gross hematuria
Tadalafil, typically used for erectile dysfunction, can improve urinary symptoms in BPH by:
A. Increasing urethral tone
B. Reducing prostate gland size
C. Inducing smooth muscle relaxation
D. Decreasing testosterone production
C. Inducing smooth muscle relaxation
a 25-year-old male with a dull, achy scrotal pain that has been gradually increasing over the last several days. He also reports pain with urination. Physical exam reveals a swollen right testicle with substantial induration. Urinalysis reveals positive leukocyte esterase and 20 WBC/HPF what is the most likely cause of the patients symptoms?
Epididymitis
describe a postive phrens sign
pain improves when you lift the scrotum → think epididymitis.
what is epididymitis?
retrograde spread of organisms through vas deferen
A 27-year-old man presents with gradual onset of scrotal pain and swelling over the past two days. He reports dysuria and has been sexually active with multiple partners without consistent condom use. Which of the following is the most likely causative organism?
A. Escherichia coli
B. Klebsiella pneumoniae
C. Chlamydia trachomatis
D. Pseudomonas aeruginosa
C. Chlamydia trachomatis
A 62-year-old man presents with gradual onset of right scrotal pain and swelling. He denies any recent sexual activity. On exam, his scrotum is tender, but elevation of the scrotum relieves his pain (positive Prehn’s sign). Urinalysis shows pyuria. Which of the following is the most likely causative organism?
A. Chlamydia trachomatis
B. Neisseria gonorrhoeae
C. Escherichia coli
D. Treponema pallidum
C. Escherichia coli
what is the treatment of choice for epididimytis caused by E.coli (patient will usually be over 35)?
Levofloxacin (Levaquin) 500 mg/day PO for 10 days
or
Trimethoprim-sulfamethoxazole
what is the treatment of choice for epididimytis caused by gonorrhea and chalmydia ?(patient will usually be under 35)?
Ceftriaxone + Doxycycline
a 60-year-old man who presents to your clinic for evaluation of erectile dysfunction. His wife died 5 years ago and he would like to start dating again. He denies having any life stressors. He reports having no morning or night-time erections. His past medical history includes hyperlipidemia managed with medication and pre-diabetes managed with an active lifestyle and diet. what medication would help treat this patients symptoms ?
phosphodiesterase 5 inhibitors Sildenafil (Viagra),
Tadalafil (Cialis),
Vardenafil (Levitra)
What is glomerulonephritis ?
Damage of renal glomeruli by deposition of inflammatory proteins in glomerular membranes as a result of immunologic response
- features include hematuria, urine = tea/cola-colored, oliguria/anuria, edema of face and eyes in the morning and of the feet/ankles at night; HTN is common
What is the treatment of choice for Glomerulonephritis ?
steroids and immunosuppressive drugs to control inflammatory response; dietary management (salt and fluid intake decreased); dialysis if symptomatic azotemia present
Medical: ACE-I = renoprotective (reduce urinary protein loss) in chronic GN
Use meds as appropriate for hyperkalemia, pulmonary edema, peripheral edema, acidosis and HTN
a 45-year-old man presents to your clinic with a complaint of a painless, swollen scrotum that has been gradually enlarging over the past 6 months. On physical examination, the scrotum appears swollen on the right side, and transillumination reveals a fluid-filled mass. There is no tenderness or erythema. The patient denies any history of trauma, infection, or urinary symptoms. Ultrasound confirms the presence of a _____
hydrocele
What causes hydronephrosis ?
blockage in the ureter
What is the treatment of choice for hydronephrosis ?
removal of obstruction and drainage of the urine
Axb if theres an infection
What is nephritic syndrome ?
a kidney problem where the filters (glomeruli) get inflamed . inflammation that damages the glomerular basement membrane.Because of the inflammation, the kidney
The different disorders that could cause nephritic syndrome can be categorized into three groups:
type III hypersensitivity
-poststreptococcal glomerulonephritis
-IgA nephropathy (berger’s disease)
What is pyelonephritis?
an inflammation that results from a urinary tract infection that reaches the renal pelvis
inflammation of the spaces between renal rubules is known as ____
interstitial nephritis
What is polyscystic kidney disease
the growth of numerous cysts in the kidneys. The cysts are made of epithelial cells from the renal tubules. The cysts replace the mass of the kidneys and reduce function, leading to kidney failure
What are common symptoms associated with polyscystic kidney disease?
high blood pressure, flank/back pain, swollen abdomen
What is the treament of choice for polysytic kidney disease
no cure … supportive care
Control hypertension BP < 130/80 through the use of an ACE-inhibitor or angiotensin receptor
what are the USPSTF recommendations for prostate cancer screening?
Screen all men aged 55 to 69 eyars
What is the most common area associated with prostate cancer?
preipheral zone
asymmetrically enlarged prostate with an irregular, nodular should make you think of ___
prostate cancer
what are the follow up recommendations level.
If PSA is <4.0 ng/mL and DRE is negative,
annual follow-up is indicated
What is the next best step in management of a patient If PSA is 4.1 to 10.0 and DRE is negative?
a biopsy is usually recommended
What is the next best step in management of a patient with PSA level >10 ng/mL
or
if DRE is abnormal
Transrectal Ultrasonography (TRUS) with biopsy is inidicated
True or false If DRE is abnormal, TRUS with biopsy is indicated, regardless of PSA level.
T
A 32-year-old man presents to the clinic with a 3-day history of dysuria, perineal pain, and fever. He reports urinary frequency and urgency but denies hematuria. On physical exam, his prostate is tender, swollen, and warm on digital rectal examination. His urine culture grows Escherichia coli.
Which of the following is the most appropriate initial treatment?
A) Ciprofloxacin for 4–6 weeks
B) Trimethoprim-sulfamethoxazole for 3 days
C) Alpha-blocker therapy alone
D) Watchful waiting without antibiotics
E) Immediate prostate
massage
A) Ciprofloxacin for 4-6 weeks
NSAIDS for anagesia
a 32-year-old female presents with fever, chills, nausea and flank pain for 24 hours. She developed dysuria and urinary frequency 3 days prior and states that both have worsened. On physical exam, you note suprapubic abdominal pain and CVA tenderness. The urinalysis reveals white blood cell casts. What is the most likely diagnose?
Pyelonephritis
What is the recommend inpatient treatment for pylelonephirits?
IV FQ,
3rd/4th gen cephalosporins, extended-spectrum penicillins, gentamicin
what is the recommended out patient treatment of pylelonephiritis ?
FQ (Cipro/Levaquin)/Bactrim for 1-2 weeks (longer if immunocompromised
A 45-year-old man presents to the emergency department with sudden onset of severe right flank pain radiating to the groin. He describes the pain as sharp and is visibly uncomfortable, frequently shifting positions on the stretcher. He also reports nausea and gross hematuria. His vital signs are stable.
Which of the following is the most appropriate initial imaging study to confirm the diagnosis?
A) Abdominal ultrasound
B) Intravenous pyelogram (IVP)
C) Non-contrast spiral CT scan of the abdomen and pelvis
D) MRI of the abdomen and pelvis
E) Contrast-enhanced CT scan of the abdomen and pelvis
C) Non-contrast spiral CT scan of the abdomen and pelvis
What is the most common type of stones associated with renal calculi
Calcium oxalate (80%)
What are the genral measures for treating renal stones?
Analgesia: IV morphine, parenteral NSAIDs (ketorolac)
Vigorous fluid hydration—beneficial in all forms of nephrolithiasis
Antibiotics—if UTI is present
Alpha-blocker therapy
( Tamsulosin-Flomax) for patients with symptomatic ureteral stones >5 mm and ≤10 mm to facilita
What stone size indicates that a stone is not likely to pass spontaneously. Ureteral stent or percutaneous nephrostomy (gold standard) should be used if renal function is jeopardized
> 10mm
What stone size elective lithotripsy be considered ?
> 5 – 10 mm
What is the inital imaging of choice for renal vascular disease
US
What is the gold standard imaging used to diagnose renal artery stenosis
renal arteriography
What is the most likely organism in a UTI patient?
E Coli
what is the typical presentation of a patient with a UTI?
Dysuria without urethral discharge, urgency, frequency, hematuria, new-onset incontinence (in toilet-trained children). Abdominal or suprapubic pain
Absence of fever, chills, or flank pain. Change in urine color/odor
Urine dipstick: nitrite, leukocyte esterase
Urinalysis: pyuria, bacteriuria +/− hematuria +/− nitrites
A 22-year-old man presents with a dull, aching pain in his left scrotum that worsens with prolonged standing and improves when lying down. On physical exam, there is a soft, irregular mass above the left testicle that feels like a “bag of worms” when palpated.Which of the following is the most likely diagnosis?
A) Hydrocele
B) Spermatocele
C) Varicocele
D) Testicular torsion
C) Varicocele
What is the treatment of choice for non complicated UTI’s?
Nitrofurantoin, Bactrim, Fosfomycin
What is the treatment of choice dor complicated UTI’s?
Cirpofloxacin
What is the treatment of choice for Lower UTI in pregancy>
Nitrofurantoin (Macrobid): 100 mg PO BID × 7 days
or
Cephalexin (Keflex): 500 mg PO BID × 7 days
What is a varicocele ?
enlargement of the veins within the scrotum (dilation of the pampiniform plexus)
