Urology Flashcards
What GFR indicates kidney failure
< 15
What is the number 1 cause of renal vascular disease
Diabetic kidney disease
What in the labs, indicates an AKI
An abrupt or rapid decline in renal filtration
Elevated serum creatinine and decrease GFR
Azotemia
What is azotemia
rise in blood urea nitrogen (BUN) concentration
What causes pre renal azotemia
perfusion (50%) – kidney working fine but the things that perfuse it aren’t
volume loss, heart failure, loss of peripheral vascular resistance
What is the most common cause of prerenal azotemia
Hypovolemia
*meds: ACE, ARB, NSAID, Contrast
What causes intrinsic kidney injury
Tumor lysis syndrome
Vasculitis (SLE, Sarcoidosis)
Crystals from gout
Myoglobin from rhabdomyolysis
Nephrotoxic drugs
What are nephrotoxic drugs
aminoglycosides (gentamicin), cyclosporine
What do RBC casts indicate
glomerulonephritis
What do WBC casts indicate
Pyelonephritis
What do muddy brown casts indicate
ATN
What do waxy casts indicate
CKD
What do Hyaline casts indicate
Normal
How do you treat an AKI
IV Fluids remove drugs if present and sometimes Lasix to get the kidneys moving
What is generally the cause of post renal AKI
Obstructive issue –> most likely the prostate
What causes acute tubular necrosis
from kidney ischemia/toxins
*pre renal failure is most common
What is seen with interstitial nephritis
WBC casts + eos + hematuria
How do you diagnose interstitial nephritis
renal biopsy, discontinue offending drug, steroids, dialysis if needed, usually self-limiting
What are the common causes of glomerulonephritis
group A strep, IGA, anti-GBM, ANCA
what is the MC infectious cause of acute glomerulonephritis
post strep glomerulonephritis
- either from strep pharyngitis or strep skin infection (impetigo)
What is the gold standard for diagnosing CKD
measurement of GFR
How is CKD managed
Blood pressure control < 130/80, ACE or ARB, A1c 6.5-7.5%
How will someone in CKD typically present
hypocalcemia, hyperphosphatemia, and metabolic acidosis
a 62-year-old man who presents to your office with a sudden onset of fever and rash. His review of systems is negative. He was recently started on omeprazole for acid reflux 14 days ago. Routine laboratory tests reveal a serum creatinine of 3.5 mg/dL and eosinophilia. Urine studies showed white blood cell casts. What is the likely diagnosis
Acute interstitial nephritis
What are the 5 Ps that cause interstitial nephritis
Pee (diuretics)
Pain (NSAIDs)
Penicillin
PPI
RifamPin
What alpha blockers are used with BPH
Tamsulosin
Terazosin
What does Finasteride do
Helps shrink the size of the prostate gland in those with BPH
What is a TURP and what is it used for
Transurethral resection of the prostate
For those with refractory BPH
an 85-year-old man who comes to his primary care provider after a week of hematuria. He has not been ill lately and has had no complaints of pain on urination. A CT scan with contrast is ordered demonstrating a variable filling defect. What is the likely diagnosis
bladder cancer
What is the typical presentation of someone with bladder cancer
Cigarette smoker; presents with painless gross hematuria
What is the most common type of bladder cancer
transitional cell carcinoma
What is the gold standard for diagnosing bladder cancer
cystoscopy with Biopsy
How do you treat bladder cancer
surgery, biologics, and chemo
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 likely diagnosis
Epididymitis
How is epididymitis acquired
by the retrograde spread of organisms through vas deferens
What are the risk factors for epididimytis
Men < 35: chlamydia/ gonorrhea
Men > 35: E.coli
What are the common symptoms of epididymitis
Epididymitis is characterized by dysuria, unilateral dull aching scrotal pain that can radiate up the ipsilateral flank
What is prehn’s sign
Prehn’s sign = relief with elevation
How do you diagnose epididymitis
Urinalysis reveals pyuria and bacteriuria; cultures are positive for suspected organisms
How do you treat epididymitis
supportive
If E.Coli: Levofloxacin or Bactrim
STI: ceftriaxone + doxy
*Refer sexual partner(s) for evaluation and treatment if contact within 60 days of the onset of symptoms
What is glomerulonephritis
Damage of renal glomeruli by deposition of inflammatory proteins in glomerular membranes as a result of immunologic response
What are the main causes of glomerulonephritis
hematuria, Henoch-Schonlein purpura, postinfectious GN, IgA nephropathy, hereditary nephritis
What is the general presentation of glomerulonephritis
- 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
How do you diagnose glomerulonephritis
hematuria, RBC casts, proteinuria, HTN, decreased GFR
How do you diagnose hypervolemia
Pulmonary artery catheter (Swan-Ganz) to measure CVP (definitive):
How do you treat hypervolemia
fluid restriction
What is the basic difference between nephritic and nephrotic syndrome
nephrotic syndrome involves the loss of a lot of protein, whereas nephritic syndrome involves the loss of a lot of blood
What are some causes of nephritic syndrome
infections, immune system disorders and inflammation of the blood vessels
How do you diagnose nephritic syndrome
high levels of BUN and creatinine and on urinalysis, there’s hematuria, proteinuria and RBC casts in the urine
*A 24-hour protein collection is necessary to quantify how many proteins are lost through urine - proteinuria is generally under 3.5 grams per day
If glomerulonephritis is caused by strep, how do you treat it
Nifedipine instead of ACE/ARB
a 34-year-old male with hematuria and flank/abdominal pain. He denies any recent trauma. He reports a history of recurrent urinary tract infections, and his family history is significant for his mother who died of a “brain bleed” at age 42. Vital signs are significant for a blood pressure of 158/105 mmHg. On physical exam, there a late systolic crescendo murmur with a midsystolic click and tenderness upon palpation of the abdominal flanks. An ultrasound of the abdomen shows bilateral anechoic renal cysts with posterior enhancement. What is the likely diagnosis
Polycystic kidney disease
What are the common symptoms associated with polycystic kidney disease
high blood pressure, back or flank pain, and a swollen abdomen
*associated with cerebral aneurysms
What is the diagnostic test of choice for polycystic kidney disease
ultrasound
Where is the most common area for prostate cancer to appear
peripheral zone
What is the normal prostate level
4
*if over 4–> BPH, cancer, or prostatitis
What is the age range for prostate cancer screening recommendation
55-69
*over 70 is contraindicated
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 likely diagnosis
pyelonephritis
What are the common symptoms of pyelonephritis
Irritative voiding + fever + flank Pain + nausea and vomiting + CVA tenderness
What typically causes pyelonephritis
E. coli
Colicky flank pain radiating to the groin, hematuria, CVA tenderness, and nausea and vomiting. What is the likely diagnosis
Renal calculi
What should be avoided with a calcium oxalate stone in the kidney
*most common stone
avoid grapefruit juice
