Urology/Nephrology Flashcards
primary nocturnal enuresis
lifelong enuresis
Secondary nocturnal enuresis
bedwetting after being dry for at least 6 months
At what age should you become concerned about bed wetting?
6
What are causes of bed wetting?
small bladder capacity, detrusor muscle instability, UTI, bacteruria without dysuria, constipation, hypercalcuria, bladder foreign body. Also associated with nighttime snoring
Desmopressin
reduces urine production in the distal tubules (vasopressin). one nasal spray nightly, Side effects, Headache, abdominal pain, expensive $1.50 per spray
Imaprimine
anticholinergic and noradrenergic effect to stabilize detrusor muscles. Overdose can be lethal (VT, sz)
Oxybutyrin
Anticholinergic, antispasmotic to stabilize detrusor muscle. Side effects are dry mouth, constipation, drowsiness. Drug of choice is have polysymptomatic enuresis.
When to use drugs for nocturnal enuresis?
Pts> 8, for special occasions.
Mpgn
Hematuria, htn, low c3 , nephrotic range proteinuria Does not respond to high dose steroids
Treatment of congenital nephrotic syndrome
Unilateral or bilateral nephrectomy with pd and albumin infusion until transplant. Disease does not recur in new kidney
Postural proteinuria
Occurs when supine not upright
Which diseases have decreases c3?
Sle, post strepto gn, mp gn
Adrenoleukodystrophy
X linked disorder characterized by Cns demyelination and adrenal failure
Best way to evaluated proteinuria
early morning urine sample (Prot:Cr ratio >0.2)
Management of prenatal hydronephrosis
Put on prophy antibiotics - amox for first month, then bactrim or nitrofurantoin therafter. Continue until nature of lesion is defined. Should have renal u/s and VCUG early on.
Posterior urethral valves
rare cause of postnatal b/l hydronephrosis. Treated with primary valve ablation in first few days of life
Waht is the most common cause of prenatally detected hydronephrosis?
Uteropelvic junction obstruction
What is the appropriate age for an ochioplexy?
6-12 months.
Causes of pediatric nephrolithiasis
hereditary hypercalciuria, hyperparathyroidism, defects of purine metabolism, distal RTA, UTIs
What is hypophoshatemic rickets?
x linked inherited disorder, not 2/2 vitamin D deficiency. Normal calciu and bicarb, normal PTH and vita D. Treat with phosphate supplements but must be judicious as to not cause nephrocalcinosis.
Cystinosis
AR metabolic disorder caused by mutations in the lysosome. Causes global proximal RTA and progressive glomerular dysfunction. Growth failure, light complexion, rickets. Diagnose via slit lamp or BMB to see cystine crystals.
How does secondary hyperparathyroidism manifest from renal failure?
Kidneys failing thus effectively vita d deficient and increase PTH leading to osteitis fibrosa cystica
What is paraphimosis?
Inability to retract a tight prepuce and it is retracted over the glans to the level of the corona. The constricted ring of skin can act as a tourniquet and ischemia may results.
Bartters syndrome
which is a genetic disorder typically involving the Na/K/2Cl- channel in the thick ascending limb of the loop of Henle. Due to the electrolyte losses, patients develop hypokalemia, hyponatremia, and contraction alkalosis with severe dehydration. Like on Lasix