Urology/Nephrology/ocular Flashcards
HIV associated nephropathy is what kind of kidney disease…
collapsing focal and segmental glomerulosclerosis
=proteinuria with renal failure
protein to creatinine ratio versus 24 hr urine protein
ratio can be more accurate and is easier/faster
if have to choose, do the ratio
if patient has microalbuminuria, next step
microalbuminuria can worsen renal function over time
start patient on an ace i or arb
if eosinophils are found on UA, 2 possible conditions?
acute interstitial nephritis or allergic interstitial nephritis
false positives for hematuria on dipstick are caused by what 2 factors?
confirm dipstick with?
hemoglobin or myoglobin
confirm with urine microscopy
intravenous pyelogram is always ____
wrong
it is slow and contrast is toxic
“dysmorphic” red cells on UA =
glomerulonephritis
types of cast = .... 1 rbc cast 2 wbc cast 3 eosinophil cast 4 hyaline cast 5 broad way cast 6 granular muddy brown cast
1 glomerulonephritis
2 pyelonephritis
3 acute (allergic) interstitial nephritis
4 dehydration (normal tamhorsfall protein)
5 chronic renal disease
6 ATN
types of AKi
prerenal azotemia (dehydration/hypotension, or renal artery stenosis) postrenal (obstruction - must obstruct both kidneys for Cr to rise) intrinsic renal disease
UNa and FeNa for PRERENAL
UNa <20
FeNa<1%
urine osmolality in ATN is….
inappropriately LOW because the tubule cells are damaged and cant resorb water correctly
isosthenuria (osm of U = osm of serum) indicated ATN
lab values seen in CONTRAST induced renal failure/injury
UNa, FeNa, and specific gravity
what about for normal ATN?
UNa LOW
FeNa <1% (afferent arteriole spasm)
U spec grav very high
normal ATN shows high UNa( >20), Fena >1%, and low spec grav
after chemo, Cr rises 2 days later….
cisplatin or hyperuricemia?
what could have prevented this?
hyperuricemia due to tumor lysis syndrome
cisplatin would not produce a rise in Cr for 5-10 days
give allopurinol, hydration, and rasburicase prior to chemo to prevent renal failure from TLS
you see ingestion hx plus renal failure 3 days later + low calcium level and envelop crystals
toxic ingestion?
ethylene glycol
oxalate crystals (calcium oxalate) lead to low ca
rhabdomyolysis UA and dipstick findings
what happens to electrolytes?
UA no cells
dipstick positive for large amount of blood (myoglobin spilling into urine)
CPK high
hyperK and hyperuricemia (both from lysis of cells) and hypoCa (ca bound to damaged muscle)
tx for rhabdomyolysis
saline hydration mannitol as osm diuretic (saline and diuretic to increase flow through tubular cells and prevent damage) \+ bicarbonate to drive K back into cells
first step if someone comes in w seizure from suspected rhabdo?
EKG to make sure there isnt a like threatening hyperK
dipstick and cpk can wait
diuretic that can cause ototoxicity?
furosemide
indications for dialysis?
fluid overload encephalopathy pericarditis met acidosis hyperK
hepatorenal syndrome
kidney failure d/t liver dz
cirrhosis + prerenal picture
blue/purple lesions in fingers toes + livedo reticularis + AKI
cholesterol emboli
meds that cause acute (allergic) interstitial nephritis and drug rash (SJS/TEN)
penicillins cephalosporins sulfa (diuretics like furosemide and thiazide)phenytoin rifampin quinolones allopurinol PPI
what stain to see if eosinophils are in urine?
hansel or wright stain
papillary necrosis
presentation
dx
tx
sloughing of renal papillae
(extra nsaid use, sickle, DM)
looks like pyelo = sudden onset flank pain, fever, hematuria
UA with necrotic tissue and culture is normal (no growth)
CT scan shows loss of papillae
no tx
drugs AKI occurs in what structure
tubules
glomerulus is not damaged from drugs
goodpastures
lung and kidneys (no upper resp involvement or systemic signs which differentiates it from wegeners)
anti GBM ab = linear deposits
tx plasmapheresis and steroids
berger disease (iga nephropathy)
vs
post strep glomerulonephritis
gross hematuria 1-2days after URI
post strep is dark urine/periorbital edema ~ 1-2 weeks after strep
alport syndrome
defect of collagen leading to glomerular disease and hearing loss + vision disturbance
polyarteritis nodosa
fatigue, weight loss, arthralgias/myalgias
glomerulonephritis + GI abd pain + other organ systems
aneurysmal dilatiation on angiography or biopsy
tx cyclophosphamide and prednisone + treat for hep B if present
amyloidosis
biopsy?
tx?
large kidneys –> green birefringence on congo red staining
melphalan and prednisone
nephrotic syndrome
proteinuria (>3.5 g/24 hrs) so large that liver can no longer compensate with production
protein loss leads to edema, hyperlipidemia, and thrombosis (urinary loss of natural anticoagulants like protein S, C, and antithrombin)
what kind of nephrotic syndrome occurs with injection drug use and AIDS?
cancer?
kids?
focal segmental
cancer –> membranous
kids –> minimal change
WHAT CAN BE GIVEN TO bind phosphate in end stage renal disease with hyperphos?
ca acetate or ca carbonate or sevelamer or lanthanum
in HUS and TTP what happens to PT and aPTT
tx?
they are NORMAL
HUS willresolve spontaneously
TTP requires plasmapheresis or FFP (NOT steroids)
features of a benign simple kidney cyst
echo free, smooth thin walls, sharp demarcation, and good transmission to back
no aspiration needed!
mc cause of death in polycystic kidney disease?
renal failure
DI
water loss from insufficient or ineffective ADH
which responds to ADH: central or nephrogenic DI
central
if water deprivation test shows decreased U volume….if it shows continued high volume U?
next test?
dec: psychogenic polydipsia
stays high: DI
next test: ADH administration
addison disease which is loss of ___fxn causes ______ due to loss of _____
adrenal fxn
hyponatremia
aldosterone
demeclocycline
tx for chronic SIADH
blocks ADH action at tubules
correction of Na must occur ____
if it is too ___, you risk increases of….
slowly
less than 0.5 -1 meq per hr or 12-24 meq per day
central pontine myelinolysis (osmotic demyelinization)
insulin and K relationship
insulin usually drives K into cells
ekg shows peaked t waves and wide qrs
hyperKalemia
tx for hyperkalemia
if there are ekg changes –> calcium cl or gluconate will protect the heart (but doesnt lower K level)
insulin/gluc and bicarb redistribute it
kayexylate will remove it from body over days
u waves or flat T waves
hypokalemia
calculate anion gap (norm 12 or less)
Na - (Cl + bicarb)
distal renal tubule acidosis (type 1)
distal tubule makes new bicarb
if damaged, UA ph will be >5.5 since acid cant be excreted
tx give bicarb
proximal RTA (type 2)
proximal tubule is damaged and kidney cant resorb all the filtered bicarb
pH is low <5.5
chronic met acidosis leaches ca out of bones = osteomalacia
tx thiazide diuretics
type 4 rta
urine salt loss (hyperenin, hypoaldosterone)
tx with flucortisone
type of rta with nephrolithiasis
type 1 distal
first steps for someone with acute kidney stone and pain
ketorolac /analgesics
then get CT
kidney stones that are 0.5 - 2 cm are tx w
lithotripsy
surg for 2 cm
man w ca oxalate stone
gets lithotripsy
has hyperca in urine
what med?
HCTZ
Uveitis v glaucoma v abrasion
Uveitis- W autoimmune diseases, photophobia, dc w slit lamp, Tx topical steroids
Glaucoma - pain, fixed midpoint pupil, dx w tonometry, Tx acetazolamide or mannitol
Abrasion - trauma, sand in eyes, dx w fluorescein stain, tx none
Tonometry is used to dx…
Glaucoma
Sudden onset painful red eye that is hard, no reaction of pupil to light
Acute angle closure glaucoma
Red swollen eye w pain
Dendritic pattern seen in fluorescein stain
Herpes keratitis
DONT GIVE STEROIDS
Tx w oral acyclovir (or famicyclovir or valacyclovir)
Nonproliferation retinopathy is treated w
Controlling glucose
Proliferative retinopathy in diabetics is treated with
Laser photocoagulation
Sudden onset monocular vision loss
Dx? Tx?
Retinal artery or vein occlusion
Retinal examination
Artery occ will have cherry red macula and pale retina
Vein occ will have blood extravasation into retina (red image)
Tx for artery occlusion is 100oxygen, ocular massage, acetazolamide, and thrombolytics
Sudden onset painless unilateral loss of vision like curtain coming down
Surgical reattachment
Best tx for macular degeneration
Vegf inhibitor
Like ranibizumab or bevaciumab
vitreous hemorrhage
onset of loss of vision suddenly and floaters!
