Urology/Renal (3%) Flashcards
Rapidly progressive glomerulonephritis (RPGN) is associated with a (poor/good) prognosis with _____ formation on bx
poor
crescent
crescents formed due to fibrin & plasma protein deposition collapsing the crescent shape of Bowman’s capsule
Can r/o a testicular tumor and rule in a hydrocele by performing what test on PE?
transillumination
Any cause of AGN can present with RPGN, which 2 ONLY PRESENT with RPGN?
Goodpasture’s dz
Vasculitis
What is vesicourethral reflux?
The backflow of urine from the bladder to the kidney
VUR allows bacteria, which may be present in the urine in the bladder, to reach the kidneys, which can lead to kidney infection, scarring, and damage
Berger’s disease often affects young (males/females) within days after _______ or _______ infection
males
URI or GI
Pts with vesicourethral reflux have sx similar to pts with ______
cystitis
How to tx paraphimosis?
Manual reduction: restore original position of the foreskin
Reduce edema with cool compresses or pressure dressing then gentle pressure to restore the foreskin to its normal position
Pharmacologic therapy: granulated sugar, injection of hyaluronidase, Incision (ex. dorsal slit)
<em>osmotic agents, such as granulated sugar or mannitol have been reported as effective agents to reduce swelling</em>
<em>Hyaluronidase has been effectively used in the pediatric population as a method of increasing fluid diffusion, thus decreasing local edema</em>
What are some sx a pt may experience with cystitis?
dysuria, increased frequency, urgeny, hematuria, suprapubic discomfort
In testicular torsion, the cremasteric reflex is (+/-)
What is the cremasteric reflex?
(-) (absent)
elevation of the testicle after stroking upper inner thigh
How to tx Goodpasture’s dz?
High dose corticosteroids + cyclophosphamide + plasmaphersis
In testicular torsion, Prehn’s sign is (+/-)
What is Prehn’s sign?
(-)
no pain relief with scrotal elevation
Management of testicular torsion?
- Detorsion & orchiopexy w/in 6 hours and in obvious cases
<em>Orchiopexy = testicle fixation in the scrotum</em>
- Orchiectomy if the testicle is not salvageable
Testicular torsion occurs when the spermatic cord twists & cuts off testicular blood supply due to congenital malformation (called a _____ ______), which allows the testicle to be free floating in the tunica vaginalis (90%) causing it to twist on itself
“bell clapper” deformity of the processus vaginalis
How to treat IgA nephropathy?
ACE Inhibitors, +/- Corticosteroids
Post infectious acute glomerulonephritis is most commonly seen after what infxn?
GABHS
Tx for pyelonephritis?
Fluoroquinolone PO or IV, Aminoglycoside x14 days (7 days may be used in healthy, young women)
A majority of testicular torsion cases occur in what age group?
teenagers
Tx for complicated cystitis?
Fluoroquinolone PO or IV, Aminoglycosides
If a pt has HTN, hematuria (RBC casts), dependent edema (proteinuria), and azotemia, what underlying condition is present?
Acute glomerulonephritis
Azotemia is a medical condition characterized by abnormally high levels of nitrogen-containing compounds (<em>urea, creatinine, various body waste compounds, and other nitrogen-rich compounds</em>) in the blood
T/F: Testicular torsion is a true urologic emergency
TRUE!!!
What type of hydrocele is worse with valsalva?
Communicating
What is a potential complication of cryptorchidism?
Testicular cancer
subfertility
<em>can be prevented with early dx and tx</em>
In crytorchidism, where is the undescended testicle most commonly located?
In the inguinal canal
What is (+) blue dot sign indicate?
torsion of appendix of testicle (mullerian remnant)
What two body systems does Goodpasture’s dz affect?
Kidney
Lung
What is the most common cause of painless scrotal swelling?
Hydrocele
What are the different types of hydrocele?
Communicating: Peritoneal/abd fluid enters the scrotum via a patent processus vaginalis that failed to close
Noncommunicating: derived from fluid from the mesothelial lining of the tunica vaginalis (no connection to the peritoneum
What is paraphimosis?
Is it a urologic emergency?
FORESKIN BECOMES TRAPPED BEHIND THE CORONA OF GLANS & forms tight band, constricting penile tissues
Foreskin cannot be pulled forward
The ring of tissue impairs blood & lymphatic flow gangrene & auto-amputation (days to weeks)
Urologic emergency!
T/F: usually no tx is needed for a hydrocele
TRUE
- most resolve by the pts 1st bday*
- surgical repair may be required if it persists beyond 1 year of age or if an older pt with a communicating hydrocele*
What is the recommended course of tx for a pt with vesicourethral reflux?
Usually will self-resolve as child grows older and ureters grow in size
Abx may be required
Surgery if severe
_________ is a similar disease to IgA nephropathy (berger’s disease) but associated with generalized IgA vasculitis
Henoch schonlein purpura
What is enuresis?
Bedwetting
distinct episodes of urinary incontinence while sleeping in children >/=5 y/o in the absence of sx of infxn
What are risk factors associated with cystitis in children/neonates?
vesicourethral reflux, newborns with FUO (fever of unknown origin)
Other: DM, catheter
What are medication options for management of uncomplicated cystitis?
Nitrofurantoin
Fluoroquinolones
Trimethoprim-sulfamethoxazole
How to dx a pt with acute glomerulonephritis?
Gold standard?
Urinalysis (UA): hematuria (RBC casts), dysmorphic RBCs, proteinuria (usually <3g/d but may be in the nephrotic range), high specific gravity > 1.020 osm, ± WBCs
Increased BUN, increased Creatinine to varying degrees
Renal biopsy gold standard (not needed if poststrep suspected)
In a pt with pyelonephritis, what sx may be present?
fever, tachycardia, back/flank pain, +CVA tenderness, N/V
What is cryptorchidism?
What population is at highest risk?
Most common on right or left?
Undescended testicle
Premature infants or low birth weight
Right sided
What two conditions present with + ANCA antibodies and a ack of immune deposits?
Microscopic Polyangiitis (vasculitis of small renal vessels): +P-ANCA
Granulomatosis with Polyangiitis (Wegener’s): necrotizing vasculitis +C-ANCA
What is complicated cystitis?
underlying condition with risk of therapeutic failure: sx >7 days, pregnancy, DM, immunosuppression, indwelling catheter, anatomic abnormality, elderly, males
What is the most common cause of AGN in adults, worldwide?
IgA Nephropathy (berger’s disease)
What is the most common organism to cause cystitis?
E. coli
T/F: Glomerulonephritis is usually self-limited with a good prognosis
TRUE
except in cases of RPGN
What is hypospadias?
An abnormality of anterior urethral and penile development in which the urethral opening is ectopically located on the ventral aspect of the penis proximal to the tip of the glans penis, which, in this condition, is splayed open
If a pt with cystitis is pregnant, what tx options are there?
Amoxicillin, Augmentin, Cephalexin, Cefpodoxime, Nitrofurantoin, Fosfomycin, Sulfisoxazole is safe except in last days of pregnancy (Increased kernicterus)
Tx for enuresis?
Behavioral: motivational, education, and reassurance; bladder training, avoid caffeine, fluid restriction
Enuresis alarm: used if kids fail to respond to behavioral therapy
Desmopressin (DDAVP): synthetic antidiuretic hormone (ADH)
TCAs: Imipramine
Tx for rapidly progressive glomerulonephritis?
Corticosteroids + Cyclophosphamide
What are tx options for cryptorchidism?
Orchiopexy (as early as 6 months old, ideally before 1 y/o)
Observation only if <6 months old
hCG or gonadotropin releasing hormone prior to orchiopexy
Orchiectomy recomended if detected at puberty to reduce testicular CA risk
What is the best initial test to dx testicular torsion?
Testicular doppler US
What is phimosis?
How does it differ from paraphimosis?
Phimosis is the inability to retract foreskin over the glans
Not emergent!
Management is circumcision
Hydroceles in infants are usually (congenital/acquired), and in adults are usually (congenital/acquired)
congenital
acquired
Post infectious glomerulonephritis classically presents as a ____-____ y/o (boy/girl) with ______ edema up to 3 weeks after Strep with scanty, ________ urine
2-14 y/o
boy
facial
cola-colored/dark
What are the clinical manifestations of testicular torsions?
ABRUPT onset of scrotal, inguinal or lower abdominal pain (usually <6 hours}, ± nausea & vomiting
If nausea/vomiting presents, suspect torsion (usually absent in epididymitis)
How to dx a pt with cystitis?
UA
Diptick
Recommended tx for hypospadias?
Some forms of hypospadias are very minor and do not require surgery
However, treatment usually involves surgery to reposition the urethral opening and, if necessary, straighten the shaft of the penis
Surgery is usually done between the ages of 6 and 12 months
Acute glomerulitis is an immunologic inflammation of the glomeruli causing ____ and _____ leakage into the urine
protein and RBCs
What is the difference between the two types of vesicourethral reflux?
Primary VUR: present at birth, caused by a defect in the development of the valve at the end of the ureter, MC type of VUR, usually detected shortly after birth
Secondary VUR: obstruction in the bladder or urethra causes urine to flow backward into the kidneys, can occur at any age, can be caused by surgery, injury, a pattern of emptying the bladder that is abnormal, or a past infxn that puts pressure on the bladder, more common in children who have other birth defects (i.e. spina bifida)
