Urology / Renal / Electrolytes Flashcards
Most common cause of HTN in young person
renal parenchymal disease
Workup:
a urinalysis
urine culture
renal ultrasonography
Urinary incontinence
5 types
Urge Stress Functional Reflex Overflow
Urge incontinence
#1 in old 2/2 involuntary + uninhibited detrusor contractions detrusor instability causes an intense urge to void, which overcomes the patient’s voluntary attempt to hold the sphincter close
Large urination, small post void, nocturnal urination
Dx: urodynamic study
Tx:
- Nonpharmacologic therapy is recommended for all patients with an overactive bladder.
- oxybutynin
- TCAs
Stress incontinence
#1 in women < 70 2/2 pelvic floor weakness where urethra goes inferior and urinate with increased intraab pressure
Small post void residual
R/o infection w/ UA
Tx: Kegels
Urethropexy
estrogen replacement therapy
Functional incontinence
2/2 disabling and debilitating dx
Reflex incontinence
1 cause - spinal cord injury
No sense need to urinate
Overflow incontinence
Common w/ diabetics, pts w/ neuro d/o, BPH
NOt enough bladder contraction or bladder outlet obstruction
Large post void residual (> 100)
Tx:
- self cath
- bethanechol
- alpha blockers
Normal post-void residual
< 50 mL
How best to image upper and lower urinary tract?
Upper
IVP
CT scan
Lower
Cystoscopy
Upper vs lower urinary tract
Upper= kidneys and ureters
Lower= urinary bladder and urethra
Eosinophils in urine. What could this be?
Interstitial nephritis
How to reduce risk of contrast nephropathy ?
Premedication with
N acetycysteine
IV sodium bicarbonate
NSAIDs induce renal injury by
acutely reducing renal blood flow and, in some patients, by causing interstitial nephritis.
1 cause interstitial nephritis
Tx?
Abx
Corticosteroids to tx
When proteinuria is noted on a dipstick and the history, examination, full urinalysis, and serum studies suggest no obvious underlying problem or renal insufficiency, what is recommended
a urine protein/creatinine ratio is recommended.
Reducing calcium oxalate stones
A low-sodium, restricted-protein diet with increased fluid intake reduces stone formation.
A low-calcium diet has been shown to be ineffective.
Oxalate restriction also reduces stone formation. Oxalate-containing foods include spinach, chocolate, tea, and nuts, but not yellow vegetables.
Potassium citrate should be taken at mealtime to increase urinary pH and urinary citrate
When suspect ethylene glycol poisoning?
This diagnosis should be considered in a patient who appears intoxicated but does not have an odor of alcohol, and has anion gap acidosis, hypocalcemia, urinary crystals, and nontoxic blood alcohol levels.
Tx ethyelene glycol poisoning
If early, fomepizole
- Fomepizole is a competitive inhibitor of alcohol dehydrogenase
If late, sodium bicarbonate, ethanol, and hemodialysis
First-line therapies for urge urinary incontinence include
behavioral therapy, such as pelvic muscle contractions,
anticholinergic therapy.
What will provide the fastest and most consistent early lowering of serum potassium
Insulin and glucose IV
What is the preferred initial test for renovascular hypertension in patients with impaired renal function?
Duplex Doppler ultrasonography
Tests involving intravenous radiographic contrast material may cause deterioration in renal function
What is the gold standard for the diagnosis of renal colic
CT
Although most cases of nephrotic syndrome are caused by primary kidney disease, the most common secondary cause of nephrotic syndrome in adults is
diabetes mellitus.
Primary causes include membranous nephropathy and focal segmental glomerulosclerosis, each accounting for approximately one third of cases
Bulimia electrolyte disturbance =
hypokalemia
Tx urge incontinence
Mild:
The first approach to this problem should be behavioral.
For more severe cases, various pharmacologic agents, including anticholinergics, are useful. Failure of these modalities should lead to urodynamic testing and consideration of surgery.
Persons younger than 30 years of age who excrete less than 2 g of protein per day and who have a normal creatinine clearance should be tested for
orthostatic proteinuria. = increased protein excretion in the upright position, but normal protein excretion when the patient is supine.
- It is diagnosed using split urine collections as described in the question.
- The daytime specimen has an increased concentration of protein, while the nighttime specimen contains a normal concentration.
Since this is a benign condition with normal renal function, no further evaluation is necessary.
What is the most appropriate imaging procedure for hematuria in all patients?
CT urography or intravenous pyelography
with the exception of those with generalized renal parenchymal disease, young women with hemorrhagic cystitis, children, and pregnant females
Development of Acute interstitial nephritis usually becomes evident approximately how long?
2 weeks after starting a medication and is not dose-related.
Microscopic hematuria in 40 yo…what next
clinically significant microscopic hematuria as ≥3 RBCs/hpf.
- radiographic assessment of the upper urinary tract,
- urine cytology studies.
all patients > 40 and those who are younger but have risk factors for bladder cancer undergo cystoscopy to complete the evaluation.
For UTIs, which fluoroquinolone should not be used?
Moxifloxacin
When trimethoprim/sulfamethoxazole is contraindicated, a 3-day course of ciprofloxacin, levofloxacin, norfloxacin, lomefloxacin, or gatifloxacin is a reasonable alternative.
What is the best study for confirming the diagnosis of a urinary tract stone in a patient with acute flank pain?
An noncontrast helical CT scan of the abdomen and pelvis
Although abdominal ultrasonography has a very high specificity, it is still not better than CT, and its sensitivity is much lower; thus, its use is usually confined to pregnant patients with a suspected stone.
Children under the age of 5 years with a UTI, any child with a UTI and a fever, school-aged girls who have had two or more UTIs, and any boy with a UTI should have
a voiding cystourethrogram (VCUG) to evaluate for vesiculoureteral reflux and renal ultrasonography to evaluate the kidneys.
The most common cause of proteinuria in children is: (check one)
A. Acute postinfectious glomerulonephritis
B. Lupus glomerulonephritis
C. Hydronephrosis
D. Orthostatic proteinuria
E. Reflux nephropathy
Orthostatic proteinuria accounts for up to 60% of all cases of asymptomatic proteinuria reported in children, with an even higher incidence in adolescents
Tx SIADH
Hemodynamically stable –> free water restriction
- demeclocycline if cannot do water restriction
Neuro sx –> hypertonic saline
