Uronephro Flashcards
DxD IRA post rénal
Intrarenal and Ureteral Causes
Kidney stone
Sloughed papilla
Malignancy
Retroperitoneal fibrosis
Uric acid, oxalic acid, or phosphate crystal precipitation
Sulfonamide, methotrexate, acyclovir, or indinavir precipitation
Bladder
Kidney stone
Blood clot
Prostatic hypertrophy
Bladder carcinoma
Neurogenic bladder
Urethra
Phimosis
Stricture
DxD IRA origine rénale
Vascular Diseases
Large-Vessel Diseases
Renal artery thrombosis or stenosis
Renal vein thrombosis
Atheroembolic disease
Small- and Medium-Sized Vessel Diseases
Scleroderma
Malignant hypertension
Hemolytic uremic syndrome
Thrombotic thrombocytopenic purpura
HIV-associated microangiopathy
Glomerular Diseases
Systemic Diseases
Systemic lupus erythematosus
Infective endocarditis
Systemic vasculitis (eg, periarteritis nodosa, Wegener’s granulomatosis)
Henoch-Schönlein purpura
HIV-associated nephropathy
Essential mixed cryoglobulinemia
Goodpasture’s syndrome
Primary Renal Diseases
Poststreptococcal glomerulonephritis
Other postinfectious glomerulonephritis
Rapidly progressive glomerulonephritis
Tubulointerstitial Diseases and Conditions
Néphrite interstitielle: surtout penicillins, diuretics, and NSAIDs. Aussi associées aux infections bactériennes, fongiques, rickettsies
Drugs (many)
Toxins (eg, heavy metals, ethylene glycol)
Infections
Multiple myeloma
Acute Tubular Necrosis
Ischemia
Shock
Sepsis
Severe prerenal azotemia
Nephrotoxins
Antibiotics
Radiographic contrast agents
Myoglobinuria
Hemoglobinuria
Other Diseases and Conditions
Severe liver disease
Allergic reactions
NSAIDs
Nommer 10 causes de myoglobinurie/rhabdomyolyse/hémoglobinurie
Rhabdomyolysis and myoglobinuria
Crush injury
Compartment syndrome
Electrical injury
Myonecrosis from coma or immobilization
Acute arterial occlusion
Vigorous exertion
Status epilepticus
Hyperthermia/heat stress
Metabolic myopathy
Drugs/toxins
Hypokalemia
Hypophosphatemia
Hemoglobinuria
Acute hemolysis
Transfusion reaction
Drugs/toxins
Infections
Nommer 5 FR de néphropathie de contraste
preexisting renal insufficiency, diabetes mellitus (surtout si créat base sup 130), multiple myeloma, age older than 60 years, volume depletion, and higher doses of contrast material
Discuter des différents types de cylindres urinaires
Casts are formed from urinary Tamm-Horsfall protein
Hyaline casts, those that are devoid of contents, are seen with dehydration, after exercise, or in association with glomerular proteinuria. Red cell casts indicate glomerular hematuria, as seen in glomerulonephritis; the presence of even a few red cell casts is significant. White cell casts imply the presence of renal parenchymal inflammation. Granular casts are composed of cellular remnants and debris. Fatty casts, like oval fat bodies, generally are associated with heavy proteinuria and nephrotic syndrome.
DxD IRC
Vascular Causes
Renal arterial disease
Hypertensive nephrosclerosis
Glomerular Causes
Primary Glomerulopathies
Focal sclerosing glomerulonephritis (GN)
Membranoproliferative GN
Membranous GN
Crescentic GN
IgA nephropathy
Secondary Glomerulopathies
Diabetic nephropathy
Collagen vascular disease
Amyloidosis
Postinfectious
HIV nephropathy
Tubulointerstitial Causes
Nephrotoxins
Analgesic nephropathy
Hypercalcemia or nephrocalcinosis
Multiple myeloma
Reflux nephropathy
Sickle nephropathy
Chronic pyelonephritis
Tuberculosis
Obstructive Causes
Nephrolithiasis
Ureteral tuberculosis
Retroperitoneal fibrosis
Retroperitoneal tumor
Prostatic obstruction
Congenital abnormalities
Hereditary Causes
Polycystic kidney disease
Alport’s syndrome
Medullary cystic disease
Nommer 10 mécanismes de toxicité médicamenteuses en IRC
Excessive drug level
Impaired renal excretion of drug
Impaired renal excretion of active metabolite
Impaired hepatic metabolism
Increased sensitivity to drug
Changes in protein binding
Changes in volume of distribution
Changes in target organ sensitivity
Metabolic loads administered with drug
Misinterpretation of measured serum drug level (ie, change in therapeutic range)
Dxd hypotension péri-dialyse
Hypovolemia
Excessive fluid removal
Hemorrhage
Septicemia
Cardiogenic shock
Dysrhythmia
Pericardial tamponade
Myocardial infarction
Myocardial or valvular dysfunction
Electrolyte disorders
Hyperkalemia or hypokalemia
Hypercalcemia or hypocalcemia
Hypermagnesemia
Vascular instability
Drug-related
Dialysate-related
Autonomic neuropathy
Excessive access arteriovenous flow
Anaphylactoid reaction
Air embolism
DxD AEC péridialyse
Structural Conditions
Cerebrovascular accident (particularly hemorrhage)
Subdural hematoma
Intracerebral abscess
Brain tumor
Metabolic Conditions
Disequilibrium syndrome
Uremia
Drug effects
Meningitis
Hypertensive encephalopathy
Hypotension
Postictal state
Hypernatremia or hyponatremia
Hypercalcemia
Hypermagnesemia
Hypoglycemia
Severe hyperglycemia
Hypoxemia
Dialysis dementia
Dx/ Tx péritonite en dialyse péritonéale
Dx : dialysat trouble, dlr abdo, malaise, no/vo
> 100 GB / mL ou culture positive
Tx: Vanco 30mg/kg IP puis q 5-7 jours et ceftazidime 1g IP ou genta 0,6mg/kg IP et die dans échanges
Groupes de patients où le DCA est nécessaire (10)
Children
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Adult men
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Immunocompromised patients
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Patients with treatment failure (ie, with persistent urinary symptoms despite recently completed course of antibiotics)
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Patients with duration of symptoms more than 4 to 6 days
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Older patients at risk for bacteremia
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Ill-appearing patients with signs and symptoms suggestive of pyelonephritis or bacteremia
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Pregnant women
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Patients with known chronic or recurrent renal infection
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Patients with known anatomic urologic abnormalities
•
Patients in whom urinary tract obstruction is suspected (eg, stones, benign prostatic hypertrophy)
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Patients with serious medical diseases, including diabetes mellitus, sickle cell anemia, cancer, and other debilitating diseases
•
Patients with alcoholism or drug dependence
•
Recently hospitalized patients
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Patients taking antibiotics
•
Patients who recently have undergone urinary tract instrumentation (eg, cystoscopy, catheterization)
Nommer 10 FR d’urolithiase
Metabolic disease or disturbance
Crohn’s disease
Milk-alkali syndrome
Primary hyperparathyroidism
Hypernatriuria
Hyperuricosuria
Sarcoidosis
Recurrent UTI
Renal tubular acidosis (type I)
Gout
Laxative abuse
Positive family history
Hot arid climates (southeast United States)
Male gender (white men affected more commonly than black men)
Previous kidney stone
Dehydration
Nommer les indications d’hospitalisation des patients avec urolithiase
Absolute
Obstructing stone with signs of urinary infection
Intractable nausea or vomiting
Severe pain requiring parenteral analgesics
Urinary extravasation
Hypercalcemic crisis
Relative
Significant comorbid illness complicating outpatient management
High-grade obstruction
Leukocytosis
Solitary kidney or intrinsic renal disease
Psychosocial factors adversely affecting home management
DxD oedème scrotal aigu
Hernie
hydrocèle
Trauma
Épidydimite
Torsion
Tumeur
Gangrène de Fournier
Tx épididymite
