UWORLD REnal Flashcards
Diagnostic testing urethral diverticulum
UA, culture
MRI of the pelvis
Transnational Ultrasound
TX urethral diverticulum
Manual decompression, needle aspiration or surgical repair
Post operative urinary retention risk factors
Age >50
Surgery >2 hours duration
>750ml intraoperative fluids
regional anesthesia
Neurological disease
Underlying bladder dysfunction
Previous pelvic surgery
Post operative urinary retention clinical features
Decreased urine output
Abdominal dissension
Suprapubic pressure/ pain
Diagnosis and management of post operative urinary retention
Urinary catheter is both diagnostic and therapeutic large volume of urine is evacuated and prevents continued over dissension
Patients undergo an outpatient voiding trail within a week, after which the catheter is removed
Mechanism of post operative urinary
Anesthesia causes bladder stretch receptor dysfunction and decreases detrusor contractility which along with large fluid volumes results in rapid overdistension.
Child with acute onset of edema and hypoalbuminemia and hyperlipideamia and proteinuria.
Nephrotic syndrome most common: minimal change.
Caused by cytokine-mediated podocyte injury.
Treatment minimal change disease
Diagnosis is clinical and management is empiric immunosuppressive therapy with corticosteroids to counter T-cell dysregulation and cytokine-mediated damage
Long term effects of relapsing MCD requiring prolonged steroid use.
Common adverse effects include adrenal suppression, decreased bone density, weight gain, and hypertension. Impair linear growth. Glucocorticoid-induced changes to lens epithelial cell gene transcription can lead to cataract formation requiring frequent ophthalmologist examination for early detection.
WBC casts
Acute interstitial nephritis
Due to antigen hypersensitivity leads to tubulointerstitial mononuclear cell infiltration
Most common cause of Acute Kidney INjury
Antibiotics (especially beta-lactate such as cefazolin)
NSAIDs
PPI
Muddy brown casts
Acute tubular necrosis
Caused by renal ischemia
Tubulointestinal invasion by neutrophils vs mononuclear cells
Neutrophils is indicative of pylonephritis
Mononuclear is indicative of AIN
UTI in pregnancy
-Amoxicillin* or amoxicillin-clavulanate for 5-7 days
-Cephalexin for 5-7 days
-Fosfomycin as a single dose
-Nitrofurantoin for 5-7 days (avoid in 1st trimester & at term)
-No fluoroquinolones in any trimester
-No trimethoprim-sulfamethoxazole in 1st trimester or at term
Treatment of asymptomatic bacteriruria in pregnancy vs non pregnancy
Nonpreganant patients do not require treatment
Preagnancy increases risk for acute pylo due to the effects of progesterone on the upper urinary tract (eg smooth muscle dilation, ureteral enlargement, visicoureteral valve dysfunction). In addition to fetal complications (preterm birth, low weight, perinatal mortality)
TMPSMX in pregnancy
Use in first trimester has been associated with neural tube defects due to the folate antagonist properties of temp. Use at term is avoided due to a possible association with neonatal kernicterus.
Diagnosis of posterior urethral valve
Diagnosis is confirmed using a voiding cystourethrogram (VCURG).
Shows visualization of dilated proximal urethra when the catheter is removed (the catheter keeps the valve open and must be removed before the ending of imaging)
Management of Posterior urethral valve
Once confirmed infants should have a Foley catheter placed to temporarily relive the obstruction.
Once stabilized, cystoscope allows direct visualization and ablation of the valve (curative)
pathophys of AIN
tubulointerstitial mononuclear infiltration (t lymphocytes, macrophages)
This results in the tubular accumulation of WBCs (ie, pyuria, WBC casts) and, often, mild proteinuria and/or hematuria
presentation of AIN
Urinalysis: WBCs & WBC casts ± mild RBCs & proteinuria
Peripheral eosinophilia ± urine eosinophils
causes of AIN (acute interstitial nephritis)
-Medications (eg, antibiotics (b-lactams), NSAIDs, PPIs)*
-Rheumatologic disease (eg, SLE, Sjögren syndrome, sarcoidosis)
-Infections (eg, Legionella, tuberculosis, CMV)
pharmacological tx for reccurent stones that do not respond to diet
Thiazide diuretics are the first-line pharmacotherapy for patients with hypercalciuria and recurrent calcium stones.
asymptomatic bacteriuria in pregnancy
increased risk for acute pyelonephritis due to the effects of progesterone on the upper urinary tract
associated with fetal complications, including preterm birth, low birth weight, and perinatal mortality.
tx of asymptomatic bacteriuria in pregnancy
first line
First-line antibiotic choices
-cephalexin for 5-7 days,
-amoxicillin-clavulanate for 5-7 days, –fosfomycin as a single dose.
tx of asymptomatic bacteriuria in pregnancy
abx to avoid
-Nitrofurantoin for 5-7 days (avoid in 1st trimester & at term)
-No fluoroquinolones in any trimester
-No trimethoprim-sulfamethoxazole in 1st trimester or at term
sxs of SIADH
-Mild/moderate hyponatremia: nausea, forgetfulness
-Severe hyponatremia: seizures, coma
-Euvolemia (eg,moist mucous membranes, no edema, no JVD)
-Hyponatremia
-Serum osmolality <275mOsm/kgH2O (hypotonic)
Urine osmolality >100mOsm/kgH2O
SIADH post operative
Postoperative SIADH is common due to prominent nonosmotic stimuli for ADH secretion (eg, pain, nausea, physical and emotional stress).
Worsened by postoperative administration of IV fluids which, in the setting of SIADH, can lead to further water retention.
tx of severe SIADH
tonic-clonic seizure with severe hyponatremia = cerebral edema and risk of brainstem herniation
Urgent increase in their serum sodium = hypertonic (3%) saline.
pathophys mechanism of Iga
Mesangial deposition of abnormal IgA (eg, synthesized in response to a mucosal respiratory infection)
clinical presentation of IgA
Onset: spontaneous or several days after URI
Episodic gross hematuria (isolated or recurrent)
± (Flank pain, low-grade fever, ↑ BP)
Asymptomatic: microscopic hematuria can occur
poor prognostic factors of IgA nephropathy
-Elevated serum creatinine
-Hypertension (>140/90 mm Hg)
-Persistent proteinuria (>1 g/day)
Risk of BPH causing acute urinary retention
Increased with
bladder/urethral infection,
genitourinary trauma,
certain medications (eg, baclofen, anticholinergics).
nepholithisis in pregnancy sxs
abdominal pain that is paroxysmal, severe
nausea and vomiting
inability to find a comfortable position
radiating to the labia in the context of a normal abdominal examination
diagnostic test for nepholithiasis in pregnancy
Renal and pelvic ultrasonography
Even no direct visualize a stone, the presence of hydronephrosis and/or hydroureter is consistent with ureteral obstruction due to nephrolithiasis.
nocturnal enuresis child >5
- behavioral nodification
- motivational therapy
- enuresis alarm therapy, a first-line treatment that has the best long-term outcome and a low risk of relapse
suspicion for renal cell carcinoma
common (all 3 present <9%):
flank pain,
hematuria
palpable abdominal mass
Paraneoplastic syndromes:
erythropoietin production (erythrocytosis)
