Day 9 - GU1 Flashcards Preview

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Flashcards in Day 9 - GU1 Deck (35):
1

Diuretic(s) most useful: acute pulmonary edema

Loop diuretic (recall: LMNOP)

2

Diuretic(s) most useful: Hypercalciuria causing kidney stone

Thiazides

3

Diuretic(s) most useful: Glaucoma

Acetazolamide or Mannitol

4

Diuretic(s) most useful: Mild to moderate CHF & expanded extracellular volume

Loop diuretic (~double dose to get fluid off, then assess for UOP for adjustments); Note: All CHF pts should be on low-dose, potassium-sparing diuretic (e.g., spironolactone or eplerenone), which reduces long-term mortality

5

Metolazone: drug class & use

Thiazide diuretic used in cases of cirrhosis (mixed w/ loop diuretic)

6

Diuretic(s) most useful: in conjunction w/ loop diuretics to retain potassium

Potassium-sparing diuretics

7

Diuretic(s) most useful: Edema assoc. w/ nephrotic syndrome

Loop diuretic, Metolazone (one of strongest thiazides)

8

Diuretic(s) most useful: Increased ICP

Mannitol

9

Diuretic(s) most useful: Mild to moderate HTN

Thiazides

10

Diuretic(s) most useful: Hypercalcemia

Loop diuretic

11

Diuretic(s) most useful: Altitude sickness

Acetazolamide

12

Diuretic(s) most useful: Hyperaldosteronism

Potassium sparing diuretics

13

Nephrolithiasis Expectant mgt

Strain urine w/ strainer - analyze stone after passing; Most pass spontaneously in 1-2 wk, especially if

14

Surgical tx for kidney stones: indications & options

Surgical tx - 10-20% required in cases; Indications: unable to pass after 1 mo, complete urinary obstrx, impariment renal infx, peristent infx; Surgical options: Extracorporeal shock wave lithotripsy for stones in renal pelvis or ureter; Ureterorenalscopy for ureteral stones for possible lithotripsy and stent placment; Percutaneous nephrostolithotomy Staghorn calculi need possible

15

Hematuria w/u

H & P, UA w/ cell ct, CBC, Chemistry w/ electrolytes, PSA (men > 40, elevated w/ any prostate pathology); Note: tampon placement to prevent menstrual bleeding into UA OR do straight cath; Imaging - (1) CT scan ab/pelvis stone protocol (2) If no stones, CT ab/pelvis w/ contrast to eval kidney/ureters (3) Co-CT KUB x-ray (since already giving contrast), equivalent to IVP to view radiopaque stones; If low suspicion of disease, consider tx for UTI and f/u UA in 3-5 days

16

Indications for cystoscopy in case of hematuria

If no clear etiology and... Age > 50, Smoker, FH urinary tract cancer, PMH cyclophosphamide, suspicion for cancer => Send urine for cytology & get cystoscopy

17

Considerations/Next steps if basic hematuria w/u negative

IgA nephropathy, Thin basement membrane disease; Repeat U/A and urine cytology routinely, f/u w/ renal sonogram & cystoscopy in 1 yr

18

Glomerular diseases: Most common nephrotic syndrome in children

Minimal change disease

19

Glomerular diseases: Granular IF pattern on LM, hypercellularity glomeruli

Post streptococcal glomerulonephritis

20

Glomerular diseases: Linear pattern w/ immune complex deposition

Goodpasture's

21

Glomerular diseases: Kimmelstiel-Wilson nodular glomerulosclerosis

Diabetic nephropathy

22

Glomerular diseases: Most common nephrotic syndrome in adults

Membranous glomerulonephritis

23

Glomerular diseases: EM loss of epithelial foot processes

MCD

24

Glomerular diseases: nephrotic syndrome assoc w/ hepatitis B

Membranoproliferative glomerulonephritis

25

Glomerular diseases: HIV

FSGS

26

Glomerular diseases: Anti-GBM antibodies, hematuria, hemoptysis

Goodpasture's

27

Glomerular diseases: Subendothelial tram tracks and immune complex humbs

Membranoproliferative glomerulonephritis

28

Glomerular diseases: nephritic syndrome, cataracts, high frequency hearing loss

Alport syndrome

29

Glomerular diseases: Crescent formation in glomeruli

RPGN or crescentic glomerulonephritis

30

Glomerular diseases: Segmental sclerosis and hyalinosis

FSGS

31

Glomerular diseases: Purpura on arms & legs, Ab pain, IGA nephropathy

HSP

32

Glomerular diseases: Apple green birefringence w/ Congo red stain under polarized light

Renal amyloidosis

33

Glomerular diseases: Positive ANCA

Crescentic glomerulonephritis (aka RPGN)

34

Glomerular diseases: dsDNA antibodies

Lupus nephropathy

35

Glomerular diseases: spike and dome of basement membrane

Membranous glomerulonephropathy

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