Genioutinary #2 Flashcards by Marco DiFederico

big 3 kidney function tests

serum creatinine
blood urea nitrogen (BUN)
glomerular filtration rate (GFR)

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acute kidney injury (AKI) definition

Abrupt decline in renal function leading to increased nitrogenous waste products normally excreted by the kidney

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acute kidney injury characterized by (2)

azometmia (increased BUN and creatinine)

abnormal urine volume (can manifest as anuria or oliguria)

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etiology of hyponatreamia (serum Na+ <135 mmol/L)

diuretics (especially THIAZIDES)
diarrhea
excessive sweating

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etiology of hypernatremamia + what is it

reduced fluid intake, increased fluid loss

serum (NA+) >145 mmol/L

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hypokalemia etiology (serum K <3.5 mEq/L)

limited dietary intake
GI losses (diarrhea, laxatives)
hyperaldosteronism (e.g Conn's syndrome)

DIURETICS (FUROSEMIDE, HYDROCHLOROTHIAZIDE)

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big sign and symptom change of hypokalemia

arrythmias, found on ECG CHANGES**

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hyperkalemia etiology (serum K >5.0 mEq/L(

factitious (sample hemolysis)
renal failure

MEDS - NSAIDs, ACEI, Angiotensin 2 receptor blockers, heparin, spironolactone

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symptoms of hyperkalemia

usually asymptomatic, but will see ECG changes and cardiotoxcity

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what is key aspect of nephrotic syndrome

protienuria > 3.5g/day

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Hallmark of NEPHRITIC syndrome

(RBCs in urine) aka hematuria

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clinical features of nephritic syndrome (3)

Proteinuria (<3.5g/day)
Hematuria
Azotemia (increased creatine and urea)

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Post Streptococcal Glomerulonephritis (PSGN) cause? + age

group A beta hemolytic streptococci (strep pyogenes)

5-15years old

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PSGN hallmark sign

Gross hematuria (coca-cola or tea colored, brown, smoky) urine

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important investigation (aside from urinalysis and kidney function) for PSGN

Elevated Antistreptolysin O (ASO) titer

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NSAIDs and vasomotor acute kidney injury, what do NSAIDs cause

renal ischemia (sad!)

tx: discontinue NSAIDs

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NSAIDs and Acute Interstitial Nephritis (AIN) – what primarily does this?

Fenoprofen (60%), ibuprofen, naproxen

tx: discontinue NSAIDs!

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symptoms of Acute Interstiail Nephritis (AIN)

fever and rash shortly after first dose of medication

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What is Chronic Interstitial Nephritis caused by with meds

excessive antipyretics (PHENACETIN or ACETOMINOPHEN) in combination WITH NSAIDs!!!

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Chronic Interstitial Nephritis clinical symptoms

gross hematuria, flank pain, declining renal function

Actue tubular necrosis is caused by what med?

acetaminophen

symptoms and investigation for Acute Tubular Necrosis

mental status change, edma, fatigue, nausea + vomiting

Urinalysis, MUDDY BROWN CASTS***(dead tubular cells)

treatment for acute tubular necrosis

dialysis..

what is def of chronic kidney disease (2)

Progressive decrease of kidney function >3m

Decreased GFR <60ml/min

What is end stage kidney disease and what is needed at that point

Stave V= GRF<15 dialysis and transplantation will be required

end stage renal disease presentatiojn (4)

volume overload - weight gain + edema electrolyte abnormalities (High K, PO4, uric acid: LOW, ca2, hco3) retention of urine anemia, normocytic anemia due to decreased EPO and treatrment will be EPO replacement

normocytic anemai treatment for end stage renal disease

erythropoietin replacement therapy

2 types of cystic kidney disease

simple cysts (50% at 50) polycistic kidney disease --> 2 types, autosomal recevessive leads to renal failure in kids, while autosomal dominant causes renal failure in adults

most common adult kidney neoplasm?

renal cell carcinoma

what are the 3 subtypes of renal cell carcinomas + % + which are in pros tuvule

1. Clear cell renal cell carcinoma (70-75%) 2. Papillary renal cell carcinoma (10-16%) ^both in prox tubule^ 3. Chromophobe renal cell carcinoma (%)

hereditary renal cell carcinoma is related to?

Von Hippel_lindau (VHL) syndrome (and hereditary papillary renal carcinoma)

Von Hippel Lindau disease manifested by?

retinal angiomas, central nervous system hemangiomas, and ccRCC

VHL gene does what?

under hypoxic conditions or if inactivated the number of proangiogenic and growth factors are produced with increase tumor and endothelial cellular proliferation and angiogenesis

classic too late triad in renal cell carinoma

gross hematuria, flank pain, palpable mass

most common sites of renal cell carcinoma metastases

bone, brain, lung, and liver (1/3 of cases do)

investigations for renal cell carcinoma (aside from CBC, ESR, Urine)

contrast-enhanced CT: highest sensitivity renal biopsy

treatment for renal cell carcinoma (3)

radical nephrectomy patrial nephrectomy tyrosine kinase inhibitors for metastatic disease (Sunitinib, sorafenib)

Prognosis at diagnosis for renal cell carcinoma (T1, T2/3, metastasis)

STAGE = Most important prognostic factor T1: 90% 5 yr survival T2: 60% 5 yr survival Mets: <5% 10 yr survival ):

main risk factor for bladder carcinoma

smoking (implicated in 60% of cases)

bladder classification (most common?)

Urothelial carcinoma (>90%)

Clinical features of bladder carcinoma

Hematuria is KEY SYMPTOM 85-90% of the time at diagnosis pain 50% of time

bladder cancer gold standard investigation

Transurethral resection of bladder tumor (TURBT) 2nd best- cystoscopy with biopsy

Benign prostatic hyperplasia - what will you find on digital rectal exam

prostate is smooth, rubbery, and symmetrically enlarged

investigations for BPH

PSA <4 (normal) PSA>10 (consider prostate cancer) between 4 and 10 is grey zone -physical exam (DRE)

Prostate Cancer - Digital Rectal Exam finding

hard, irregular asymmetrical nodule

MC cause of prostatitis

E. Coli

Lower urinary symptoms (as they relate to prostatitis) are?

Storage symptoms (Frequency, Urgency, Nocturia, Dysuria) & Voiding Symptoms (Stream changes, Hesitancy, Incomplete Emptying, Dribbling

Etiology of chronic Prostatitis bolded term

Recurrent UTI with same organism