GU Pearls - Sheet1 Flashcards by yenna chin

Eosinophils, WBC casts and hematuria

Interstitial nephritis. Usually an allergic reaction to a drug. Dx: renal biopsy - will see interstitial inflammatory cell infiltrates. Tx: discontinuing offending drug, corticosteroids, Dialysis if needed, usually self limiting if caught early

How well did you know this?

Not at all

Perfectly

FENa > 2% + MUDDY, PIGMENTED, GRANULAR CASTS, Renal tubular epithelial cells, + High Urine Osmolality

Acute tubular necrosis (ATN) - Often caused by Ampho”terrible”, contrast, NSAIDs. –Damage to the tubules means you are unable to concentrate urine which means a high FENa

How well did you know this?

Not at all

Perfectly

Hematuria and RBC casts

glomerulonephritis

How well did you know this?

Not at all

Perfectly

Causes of glomerulonephritis

1)Autoimmune; 2)Post streptococcal = (+) ASO Titer;

How well did you know this?

Not at all

Perfectly

Broad waxy casts in urinary sediment

Chronic renal failure

How well did you know this?

Not at all

Perfectly

Measurement of ______ is the gold standard for diagnosing and following the progression of chronic renal failure

GFR - Glomerular filtration rate. Measurement of GFR is the gold standard - The Cockcroft - Gault formula (requires age, body weight and serum creatinine) or Modification of Diet in Renal Disease equation

How well did you know this?

Not at all

Perfectly

What is the GFR for Chronic Renal Failure

Typically applied to patients with GFR < 60 mL/min

How well did you know this?

Not at all

Perfectly

TRIAD: Hematuria + pretibial edema + hypertension

Glomerulonephritis

How well did you know this?

Not at all

Perfectly

Peaked T-Waves

Hyperkalemia

How well did you know this?

Not at all

Perfectly

Flattening of T waves, U wave

Hypokalemia

How well did you know this?

Not at all

Perfectly

Long QT

Hypocalcemia - Low and “slow” calcium has a long QT

How well did you know this?

Not at all

Perfectly

Short QT

Hypercalcemia; “hyper” fast calcium can shorten the QT

How well did you know this?

Not at all

Perfectly

Tall T wave

Hypomagnesemia

How well did you know this?

Not at all

Perfectly

Prolonged PR, Widened QRS

Hypermagnesemia

How well did you know this?

Not at all

Perfectly

How does chronic renal failure effect serum phosphate and calcium levels

Hyperphosphatemia (lack of urinary secretion) and Hypocalcemia. **(An impaired gastrointestinal absorption, related to low 1,25-dihydroxyvitamin D3 levels, and a decreased renal excretory capacity may render chronic kidney disease (CKD) patients at risk for either a negative or a positive calcium balance). Increased PTH and osteoporosis

How well did you know this?

Not at all

Perfectly

Young child with massive edema. Urine showing gross protein, no casts and oval fat bodies on microscopy hypoalbuminemia, hyperlipidemia and lipiduria

Nephrotic syndrome

How well did you know this?

Not at all

Perfectly

Nephrotic syndrome is defined as urinary excretion of greater than ___________ of protein on a 24 hour urine.

Nephrotic syndrome is defined as urinary excretion of > 3 g of protein on a 24 hour urine due to a glomerular disorder plus edema and hypoalbuminemia. –Proteinuria occurs because of changes to capillary endothelial cells, the glomerular basement membrane (GBM), or podocytes, which normally filter serum protein selectively by size and charge

How well did you know this?

Not at all

Perfectly

Child with idiopathic nephrotic syndrome improves after treatment with corticosteroids

Minimal change disease - Most common cause of nephrotic syndrome in children (25% of adult cases) Usually idiopathic. Dx: renal biopsy

How well did you know this?

Not at all

Perfectly

Non diabetic adult with nephrotic syndrome and history of cancer

Membranous nephropathy- Most common cause of nephrotic syndrome in adults. Immune mediated with immune complex deposition. Secondarily associated with hep B, syphilis, lupus, carcinoma and several others

How well did you know this?

Not at all

Perfectly

Adult with nephrotic syndrome and history of heroin or cocaine abuse and HTN

Focal segmental glomerulosclerosis- More nephrotic than others with RBCs. Tx: prednisone. ESRD in 5-10 years

How well did you know this?

Not at all

Perfectly

Nephrotic syndrome - glomeruli fill with amorphous deposits that stain with Congo red showing green birefringence

Amyloidosis- Accumulation of protein in various organs. ESRD in 2-3 years with five year survival < 20%

How well did you know this?

Not at all

Perfectly

Is the FENa (fractional excretion of sodium) low normal or high in acute tubular necrosis?

High- Damage to the tubules means you are unable to concentrate urine which means a high excretion of sodium into the urine

How well did you know this?

Not at all

Perfectly

Is the FENa (fractional excretion of sodium) low normal or high in pre renal failure?

Normal- Tubules work fine and are concentrating ue urine normally so you have a normal FENa

How well did you know this?

Not at all

Perfectly

Elevation of the testicle relieves the pain

a positive Prehn’s sign seen in epididymitis

How well did you know this?

Not at all

Perfectly

What urinalysis findings are consistent with acute tubular necrosis?

Muddy casts and renal tubular cells

Which type of acute renal injury is most likely following injection of radiocontrast dye?

Acute Tubular Necrosis (ATN)

What is the most common cause of prerenal failure?

Dehydration

What type of incontinence results from activity such as laughing or coughing?

Stress incontinence

What type of incontinence results from an over active detrusor muscle?

Urge incontinence

What are the most common causative agents for prostatitis in an 15-30 year old male?

Chlamydia and/or gonorrhea

What is the most common causative agent for prostatitis in an elderly male?

E. Coli

What nephropathy is associated with lupus and +ANA

Membranous nephropathy

The most common type of bladder cancer

Transitional cell carcinoma

Patient presents with flank pain and a palpable flank mass

Renal cell carcinoma

Name the two most common causes of nephrotic syndrome

Focal Segmental Glomerulosclerosis (FSGS) - Membranous glomerulonephritis

The most common type of kidney stone

Calcium oxylate

Inability to retract the foreskin from the penis

Phimosis

Inability to return foreskin to normal position causes tourniquet effect, is a medical emergency

Paraphimosis

Facial muscle contracts in response to tapping of the facial nerve

Chvostek's sign - seen in patients with hypocalcemia

Described as Bag of worms in scrotum?

Varicocele

Most common presentation for bladder carcinoma?

Painless hematuria

Proteinuria and fatty casts in urine

Nephrotic syndrome

Antineutrophilic cytoplasmic autoantibodies (ANCA)

Wegener's granulomatosis

Name the most common type of renal cell carcinoma

Clear Cell

Most common mechanism of acute renal failure? Prerenal, renal or postrenal

Prerenal- will have a low FENa < 1 (kidney has decreased perfusion which results in ↑ aldosterone and NA+ retention in an attempt to increase pressure) Since sodium is retained you will have a low to normal amount of sodium in the urine.

What type of nephropathy is associated with carcinomas?

Membranous nephropathy

Most common type of kidney damage associated with HIV?

Focal Segmental Glomerulosclerosis (FSGS) presenting as nephrotic syndrome

A 33 year old female presents with persistent hypertension refractory to medical treatment with ≥ 3 drugs. She has an abdominal bruit on exam

Think Renal Artery Stenosis

In hyponatremia serum Na should be corrected slowly by no more than ____________ 24 h to avoid osmotic demyelination syndrome

≤ 10 mEq/L = Except possibly during the first few hours of treatment of severe hyponatremia, Na should be corrected no faster than 0.5 mEq/L/h

Hyponatremia is defined as plasma sodium concentration less than ____________ mEq/L

135 mEq/L

Definition of hypernatremia

By definition, plasma sodium will be greater than 145 mEq/L

Deficient secretion of vasopressin (ADH - anti-piss-hormone) from the posterior pituitary

Neurogenic (central) diabetes insipidus

kidneys that are unresponsive to normal vasopressin levels

Nephrogenic diabetes insipidus - Usually inherited X-linked or from lithium or renal disease

What is the treatment for asymptomatic hyponatremia?

Fluid restriction

Transitional cell carcinoma

bladder cancer

Clear cell carcinoma

renal cell carcinoma

Most common type of testicular cancer

seminoma- Seminomatous tumors are radiosensitive and can be treated with radiation therapy. --Nonseminomatous tumors are radioresistant

What PSA level is considered elevated

PSA > 4 think BPH, prostate CA and prostatitis

When to start screening for prostate cancer

White male average risk: 50 years old - Black male, + FMHX or + BRCA mutations: 40 years old

Which of the following tumor markers can be used to identify early relapse in testicular cancer?

Alpha fetoprotein (AFP)

Child with painless, unilateral abdominal mass with no other signs of symptoms

Wilms tumor- also known as nephroblastoma, is the most common solid renal tumor of childhood. Most cases of Wilms tumor are curable

Treatment of lower UTI in pregnancy

Nitrofurantoin (Macrobid): 100 mg PO BID × 7 days 0r Cephalexin (Keflex): 500 mg PO BID × 7 days

Urinalysis reveals crystals resembling coffin lids. KUB reveals a staghorn calculus in the right kidney

Struvite stones

When to refer for orchiopexy in a patient with cryptorchidism

If still non-palpable at 6 mo well-child exam, refer to urology/surgery for evaluation and possible orchiopexy

Asymmetric high riding testicle "bell clapper deformity"

Testicular torsion

Hyaline casts

non-specific may be seen in normal urine

Fatty casts and oval fat bodies

nephrotic syndrome due to hyperlipidemia

Waxy casts

chronic renal failure - likely chronic ATN or glomerulonephritis

WBC casts

Acute interstitial nephritis or pyelonephritis

muddy brown fasts or epithelial casts

acute tubular necrosis

RBC casts

acute glomerulonephritis

Three Step Approach to Acid Base Disorders

1)Look at PH is it acidosis or alkalosis (7.35-7.45 is normal);< 7.35 = acidosis; > 7.45 = alkalosis. 2)Look at your PCO2 is it normal, low, or high (35-45 normal); ↑ CO2 and ↓PH = respiratory acidosis; ↓ CO2 and ↑ PH = respiratory alkalosis. 3)If you don't see a change in the CO2 in relation to the PH then take a look at the HCO3. 4)Finally look at the HCO3 is it normal, low, or high (20-26 normal); ↓ HCO3 and ↓PH = metabolic acidosis; ↑ HCO3 and ↑ PH =metabolic alkalosis

A patient with the following ABG has what type of acid-base disorder? PH 7.52 (7.35-7.45 normal); PCO2 25 (35-45 normal); HCO3 22 (20-26 normal)

A high PH means this is alkalosis. Next look at the PCO2 it is not normal and is low. Therefore this is a RESPIRATORY ALKALOSIS.

Elevated BUN disproportionate to Creatinine indicates?

The ratio is predictive of prerenal injury when BUN:Cr exceeds 20 or when urea:Cr exceeds 100. In prerenal injury, urea increases disproportionately to creatinine due to enhanced proximal tubular reabsorption that follows the enhanced transport of sodium and water.

Fever and Oliguria after kidney transplant

Acute rejection

GU Pearls - Sheet1 Flashcards

(75 cards)