Neph Flashcards
(97 cards)
1
Q
What are the bugs for acute cystitis?
A
e coli enterococcus klebsiella pseudomonas enterobacter
2
Q
How does the bacteria grow?
A
colonizes in the urethra and works its way down the bladder
3
Q
Child has acute cystitis - PE?
A
strong smelling urine
suprapubic pain
bloody urine
4
Q
What are acute cystitis PE for adult?
A
increase freq Burning Itching Dysuria Suprapubic pain
5
Q
What to expect on urine dipstick for acute cystitis?
A
(+) uluekocyte esterase
(+) nitrite
6
Q
What does leukocyte esterase mean? nitrite?
A
leukocyte esterase - pyruia - WBC present
nitrite - bacteria present
7
Q
When should you do a urine C&S?
A
acute cystitis suspicion is HIGH but sx are not classic
8
Q
When should you do a US in acute cystitis?
A
MALE children w/UTI
GU anomalies
9
Q
When should you do a VCUG in acute cystitis?
A
recurrent in FEMALE CHILDREN
10
Q
How to tx acute cystitis- uncomplicated?
A
bactrim DS BID x3days
cipro/levofloxacin - fluoroquinolone
ceftriaxone - 3rd gen
11
Q
How to acute cystitis -complicated/pregnant?
A
nitrofurantoin BID x5-7days
ampicillin
amoxicillin
oral cephalosporin
12
Q
How to acute cystitis - complicated/men?
A
bactrim DS BID x7days
13
Q
What should ALWAYS be added when tx acute cystitis?
A
pyridium (phenazopyridine) x2-3days to control BURNING/pain
14
Q
What should be warned about pyridium?
A
urine turning orange - shows that meds are working
15
Q
How to prevent acute cystitis?
A
cranberry juice
pee after sex
shower>bath
16
Q
What are bugs for pyelonephritis? Why?
A
e coli klebsiella enterobacter pseudomonas same as acute cystitis b/c it is a bug that works UP from the bladder to KIDNEY
17
Q
What are the types of pyelonephritis?
A
emphysematous
xantogranulomatrous
18
Q
What is emphysematous in pyelonpehritis?
A
gas in renal tissues
19
Q
What is xantogranulomatrous?
A
occurs w/ obstruction
leads to tissue destruction
20
Q
What PE to expect in pyelonephritis?
A
FEVER
N/V
CVA tenderness
21
Q
What labs to run in pyelonephritis?
A
UA - WBC casts + proteins
UA+C&S
BC
22
Q
How to tx uncomplicated pyelonpehritis?
A
fluroquinolone x5-7days
augmentin x14days
23
Q
How to tx complicated pyelonephritis?
A
IV fluids
ampicillin + gentamicin/cipro
24
Q
Pt has bladder pain that is relieved w/ urination? What to expect on UA and C&S?
A
interstitial cystisis
neg urine dipstick
neg culture
25
How to tx interstitial cystisis?
lifestyle changes
bladder training
refer
26
Pt has post dribbling of urine and decrease force?
urinary track obsturction-post renal
27
What is post renal problems?
stones
strictures
tumor
FB
28
What labs to run for urinary tract obstruction?
KUB
CT
US
UA w/ C&S
29
Tx urinary tract obstruction?
surgery
30
What are the types of nephrolithiasis?
hypercalcicuria
hyperoxaluria
urate/cystine
struvite/staghorn
31
What is hypercalcicuria?
secondary prob to hyperparathyroidism
| renals are unable to reabsorb Ca
32
How to tx hypercalcicuria- parathyroid? -renals?
resect parathyroid
| renals: TZD longterm
33
Pt had stones as a child-Type of nephrolithaisis? Tx?
hyperoxaluria-primary
| tx: low fat, oxalate diet
34
Pt had gastric bypass w/chronic diarrhea-type of nephrolithasis? Tx?
hyperoxaluria-enteric
| tx: ca supplements
35
Pt has gout w/ stones-type of nephrolithiasis? Expect pH to be? Tx?
gout
| pH
36
Pt has recurrent UTI-type of nephrolithiasis? pH?
struvite/staghorn
| ph> 7.2
37
Pt is in fetal position + flank pain radiating to groin?
nephrotlithiasis
38
When to admit nephrolithiasis?
```
vomiting
UTI
pain
Stone is >6mm via US
impaired renal fxn
```
39
How can UA pH help determine what type of nephrolithiasis? What other labs to order?
pH 7.2 - struvite/staghorn
| order CT
40
How to tx nephrolithiasis?
```
pass on own IF 5-7mm
fluids
pain control
abx for infxn
if bigger then 7mm - surgery (lithotripsy, uretroscopy) + flomax
```
41
What to tell pts if treating outpt?
50% pass sponatenously w/48hrs
| 50% can reoccur w/in 5yrs if not txd
42
How can acute kidney injury be categorized into?
pre renal
intrarenal
post renal
43
What are types of pre renal AKI?
hypoperfusion/hypovolemia
trauma
artery stenosis
CHF, NSAID --> INCREASE IN VASOCONSTRICTION
44
What are types of intrarenal AKI?
tubulointerstital disorders
- tubular injury (amniglycosides, NSAID, vancomyocin, contrast, ACUTE TUBULAR NECROSIS)
- interstitial nephritis
- glomerular disorder
45
How to differeniate between prerenal and intrinsic?
FEna
46
What labs to order in AKI?
BUN and Cr - increased in both
47
How to tx prerenal AKI?
IV fluids
48
Pt has SUDDEN HTN? What to expect on PE?
renal artery stenosis
| bruit @ L1 + L2
49
Imaging for renal artery stenosis?
renal angiogram - gold standard
| CT
50
How to tx renal artery stenosis?
stents
bypass
anioplasty
51
What is glomerulonephritis type of AKI?
intrinsic
52
What are the types of glomerulonephritis?
nephrotic and nephritic
53
How to differentiate nephrotic and nephritic - looking at it?
nephrotic - frothy
| nephritic - bloody
54
Which is more likely AKI then CKD - nephrotic or nephritic?
nephrotic - chronic
| nephritic - acute
55
In adults, nephrotic can be secondary d/t?
DM
56
Pt has HTN and mild edema - nephritic/nephrotic?
nephritic
57
Pt has edema - nephritic/nephrotic? Why?
nephrotic b/c of the increase protein leaving the body
58
What to expect for labs and UA on nephrotic?
HYPOalbuminemia-protein is all pee'd out
| UA- lipiduria and protein
59
What to expect for labs and UA on nephritic?
LOW GFR - cxing the HTN
| UA: rbc casts
60
How to tx nephrotic?
sx based:
protein leakage - ACE /ARB
hyperlipidema - statins
hypercoaguble - warfarin
61
How to tx nephritic?
corticosteroids
| ACE for HTN
62
What are probs that nephrotic can lead to?
minimal change
membranous
focal segmental
63
What are probs that nephritic can lead to?
```
IgA /berger
membranoproliferative
rapidprogressive/crescentic
post infectious
pauci-immune/ANCA/WEgners/Chrugstrause
good pasture
alport syndrome
```
64
Child had post URI and now has lipiduria? How to differentiate?
minimal change OR focal segmental -nephrotic
| bx
65
Why is differentiating minimal change and focal segmental important? How to tx?
minimal change does NOT lead to ESRD but focal does
| tx: corticosteroid in both; focal - renal transplant
66
Adult has edema + cloudy urine? Tx? Prognosis?
membranous
tx: corticosteroid +/- renal transplant
prognosis: 1/3 spontaneous remission; 1/3 relapse but GFR is ok; 1/3 ESRD
67
Child has post URI and hx of hematuria? What to expect on PE?
IgA/berger
| PE: henoch-schnlein purpura - DOES NOT BLANCH
68
What labs for IgA and tx?
IgA will be high
UA: hematuria
tx: mild-supportive; mod: ACE/ARB; high - corticosteroid for 6mo; ESRD - renal transplant
69
Pt has fever + post strep A 3wks ago? How to dx?
post infxn
serum-ASO
UA- RBC casts
70
How to tx post infxn? Prognosis?
tx strep A and DO NOT USE CORTICOSTEROIDS
| children have better prognosis; adults have ESRD 10-20yrs
71
What are the post URI + renal probs?
IgA/berger
pauci immune: ANCA
goodpasture
72
What are the types of pauci immune: ANCA? What is ANCA-nephrotic or nephritic?
C ANCA- wegners
P ANCA
Churg strause - eosinophils
nephritic
73
What s ANCA associated with?
RPGN -rapidly progressive GN
74
Pt has post URI + hemotypysis?
wegners OR goodpasture
75
Pt has post URI + asthma? What else to expect on PE?
churg strauss
| PE: purpura
76
What to expect on bx for ANCA?
necrotizing lesions + crescents
77
How to tx ANCA?
plasmpharesis/plasma exchange
78
How to differentiate between wegners and goodpasture?
blood - wegners: ANCA; goodpasture: anti GBM antibodies
79
What to expect on bx for goodpasture?
crescent
| linear igG immunofluroscence
80
How to tx goodpasture?
plasma exchange
| corticosteorids
81
Pt has hearing loss and vision loss? How to dx? Tx?
alport syndrome
dx: bx
tx: transplant
82
Pt has proteinuria AND hematuria? What are the types?
membranoproliferative glumerulnephritis
type I - secondary to chronic infxn
type II - inherited
83
How to tx membranoproflierative glumerulnephritis?
type I - tx chornic infxn
| type II - corticosteroids + renal transplant
84
Which renal probs can you tx with corticosteroids?
membranoproliferative
good pasture
all ANCA (wegners, churg-strauss)
85
What are the types intrinsic AKI?
acute tubular necrosis
| acute interstitial nephritis
86
Pt has muddy brown urine, casts and epithelial cells + casts? What to expect on lab results? How to tx?
acute tubular necrosis
blood: high K b/c Na is NOT absorbed into body so K is high
FEna >1
87
How to tx acute tubular necrosis? What to avoid?
hemodialysis
| avoid: diuretics, proteins, mg antacids
88
Pt has fever + rash + NO edema + hematuria? Cx?
acute interstitial nephritis
| d/t drug hypersensitivity
89
Labs for acute interstitial nephritis? Tx?
Eos
WBC casts
Tx: corticosteroids
90
Pt has Dm and HTN + edema in LE? What to expect on labs?
chronic kidney dz
ua: casts and proteins
blood: HIGH BUN/Cr
91
How to tx chronic kidney disease?
ACE/ ARB/ CCB to control DM and HTN
92
Pt has abdominal mass + flank pain + HTN? How to dx?
polycystic kidney dz
| dx: US
93
What renal dz are genetically related?
IgA/berger
polycystic kidney dz - autosomal dominant
wilms' tumor
94
How to tx polycystic kidney dz?
renal transplant
95
Pt has flank pain + abdominal mass + hematuria? What other sx could they have?
renal cell carcinoma
anemia - d/t decrease of erythopoiten
osteoporosis - d/t decrease of Ca absoprtion
96
Labs for renal cell carcinoma will show? Tx?
blood - hypercalcemia
nephrectomy
chemo is not effective
97
Child has painless abdominal mass? How to tx?
wilm's tumor
surgery
chemo is very effective
