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Genitourinary & Reproductive System > Nephrology: Renal & Urological System > Flashcards

Nephrology: Renal & Urological System Flashcards

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1
Q

What kidney tumor affects men twice as much as women and is associated with cigarette smoking and cadmium exposure?

A

Renal Cell Carcinoma

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2
Q

What is the classic triad of renal cell carcinoma?

A

Macroscopic hematuria
Flank pain
Palpable abdomina

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3
Q

How is renal cell carcinoma diagnosed?

A

CT with contrast or MRI
Biopsy

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4
Q

What are the common signs and symptoms of bladder cancer?

A

Unexplained hematuria; painless
Dysuria
Frequency/Urgency
Urination”burns”
Pyuria (pus in urine)
Pelvic Pain
*Fatigue, weight loss, anorexia

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5
Q

What is the hallmark of glomerular disease?

A

Proteinuria and cellular elements (casts, WBCs, and RBCs) in the urine

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6
Q

What is acute glomerulonephritis also known as?

A

Acute nephritic syndrome

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7
Q

What are the causes of acute glomerulonephritis?

A

1) Post-infectious: Most commonly post strep infection (1-6 weeks), but may be caused by other bacteria, virus, or fungi
2) Systemic causes: Vasculitis, SLE
3) Renal Disease: IgA nephropathy

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7
Q

What are some of the signs and symptoms of acute glomerulonephritis?

A

Abrupt onset
Systemic: Lethargy, malaise, anorexia, low grade fever, flank pain
Hematuria
Oliguria
Mild to Moderatet Hypertension
Edema

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8
Q

What lab findings would you expect with acute glomerulonephritis?

A

1) Urine: Smokey or grossly bloody urine, RBC casts, mild proteinuria, RBCs, WBCs
2) Metabolic: Elevated BUN, elevated creatinine
3) Elevated ESR
4) Elevated antistreptolysin- O antibody titer

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9
Q

What is pathognomonic for acute glomerulonephritis?

A

Red Blood Casts

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10
Q

What is the definition of chronic glomerulonephritis?

A

A clinical syndrome marked by irreversible and progressive diffuse fibrosis of the glomerulus with proteinuria, hematuria, HTN and an insidious loss of renal function

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11
Q

What glomerular disease affects young males and is marked by lung and renal hemorrhage with hemoptysis and hematuria?

A

Goodpasture’s Syndrome: a group of acute illnesses that affects the lungs and kidneys.

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12
Q

What are the signs and symptoms of nephrolithiasis?

A

Many are silent; asymptomatic until stone starts to move:
1)Pain: Disabling, sharp, colicky or spasmodic pain which starts in the flank and radiates down to the thigh, labia or testes
2) Nausea/Vomiting
3) If in ureter or bladder can cause dysuria, frequency and urgency

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13
Q

What type of renal calculi can be seen with x-ray?

A

Most stones except for pure uric acid stones are radiopaque

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14
Q

What is the most common type of renal calculi?

A

75-85% are Calcium oxalate or calcium phosphate

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15
Q

What diagnostic test is done first before pyelography or urography is done?

A

A scout KUB

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16
Q

What herbs are indicated for nephrolithiasis?

A

Urtica dioica
Eupatorium purpurea
Vaccinium myrtillus
Taraxacum officinalis Leaf
Solidago canadensis
Viburum spp.

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17
Q

Which stone is associated with Proteus infections?

A

Struvite Stones; indicated UTI is present

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18
Q

What would be in the DDx for nephrolithiasis?

A

Pyelonephritis (fever, chills, pyuria, vomiting)
Ectopic pregnancy, rupture of ovarian cyst
Abdominal aortic aneurysm
Never root compression at L1
Appendicitis
Cholecystitis
Pancreatitis
Bowel Obstruction
UTI

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19
Q

What is IgA nephropathy?

A

A glomerulonephritis with IgA antibodies being deposited in the glomerulus possibly related to food allergies

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20
Q

What are the clinical findings for IgA nephropathy?

A

Symptoms appear a day after infection
Acute glomerulonephritis
Hematuria
Proteinuria
Hypertension
Renal Failure

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21
Q

How is IgA nephropathy diagnosed?

A

BUN and creatinine are normal, elevated IgA, renal biopsy

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22
Q

What are some of the causes of acute glomerulonephritis?

A

Longstanding Hypertension
Renal Insufficiency: poor renal function due to reduce blood- flow by renal artery
Proteinuria

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23
Q

What is nephrotic syndrome?

A

A collection of symptoms that result from primary or secondary damage to kidneys. Excretion of heavy amounts of protein in the urine, especially albumin.

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24
What is nephrotic syndrome characterized by?
PALE: Severe proteinuria ("frothy" urine) , >50 Hypoalbuminemia (<20) HyperLipidemia Edema Hyponatremia
25
What are the lab findings for nephrotic syndrome
Proteinuria >3.5g/24 hours Presence of granular, fatty, and waxy casts Hypoalbuminemia Hyperlipidemia
26
What type of cast is pathognomonic for nephrotic syndrome?
Fatty Casts
27
What are the diagnostic criteria for nephrotic syndrome?
Severe proteinuria and peripheral edema
28
What is the most common genetic renal disorder for children?
Polycystic Kidney Disease (PKD)
29
How does the kidney look on CT in polycystic kidneys?
Moth-eaten appearance due to multiple cysts
30
What are the signs and symptoms of polycystic kidney disease?
Often asymptomatic (discovered accidentally) Acute dull low back/flank pain Hypertension Hematuria Nocturia Abdominal Pain Kidneys may be palpable Progressive renal failure Hemorrhage
31
What would be the first diagnostic test you would do if you suspect Pyelonephritis? What might you find?
Urine Dipstick: Proteinuria, hematuria, and postive leukocyte esterase
32
What organisms are primarily responsible for pyelonephritis?
(+) *Enterococcus faecalis, S. aureus, S. saphrophyticus (-) E. coli (most common), *Klebsiella, Proteus, Pseudomonas
33
What are the signs and symptoms of pyelonephritis?
Rapid onset ( no longer than 24 hours) Frequency, Urgency, Hematuria Fever, chills, nausea, vomiting, abdominal pain Malaise, myalgia PE: Murphy's Punch Sign (costovertebral angle tenderness) - CVA tenderness
34
What is found on labs with pyelonephritis?
Alkaline Urine Mild proteinuria, bacteria, WBCs, and RBCs in urine Urine culture show >100,000 organism/ml White cell casts
35
What is pathognomonic urine finding indicating pyelonephritis?
WBC casts
36
What is the definition of acute renal failure?
Kidney lose ability to properly filtrate and remove waste products from the blood. Also, lose ability to produce normal urine (volume and composition) *Increase azotemia with or without oliguria
37
What is azotemia?
Increase BUN and creatinine
38
What is the most common causes of acute renal failure?
Trauma: hemorrhage, burns, sepsis Drugs, toxins Excessive use of diuretics
39
What are some less common causes of acute renal failure
Acute glomerulonephritis Acute tubular necrosis SLE Goodpasture's Drug RXN
40
What are some causes of pre-renal acute renal failure?
Pre-renal severe drop or abruption in blood pressure/flow: Inadequate renal perfusion Extra cellular volume depletion Hemorrhage
41
What are some causes of post-renal acute renal failure?
Post-renal: sudden obstruction of urine flow due to Obstruction from calculi Englarged prostate Cancer
42
What are some causes of instrinsic acute renal failure?
Instrinsic is due to direct damage to the kidneys Prolonged renal ischemia Nephro-toxins Acute glomerulonephritis Tubular necrosis
43
What are the signs and symptoms of acute renal failure?
Edema and weight gain HTN Uremia/Azotemia: anorexia, N/V, weakness Oliguria, anouria, polyuria, or normal urine output
44
What would be seen on labs in acute renal failure?
Elevated BUN, creatine Elevated K, pCO2 Reduced Na Normochromic, normocytic anemia Urine: RBCs, WBCs, proteinuria, cast (may be present)
45
What lab test is diagnostic for acute renal failure?
A progressive daily rise in serum creatinine
46
What is the prognosis in acute renal failure?
50% fatal
47
What is the most dangerous outcome of taking NSAIDs in regard to the kidney?
Acute Renal Failure
48
What is the definition of chronic renal failure?
A slow, progressive loss of kidney function (months-years). Irreversible damage showing waxy casts in urinalysis A pathological state of loss of kidney function; insufficiency and derangement of renal excretory and regulatory function which is known as uremia.
49
What are the main causes of chronic renal failure?
Diabetes Mellitus HTN or CVD PKD Chronic pyelonephritis Connective Tissue Disorders: SLE, scleroderma
50
What are some the symptoms of early chronic renal failure?
1) Early stage is usually asymptomatic until GFR <30mL/min 2) Nocturia 3) Lassitude 4) Fatigue 5) Reduce mental acuity
51
What are some of the symptoms of advanced chronic renal failure?
1) Muscle spasms and cramps 2) Peripheral neuropathies 3) Bad taste in the mouth 4) N/V, Anorexia and weight loss 5) Pruritus 6) GI ulcers and bleeding 7) Generalized tissue wasting 8) HTN, CHF, acidosis, anemia 9) Uremic frost on the skin
52
What is seen on labs in chronic renal failure?
Elevated BUN and creatinine Metabolic Acidosis: Normal or Decreased Na, Ca, CO2, Increased K
53
What is seen on urinalysis with chronic renal failure?
Waxy casts
54
What autosomal dominant disease is characterized by normal or low blood sugar due to persistent excretion of glucose in the urine?
Renal Glucosuria: glucose in urine WITHOUT high blood sugar
55
What conditions are all considered a lower UTI?
Cystitis Urethritis Acute Prostatitis
56
What are the signs and symptoms associated with a lower UTI?
Dysuria Frequency/Urgency Nocturia Suprapubic pain Hematuria Incontinence Cloudy Urine
57
What findings on a urinalysis are synonymous with UTIs?
(+) Nitrites (+) Leukocyte esterase (+ or -) RBCs
58
What herbs are indicated for treating and preventing UTIs?
Vaccinium myrthillus Berberis spp. Galium Aparine Althaea Officinalis Taraxacum officinalis leaf Urtica dioica leaf Arctostaphylos uva-ursi Juniperus communis Equisetum Arvense
59
What are some of the homeopathic remedies to consider for UTIs?
Cantharis Equisetum
60
What acute homeopathic remedy is indicated for cystitis, especially in young women who are sexually active?
Staphysagria
61
What are the signs and symptoms of interstitial cystitis?
Interstitial Cystitis: Inflammation of the bladder not from an infectious cause Persistent discomfort in bladder when full Discomfort is relieved when emptying the bladder Urinary Frequency, urgency Dysuria Negative urine culture Suprapubic and/or pelvic pain Symptoms present for more than 6 weeks *Symptoms commonly get aggravated by full bladder, menstruation, emotional stress, sex and eating foods high in potassium*
62
How do you diagnose interstitial cystitis?
Diagnosis of exclusion, Hunner's ulcers are only found in approximately 10% of cases Hunner's ulcers in cystoscopy (gold standard of dx)
63
What types of foods may irritate interstitial cystitis?
Artificial sweeteners, alcohol, acidic foods, caffeine, carbonated drinks
64
What is the most common cause of urethritis?
Urethritis: Inflammation/infection of the lining of the urethra Gonococcal Urethritis: N. Gonorrhoeae Non-gonococcal Urethritis: Chlamydia Trachomatis

Genitourinary & Reproductive System (3 decks)

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