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Flashcards in Renal Deck (120)
1

RBC casts

Glomerular disease, vasculitis

2

WBC casts

interstitial nephritis, pyelonephritis

3

ATN

Hypovolemia, urine Osm >300, urine Na >20, FE Na>2% -------> MUDDY BROWN casts/epithelium

4

CRF casts

Broad and waxy

5

EOSINOPHILIURIA, WBC casts, hematuria, rash, arthralgias

Drug-induced interstitial nephritis = lymphocytic or eosinophilic infiltration

6

Uncomplicated cystitis tx

Nitrofurantoin 5d, TMP-SMX 3d, Fosfomycin

7

Complicated cystitis tx (DM, CKD, obstruction, cath)

Fluoroquinolones + culture

8

Gross hematuria

Bladder cancer

9

Recurrent hematuria, child, deafness, thick+thin capillary + GBM splitting

Alport syndrome

10

Coffin lid shaped crystals

Urease producing UTI organisms

11

Most common type in elderly/nursing home

Urge

12

Sudden need when walking, drinking, large volume, nocturnal wetting

Urge

13

Causes/mech of urge incontinence

UTI, stroke, MS, dementia, Parkinson --> uninhibited detrusor contractions

14

Dx & Tx of urge incontinence

Urodynamic - timed-voiding/training --> oxybuntin, imipramine

15

Urine leak w/ laughing, sneezing, small PVRV

Stress - weak muscles

16

Tx stress incontinence

Kegel, estrogen, pessary, urethropexy

17

Urinary incontinence in woman of childbearing age

MS - Urge or overflow

18

Incomplete emptying, dribbling, frequency, PVRV >100ml, nocturnal

Overflow

19

Causes/mech of overflow incontinence

Poor contraction (DM, anti-cholinergics, a-agonist) or obstruction (BPH, CA, constipation)

20

Tx overflow incontinence

Intermittent cath, bethanachol, a-blockers

21

Can't sense need to urinate

Reflex incontinence - SC injury >> MS, DM, disc, SC compression/tumor

22

Non-inflammatory chronic prostatitis

WBC <10

23

Inflammatory chronic prostatitis

WBC >10

24

Nocturia, difficulty starting stream, Cr 0.7, smooth firm prostate next step?

Urinalysis - hematuria/stones, infection, cancer, obstruction

25

Difficulty starting, nocturia, hesitancy, Cr 1.2 --> 2.1, smooth firm prostate next step?

Abd US --> hydronephrosis --> Foley --> TURP

26

Indication for prostate bx

Elevated PSA or nodule

27

Causes of priapism

Trazodone, prazosin, sickle cell, leukemia, SC, cauda equina, cavernous a ligation

28

Urgency, frequency, NO dysuria, difficulty starting urination, dribbling

BPH --> U/A, Cr

29

Tx for BPH

a-blocker (Tamsulosin), 5-a-reductase inhib (Finasteride), Foley --> TURP

30

Fever, N/V, + urine WBC, bacteria, tender DRE

Bacterial prostatitis --> UA & cx --> Cipro

31

Tx aseptic prostatitis

High dose NSAIDs

32

Sudden testicular pain, NO fever, horizontal testis, high riding

Testicular Torsion --> US or surgery untwist & b/l orchipexy

33

Sudden testicular pain, NO fever, bacturia, vertical, tender cord

Epidimytis --> US --> abx

34

Penis fracture work-up

Retrograde urethrogram + surgical exploration

35

Low urine pH and stone tx

Uric acid = K-citrate, limit protein

36

Hypercalciuric stone tx

HTCZ, hydration

37

Blood at end of urine stream

Bladder or prostate

38

Hematuria for entire stream

Kidney or ureter

39

Urine sodium <10, ascities, cirrhosis

Renal hypoperfusion - Pre-renal failure

40

Indication for cystoscopy

Hematuria suggesting stone, CA, stricture

41

Flank pain, hematuria

Kidney stone --> CT scan, U/S

42

Tx of kidney stone

Small 3cm = surgical; between = lithotripsy

43

Work-up of hematuria

CT scan, cystoscopy

44

Causes of acute urinary retention

anti-histamines, BPH --> cath for 3d --> a-blocker & 5-a reductase inhibitors

45

Pneumaturia work-up

Diverticulitis --> CT, sigmoidoscopy to r/o CA

46

Evaluate RLQ pain + urine crystals

Uric acid stones --> CT or IVP

47

Blood at meatus + scrotal hematoma, high riding prostate next step

Retrograde URETHROGRAM - pelvic fx

48

Hematuria + flank pain + mass

Renal cell carcinoma --> CT, bx --> resection and chemo

49

Hematuria, varicocele not empty supine, anemia + thromboytosis

RCC --> CT abd

50

Hematuria, hydronephrosis, hydroureter, smoking, b-alanine dye

Bladder CA --> US = hydro but 1st step = cystoscopy, best = bx, CT stage

51

Dribbling, urgency, frequency, difficulty starting urination

Prostate CA = 5-DHT (testosterone responsive)

52

When to get PSA

Firm, nodular DRE --> PSA for Dx

53

Work-up for Prostate CA

DRE --> PSA --> Bx rectal > urethral for Gleason score --> tx

54

Tx for prostate CA

Anti-androgens (Flutamide), GnRH analog (Leuprolide), orchiectomy, surgical +/- rads

55

Germ cell, painless mass

Testicular CA --> transilluminate fails --> orchiectomy

56

Seminoma tx

Platinum chemo + rad, follow LDH

57

Non-seminoma (yolk sac, choriocarcinoma, teratoma)

Follow AFP, b-HCG, teratomas are very malignant

58

Dialysis, excessive bleeding mech

Platelet dysfxn d/t uremic coagulopathy

59

Colicky abd pain --> stones Dx and prevention

CT --> NSAIDs --> inc hydration >2L/d, inc Ca, reduce protein, Na and oxalate in diet

60

HypoNa, low serum osmolarity, high urine

SIADH - NASAID use

61

Dehydration, HypoNa, low serum osmolarity

Mineralocorticoid deficiency

62

Indications for dialysis

HyperK, pul edema, pH<7.2, uremic pericarditis or enceph, coagulopathy

63

Associations w/ ADPKD

#1 = hepatic cysts, MVP, MR< diverticula, hernias, berry aneurysm

64

Linear deposits, anti-GBM

Goodpasture's (cytotoxic ab) --> emergency plasmapheresis

65

Contraction alkalosis, inc bicarb

Dehydration from furosemide

66

Prevent contrast induced kidney damage

Non-ionic contrast, NAC, IVFs or pre-tx w/ prednisone if allergic

67

#1 cause of death in dialysis pts

Cardiovascular (#1 overall)

68

Cell mediated injury renal disease

Idiopathic crescentic GN

69

# days after strep infection --> nephropathy

10 - pharyngitis, 21 - impetigo + LOW complement

70

Prevent urate crystal neuropathy in lymphoma and leukemia

Pre-tx w/ allopurinol

71

Hematuria, chronic headaches and analgesic use

Analgesic nephropathy --> ischemic vasa recta --> papillary necrosis

72

Primary glomerular damage -->

dec GFR --> pul edema, JVD, anasarca, proteinuria, RBCs, HTN

73

Oliguria w/ inc BUN, Cr - Acyclovir nephrotoxicity mechanism

Renal tubular obstruction - poorly soluble d/t poor hydration

74

Large amount of blood on UA but, 1 RBC on micro, hx seizure, inc Cr

Rhabdo --> myoglobinuria --> Acute RF

75

Chronic DM, HTN, 3+ proteinuria, retinopathy, Dec BUN

Diabetic nephropathy = microangiopathy

76

Recurrent stones, hexagonal crystals, + CN nitroprusside test

Cystinuria --> impaired dibasic a.a. transport

77

Benign renal cyst characteristics --> reassurance

Thin walls, simple, no enhancement, no divisions

78

1 umbilical artery assoc

Renal anomalies

79

#1 newborn abd mass

Hydronephrosis

80

Right flank mass w/ calcification + hemorrhage, weight loss, inc HVA, VMA in urine

Neuroblastoma = neural crest cells, CROSSES midline (vs. nephro)

81

ASx proteinuria only on dipstick

Repeat on 2 subsequent occasions

82

Transient proteinuria causes

Fever, exercise, volume depletion, stress, seizure

83

Nephrotic proteinuria, podocyte effacement

Minimal change --> steroids

84

Inc serum globulin, 3+ proteinuria, edema, hyperlipidemia, periorbital swelling

Minimal change --> steroids

85

Hodgkin lymphoma renal disease

Minimal change, sometimes Focal

86

HIV + HepB renal disease

Membranouns

87

Renal disease assoc w/ cancers

Membranous

88

Nephrotic, HBV infection, sub-EPIthelial deposits

Membranous

89

Nephrotic syndrome, sudden fever, hematuria, abd pain

Renal vein thrombosis = MEMBRANOUS

90

A.A. HIV

FSGS

91

Heavy proteinuria, rapid renal failure, HIV+, sickle, Black, obesity, drugs

FSGS

92

Previous URI, now hematuria, RBC casts, normal complement GN?

IgA - <5d after URI, normal complement
- Berger IgA = days after URI
- PSGN = 1-2 WEEKS after infection

93

LE purpura, abd pain, hematuria, arthralgia, scrotal swelling

HSP --> IgA nephropathy

94

RA, enlarged kidneys, hepatomegaly, proteinuria

Amyloidosis - deposits under polarized light + fat pad Bx

95

Slow diabetic nephropahy

Add ACE

96

1st renal abnormality w/ DM

Glomerular hyperfiltration --> GBM thickening --> mesangial --> nodular sclerosis

97

Kimmelstiel-wilson nodules in GBM

Diabetic nephropathy

98

Etiology of hypercoagulation in nephrotic syndrome

Dec ATIII, dec protein C, S, inc platelet agg --> #1 RV thrombosis

99

Complications of nephrotic syndrome (think about dec proteins/albumin)

Fe resistant anemia d/t transferrin loss
VitD deficiency --> HyperPTH
Dec thyroxine
Inc infection

100

Systemic effects of nephrotic syndrome & hypoalbuminemia

Abn lipid metabolism --> faster atherosclerosis --> hypercoag --> Inc MI & Stroke

101

Low complement GNs

Post-infectious, MPGN, Lupus, Mixed cryglobulinemia

102

Acute bloody urine, edema, HTN

Step GN

103

RBC casts, peri-orbital swelling, oliguria, low C3

PSGN

104

Grannular deposits/immune complexes, low C3

SLE, PSGN

105

Nephrotic 4+ proteinuria, hematuria

MPGN

106

URI, hematuria nephropathy

IgA

107

Dense C3 intramembranous deposits

IgG (C3 nephritic factor) MPGN-II = persistent complement activation

108

Crescent formation

RPGN

109

Rapid onset nephritic, hematuria, renal insufficiency

Crescentric

110

Acidotic, hypoK, urine pH high, fam hx kidney stones

RTA-I

111

RTA I

No H+ secretion in urine = low ammonium production by tubules

112

Dec bicarb reabs, Fanconi

RTA-II

113

RTA II

Defective bicarbonate reabsoprtion, fanconi & carbonic anhydrase inhibitors

114

HyperK, hyperCl acidosis, uropathy, cystic kidneys

RTA-IV

115

Renal insufficiency, hyperK, non-anion gap acidosis w/ low Bicarb

Renal tubular acidosis - 4 = aldosterone deficiency, worse w/ ACEs, DM

116

UTI management

7-14d abx

117

Renal and bladder US indications

<24mo, recurrent febrile, no abx response

118

UTI prophylactic abx indications

Grade III-IV vesicoureteral reflux

119

Indications for voiding cystourethrogram

Hydronephrosis, scarring, high reflux, obstruction, recurrent

120

Chronic UTI, IVUP shows blunted calyces, scarring Dx

Chronic pyelo