lab findings of analgesic nephropathy
pyuria w/ WBC casts
microcytic anemia (likely due to GI blood loss from NSAID-induced chroinc gastritis irritation)
lab findings of acute glomerulonephritis
hematuria w/ dysmorphic RBCs
38F G3P3 p/w post-void dribbling, followed by dysuria and dyspareunia. PE demonstrates anterior vaginal wall fullness. UA pos for nitrites, leuk esterase, RBCs, and WBCs. History significant for nitrites, leuk esterase, RBCs, WBCs
best diagnostic test?
acquired diverticulum of urethra - usually secondary to maternal birth trauma or instrumentation of the urethral tract
(remember the 3D's dribbling, dysuria, dyspareunia)
best test: TVUS
gross hematuria following an acute URI
electrolyte abnormality associated with hyperative DTRs
hyperative DTRs = hypocalcemia
hypoactive DTR = hypomagnesium
patient with SLE develops hematuria, proteinuria. WHat is the appropriate next step in management?
how would you monitor disease burn?
get a renal biopsy and start IV methylprednisolone
serum complement or anti-dsDNA
management of blood pressure in patients w/ ADPKD
regular BP checks
BP goals < 130/80
ACEi (controls BP and prevents progression to renal failure)
most common extra-renal manifestations of ADPKD
screening modality for asymptomatic family members of a patient w/ ADPKD
long-term risk of kidney donation
gestational complications in female donors of childbearing age (fetal loss, pre-eclampsia, gestational diabetes, gestational HTN)
which electrolyte abnormality can cause a paralytic ileus?
what is the first line intervention for enuresis when behavioral modifications fail? second line intervention?
which intervention has the best long-term outcome?
1st line: enuresis alarm (best long-term outcome)
2nd line: desmopressin
first test to do when patient presents with enuresis
rule out anything that can be causing the enuresis with a UA (specific gravity, glucosuria, infection)
Patient comes in with a symptomatic ureteral stone. What are the indications for a urology consult vs discharge?
urology consult: urosepsis, acute renal failure, complete obstruction, stone size >10mm
when is contrast induced nephropathy (CIN) typically seen? how long does it last?
within 2-3 days of contrast exposure
lasts 5-7 days
Patient w/ chronically elevated serum creatinine - what would be the most important diagnostic step and why?
get UA/urine protein to assess extent of proteinura, as it affects prognosis and treatment in patients with CKD; considered significant beginning at levels of 500-1000mg
BP goal: 130/80, reduce proteinuria to with ACEi/ARB to <500mg/day
T/F hypercalcemia is associated with chovstek's sign, hyperpigmentation, seizures, muscle weakness, and hypotension
FALSE - it is HYPOcalcemia that presents w/ these facts.
Patient develops HTN after kidney transplant. How can you assess if there is renal artery stenosis in the transplanted kidney?
give ACEi - can cause marked increase in serum creatinine after initiation of ACEi
abdominal duplex doppler US
when is antibiotic prophylaxis considered in women with urinary tract infections?
for women with:
>2 UTI in 6 months
>3 UTI in 1 year
diagnostic test if you suspect renal artery stenosis
abdominal duplex doppler US
when is a VCUG indicated?
all children <24 months w/ UTI should undergo renal/bladder US to evaluate for anatomic abnormalities that may predispose to UTIs
children w/ abnormal US (hydro, reflux, obstruction) or recurrent UTIs should undergo VCUG
(not indicated for patients with first time UTIs)
What is absolutely required prior to treating any sexually active female who presents UTI?
(doesn't actually happen in real life, only on Step 3)
pregnancy test - it will determine her treatment
TMP-SMX is pregnancy risk category C/D - affects folate metabolism during pregnancy
Cipro - pregnancy category risk C - affects fetal arthropathy
what is the preferred UTI treatment for pregnant women?
you CAN treat pregnant women with these antibiotics!
Feeding severe alcoholics is associated with this electrolyte abnormality
HYPO-phosphatemia - patients w/ severe alcoholism often have chronic depletion of phosphate secondary to decreased vitamin D and phosphate intake along with decreased intestinal intake in those with chronic diarrhea
Despite the phosphate depletion, serum levels are maintained (extracellular shift) until IVF w/ glucose is administered. This results in insulin secretion, which causes a shift of phosphate intracellularly.
Hypophosphatemia can result in rhabdomyolysis and patients often complain of new-onset of weakness. Important to trend CPK
how to differentiate between SIADH and polydipsia as a cause of hyponatremia?
check urine osmolality
in SIADH, urine osmolality is very high (aka concentrated, higher than serum osmolality)
in polydipsia, urine osmolality is very low (aka diluted, lower than serum osmolality)
patient w/ RCC - how do you determine if patient can undergo partial vs radical nephrectomy?
if the mass is confined within the renal capsule - partial
if the mass extends through the renal capsul but not beyond gerota's fascia - radical