Renal Flashcards
(181 cards)
1
Q
Most sensitive screen for diabetic nephropathy
A
Urine Microalbumin:Creatinine ratio
2
Q
Small bilateral kidneys
A
Chronic HTN
3
Q
Prevention of contrast induced nephropathy (CIN)
A
Pre-CT IVF
(+ acetylcysteine)
4
Q
Post-cardiac cath AKI
A
Cholesterol emboli vs. CIN (contrast-induced nephropathy)
- CIN resolves within 3-7d
- Cholesterol emboli can be immediate or delayed >30d
5
Q
Causes of primary adrenal insufficiency
A
Autoimmune vs. TB
6
Q
TB is a common cause of
A
Primary adrenal insufficiency
7
Q
Na+, K+, and H+ in primary adrenal insufficiency
A
Hyponatremia, hyperkalemia, and NAGMA (decreased aldosterone)
8
Q
Painless gross hematuria
A
Bladder cancer
9
Q
Red urine negative for RBCs
A
Myoglobinuria vs. Beet ingestion vs. Rifampin
10
Q
Lithium polyuria
A
Nephrogenic DI
(renal ADH resistance)
Tx: Discontinue Lithium + Salt restriction
11
Q
Common complications of ADPKD
A
IC berry aneurysms, hepatic cysts
12
Q
Potassium citrate
A
Alkalinization of urine
13
Q
Uric acid stones diet
A
Low-protein diet
(low-purine diet)
14
Q
Cause of refractory hypokalemia
A
Hypomagnesemia
15
Q
Tamsulosin
A
α-1 blocker
(tx of ureteral kidney stone)
16
Q
C3 dense deposits in glomerular BM due to persistent activation of the alternative complement pathway
A
MPGN
(persistently low C3)
17
Q
Causes of Papillary Necrosis
A
NSAID:
NSAIDs, SCD, Analgesic abuse, Infection (pyelo), DM
18
Q
Acute hypercalcemia Tx
A
Aggressive NS hydration + Calcitonin
19
Q
Bisphosphonates in acute hypercalcemia
A
NEVER choose this. Effect is 2-4d delayed.
20
Q
Increased bleeding in CKD
A
Uremic coagulopathy
(platelet dysfunction —> Increased BT)
21
Q
Cocaine abuse + elevated CPK & K+
A
Renal failure
(myoglobin-induced ATN in setting of rhabdomyolysis)
Tx:
- Aggressive hydration
- Mannitol
- Urine Alkalinization (potassium citrate)
22
Q
Kidney biopsy w/ increased extracellular matrix, basement membrane thickening, mesangial expansion, and fibrosis
A
Diabetes Mellitus
23
Q
Kidney biopsy w/ intimal thickening, luminal narrowing of renal arterioles, and e/o sclerosis
A
Hypertension
(arteriosclerosis + capillary tufts)
24
Q
Most common cause of death in dialysis patients
A
Cardiovascular disease
(SCD then acute MI)
25
Needle-shaped crystals on CT
**Uric acid stones**
* Rhomboid or Rosette on microscopy (u**R**homboid acid)
* Acidic pH
* Radiolucent (transparent) on XR
* Tx: Urine Alkalinization + Allopurinol
26
Tx of Hypercalcemia:
* **NS hydration** (first step)
* Calcitonin (inhibit bone resorption)
* Bisphosphonates
27
Euvolemic hyponatremia + **HIGH urine Osm** + **HIGH urine sodium**
SIADH
28
Tx of post-operative urinary retention (PUR)
Urgent bladder scan & catheterization!
29
Nodular glomerulosclerosis
Pathognomonic change in diabetic nephropathy
(Diabetic GN)
30
Cervical motion tenderness
**PID**
31
Metformin should be discontinued in pts w/ renal failure, liver failure, or sepsis as it can cause \_\_\_\_
**Lactic acidosis**
32
IBD predisposes to this type of nephrotic syndrome
Amyloidosis (AA)
33
RA predisposes to
Amyloidosis (AA)—abnormal proteins
34
Hyalinosis of afferent and efferent glomerular arterioles on LM
**Diabetic nephropathy**
35
Incontinence in uncontrolled diabetes
**Diabetic autonomic neuropathy**
| (DAN)
36
Congo Red staining and Apple Green birefringence in polarized light
**Amyloidosis**
| (staining of glomerular deposits)
37
Earliest renal abnormality in diabetic nephropathy
**Glomerular hyperfiltration**, followed by:
* Glomerular basement thickening
* Mesangial expansion (creating broad casts)
* Nodular glomerulosclerosis (pathognomonic for DM [Kimmelsteil-Wilson nodules])
38
Associated with HBV
**PAN**
(Polyarteritis Nodosa: small- to medium-sized vasculitis)
39
Associated with HCV
**Cryoglobulinemia**
| (HSP-like adult syndrome w/o GI)
40
Associated with Cryoglobulinemia
**HCV**
41
Test all pts with mixed cryoglobulinemia for \_\_\_\_
**HCV**
42
HSP-like renal disease in adults w/ HCV
**Mixed cryoglobulinemia**
43
GFR when uremic symptoms may occur
**GFR \<60**
44
Tx for symptomatic uremia
**Dialysis!**
(encephalopathy, pericarditis, or bleeding)
45
Indications for urgent dialysis
**AEIOU**
* **A**cidosis \<7.1 refractory to medical therapy
* **E**lectrolyte abnormalities (*severe hyperkalemia*, \>6.5 refractory to medical therapy)
* **I**ntoxication (ASA, methanol/ethylene glycol, lithium, valproic acid/carbamazepine)
* **O**verload (e.g. CKD; refractory to diuretics)
* **U**remia (Symptomatic [encephalopathy, pericarditis, bleeding; usually will have **GFR \<60)**
46
Chlorthalidone is a \_\_\_\_\_
**thiazide diuretic**
47
Thiazide diuretic effects →
* Decreased **K+** (hypokalemia)
* Decreased **Mg2+** (hypomagnesemia)
* Decreased **Na+** (hyponatremia)
* Increased **Ca2+** reabsorption (hypercalcemia)
* Increased **glucose** (hyperglycemia)
* Increased **uric acid** (hyperuricemia; predisposed to gout)
* Increased **LDL** & **TGs**
48
Contrast is required/not required to visualize ureteral stones (abd CT)
**Not required**
49
Lower abd pain that radiates to groin
**Obstructive ureterolithiasis**
| (kidney stone)
50
Winter’s Formula is used to
**calculate respiratory compensation for metabolic acidosis**
(pCO2 = 1.5(HCO3) + 8 ± 2)
51
**ASA** causes mixed respiratory alkalosis & metabolic acidosis by directly stimulating the ____ and decreasing ____ respectively
* **medullary respiratory center** (tachypnea)
* **renal elimination of lactic acid & ketoacids** (& increased production)
52
Low C3, Normal C4
**PSGN**
53
Persistently Low C3, Normal C4
**MPGN**
54
Low C3 & C4
**SLE**
55
Higher Ca2+ concentrations required to suppress PTH release due to AD mutation of Ca2+-sensing receptor (CaSR)
**FHH**
| (Familial Hypocalciuric Hypercalcemia)
56
Drug that causes red to orange discoloration of body fluids (urine, saliva, sweat, tears)
**Rifampin**
| (also causes AIN)
57
High-dose TMP-SMX requires serial monitoring of \_\_\_\_
K+ levels
58
MOA of ADH stimulation from hypovolemia
**Stretch receptors in LA**
59
**MOA of ADH** stimulation from decreased renal perfusion
**Angiotensin II**
60
**MOA of ADH** stimulation from hypotension
**Baroreceptor** stimulation in carotid arteries
61
\_\_\_\_ stimulates thirst
**Angiotensin II**
62
Decreased skin turgor
**Hypovolemia**
63
“Red Urine”
**Rifampin**
64
Elevated urinary sodium AND potassium
**Diuretic use/abuse**
65
Pre-renal causes:
* Decreased EABV (**HF, Cirrhosis**)
* Displaced intravascular fluid (**sepsis, pancreatitis**)
* Decreased afferent flow (**RAS, NSAIDs**)
66
Small bowel disease malabsorption of fatty acids and bile salts can predispose to ____ kidney stones
**calcium oxalate**
(Unabsorbed fatty acids chelate with calcium, freeing up oxalic acid for absorption)
67
Coffin-lid
(stud-shaped) kidney stone
**Struvite**
68
Kidney stone caused by infection w/ urease+ bugs
(Proteus mirabilis, Klebsiella, Staph saprophyticus)
**Staghorn calculi**
(struvite—ammonium magnesium phosphate stone)
caused by bacterial conversion of urea to ammonia
**Tx: Abx + Surgery**
69
Tx of calcium oxalate kidney stones
* IVF
* Low sodium diet
* Thiazides (prevent hypercalciuria)
* Citrate (lowers insoluble calcium oxalate formation)
70
Dumbell-shaped crystals
**Calcium oxalate**
| (alternatively “envelope-shaped”)
71
Rhomboid or rosette-shaped stones
**Uric acid stones**
72
Radiolucent (transparent) on XR and CT
* **Uric acid stones** (visible on US)
* **Cystine stones**
73
Hexagonal kidney stones
**Cystine stones**
(AR cystinuria; +sodium cyanide nitroprusside test)
74
Acidic urine predisposes to ____ kidney stones
* Uric acid stones
* Cystine stones (AR cystinuria—sodium cyanide nitroprusside test+)
* Tx for both: **Alkalinization of urine**
* **+allopurinol** for **UA** stones and low **Na+ diet** for cystine stones
75
Kidney stones are radioopaque on CT and XR
* Calcium oxalate
* Calcium phosphate
* Struvite (ammonium magnesium phosphate)
76
\_\_\_ kidney stones occur in dehydration and acidic urine
**Uric acid stones**
77
\_\_\_\_ kidney stones are common in primary hyperparathyroidism
**Calcium phosphate**
78
75-90% of kidney stones are composed of \_\_\_\_
**Calcium oxalate**
79
Renal stones measuring less than ___ in diameter typically pass spontaneously w/ conservative management (IVF \>2L/day & analgesia)
**5mm**
80
Acyclovir can cause ____ if adequate hydration/IVF is not also provided
Crystalline nephropathy w/ renal tubular damage
81
Chronic diarrhea leads to metabolic \_\_\_\_
**alkalosis**
| (due to loss of bicarbonate)
82
**Contraction alkalosis**
when **aldosterone increases** to restore intravascular volume, which leads to urinary **H+ loss in the process**
* **Aldosterone** functions to retain water by pulling in bicarb at the expense of excreting both potassium and acid in the urine.
83
Respiratory alkalosis induced by mechanical hyperventilation is compensated by \_\_\_\_\_
the kidney preferentially excreting **bicarbonate in the urine**
(high urine pH)
84
Decreased renal perfusion in hepatorenal syndrome is due to \_\_\_\_
**afferent vasoconstriction 2/2** splanchnic vasodilation
85
· Tx for prevention of recurrent calcium oxalate kidney stones
* Diet recs: Increased fluid intake, decreased sodium intake, and normal calcium intake
* **Sodium-restricted diet** (low sodium promotes sodium & calcium reabsorption thru effect on medullary concentration gradient)
* **HCTZ** (reduces Ca2+ excretion; use in pts w/ hypercalciuria)
86
Anticholinergic treatment for detrusor instability in uninhibited detrusor contractions (urge incontinence)
**Oxybutynin**
87
Stress incontinence Tx
Kegels, Duloxetine, Pseudoephedrine
88
Neurogenic bladder Tx
**Bethanechol**
(cholinergic agonist)
or Intermittent urethral catheterization
89
Normal PVR (Post-Void Residual)
\<150mL in women, \<50mL in men
(rules out **urinary retention)**
90
Crystal-induced AKI w/ renal **tubular** injury/obstruction
* Acyclovir
* Sulfonamides
* MTX
* Ethylene glycol (rectangular envelope-shaped)
* Protease inhibitors
91
Acyclovir renal complication
Crystal-induced AKI w/ intratubular obstruction (**Always give w/ IVF!**)
92
Drug-reaction AKI
**AIN**
(**P**ee, **P**ain-free, **P**CN, **P**PI, rifam**P**in)
* +Cephalosporins
* +TMP-SMX
* +Pyuria, +Azotemia
93
Benign recurrent hematuria
**Thin basement membrane nephropathy**
(familial isolated microscopic hematuria, aka Benign Familial Hematuria)
94
Anti-GBM antibodies
**Pulmonary renal syndrome**
| (Goodpasture’s)
95
XL defect in collagen IV formation w/ ocular abnormalities & hematuria
**Alport syndrome**
(+hearing loss, +progressive renal insufficiency)
96
Post-infectious hematuria 10-21d post-pharyngitis
**PSGN**
| (low C3, elevated ASO ± anti-DNAse B)
97
Post-URI hematuria (within 5 days)
**IgA Nephropathy**
| (normal complement levels)
98
Rectangular envelope-shaped crystals w/ AGMA
**Calcium oxalate crystals**
(ethylene glycol poisoning [antifreeze] in setting of AGMA)
99
Diarrhea effect on serum potassium
**Hypokalemia**
100
Decreased mineralocorticoid activity effect on serum potassium
**Hyperkalemia**
| (Hyperaldosteronism excretes K)
101
Acidosis effect on serum potassium
**Hyperkalemia**
102
Insulin effect on serum potassium
**Hypokalemia**
| (C BIG K)
103
**Albuterol** effect on serum potassium
**Hypokalemia**
| (part of C **B**IG K DD tx for hyperK+)
104
**BB**s effect on serum potassium
**Hyperkalemia**
105
Very nephrotoxic antibiotics
Aminoglycosides
**(STANKG**)
106
Tx for cyanide toxicity
**Sodium thiosulfate**
107
Prolonged hypovolemic shock renal injury
**ATN**
| (muddy brown casts)
108
Muddy brown granular cast
**ATN**
pathognomonic)
109
RBC casts
**Glomerulonephritis, Malignant HTN**
110
WBC casts
**Interstitial nephritis, Pyelonephritis, Transplant rejection**
111
Fatty casts
| (“oval fat bodies”)
**Nephrotic syndrome**
| (assoc. w/ “Maltese cross” sign)
112
Broad & waxy casts
**Chronic renal failure**
113
Hyaline casts
**Normal or ASx** prerenal azotemia
114
Renal vein thrombosis presentation
**Abd pain + hematuria**
115
MPGN
**HCV** infection
116
Bland urine sediment
**no red cells, casts, or protein**
| (no intrinsic renal pathology)
117
Very low urine sodium level
Prerenal: **FENa \<1% or \<10mEq/L** —\> Hepatorenal syndrome renal failure
(renal hypoperfusion), dehydration, etc.
118
**Eosinophils** in urine
Interstitial nephritis (**AIN**)
* Think drug reaction (hapten-like drugs; 5 P's)
* +pyuria, +azotemia
* **P**ee (diuretics)
* **P**ain-free (NSAIDs)
* **P**CN or cephalosporins
* **P**PI
* rifam**P**in
119
Metabolic alkalosis w/ **low** urine chloride (\<20 mEq/L)
**Saline-responsive metabolic alkalosis:**
* Surreptitious vomiting
* NG aspiration
* Prior diuretic use
120
Metabolic Alkalosis w/ **high** urine chloride (\>20mEq/L)
**Saline-unresponsive metabolic alkalosis:**
## Footnote
**Hypovolemic:**
* Current diuretic use (this one is saline-responsive)
* Bartter syndrome
* Gitelman syndrome
**Hypervolemic** = excess mineralocorticoid activity
* Primary hyperaldosteronism
* Cushing disease
* Ectopic ACTH production
121
Black licorice ingestion
**“hyperaldosteronism”** presentation
122
Hyperkalemia-causing drugs:
**ACE-I/ARBs, BBs**
(nonselective), K-sparing Diuretics, **NSAIDs**
123
AGMA
**MUDPILES**
* **M**ethanol (formic acid)
* **U**remia
* **D**KA
* **P**ropylene glycol
* **I**NH or Iron tablets
* **L**actic acidosis
* **E**thylene glycol (—\> —\> oxalic acid)
* **S**alicylates (late)
124
NAGMA
**HARDASS**
**H**yperalimentation
**A**ddison disease
**R**TA
**D**iarrhea
**A**cetazolamide
**S**pironolactone
**S**aline infusion
125
Metabolic Alkalosis:
**LVAH**
## Footnote
**L**oop diuretics
**V**omiting (Tx: NS infusion)
**A**ntacid use
**H**yperaldosteronism (Tx: aldosterone antagonists)
126
Respiratory Alkalosis:
**Hyperventilation**
* Hysteria
* Hypoxemia (high-altitude)
* Salicylates (early)
* Tumor
* PE
127
Respiratory Acidosis:
**Hypoventilation**
* Airway obstruction
* Acute or chronic lung disease
* Opioids, sedatives
* Weakening of respiratory muscles
128
Urinary protein excretion \>3.5g/day
**Nephrotic proteinuria**
129
High water channels
**SIADH**
| (too much ADH)
130
SIADH vs. Diabetes Insipidus
**SIADH:**
Too much ADH, excessive water retention; DI: Not enough ADH; excessive water loss
131
Urine osmolality \<100
**Dilute urine**
1. Primary polydipsia, or
2. Beer potomania (malnutrition--poor dietary solute intake mixed w/ excessive intake of alcohol)
132
Urine osmolality in increased ADH
**Increased**
| (concentrated)
133
Urine osmolality \> Serum osmolality
**Concentrated urine**
2/2 dehydration and increased ADH; or hyponatremia
134
Recurrent stones
* **Cystinuria** (cystine)
* Klebsiella **UTI** (Struvite stone formation)
* Parathyroid adenoma
135
Dipstick+ for leukocyte **esterase**
**Pyuria in urine**
136
Dipstick+ for nitrites
**E. Coli**
137
Hexagonal crystals on UA
**Cystinuria**
(inherited recurrent kidney stones)
* Acidic pH
* Radiolucent (transparent on XR)
* Begins in childhood (usually)
* Dx: Sodium cyanide nitroprusside test
* Purple urine within 2-10 min: Positive test (aminoaciduria)
* Cyanide converts cystine to cysteine; nitroprusside binds w/ cysteine, producing purple color
* Tx: Urine Alkalinization + Low sodium diet
138
Cyanide nitroprusside test
**Cystinuria**
(recurrent kidney stones)
* Purple urine = Positive test = Aminoaciduria
139
Nephrotic syndrome (adults)
**Focal Segmental Glomerulosclerosis**
**(FSGS)**
140
Nephrotic syndrome (kids)
**Minimal change disease**
141
Nephrotic syndrome (Hodgkins)
**Minimal change disease**
142
Nephrotic syndrome
(lung/breast/prostate/colon malignancy)
**Membranous Glomerulonephropathy**
143
Nephrotic syndrome (Multiple Myeloma)
**Amyloidosis**
144
Renal disease in HBV or HCV
**MPGN**
145
Hyperkalemia Tx
**C BIG K DD**
* **C**alcium gluconate (IV)
* **B**icarbonate/**B**eta-agonists (albuterol)
* **I**nsulin
* **G**lucose
* **K**ayexalate
* **D**iuretics
* **D**ialysis
* Cation Exchange Resins (Polystyrene)
146
Fever, tinnitus, tachypnea
**Salicylate toxicity (ASA)**
Tx: Sodium bicarbonate
147
Kussmaul breathing (deep, rapid)
**DKA**
**(T1DM)**
148
Metabolic acidosis after seizure is due to:
**Postictal lactic acidosis**
(MUDPIL**E**S)
* Transient & self-ltd AGMA, resolves within 90 minutes
149
Pt w/ nephrotic syndrome is at most risk for:
**HypercOagulability** 2/2 renal loss of ATIII
(PrOteinuria, HypOalbuminemia, Edema, HLD)
* _Renal vein thrombosis_ (most common complication)
* Pulmonary embolism
* Other thromboses
* Protein malnutrition (hypoalbuminemia 2/2 renal loss)
* Iron-resistant hypochromic microcytic anemia
* Increased susceptibility to infection
* Vitamin D deficiecny (loss of cholecalciferol-binding protein)
* Decreased thyroxin (loss of thyroxin-binding globulin)
150
Sodium nitroprusside infusion
**Cyanide toxicity**
* AGMA (MUDPI**L**ES) from lactic acidosis 2/2 cellular shift to anaerobic metabolism due to cyanide binding to cytochrome oxidase (inhibiting oxidative phosphorylation in mitochondria)
* Can occur from combustion of carbon-containing compounds (house fires, wool, silk), industrial exposure (metal extraction in mining), or IV infusion of sodium nitroprusside
* p/w:
* Tx: **Sodium thiosulfate**
151
WBC casts, pyuria, eosinophiluria
AIN (drug-induced interstitial nephritis)
* 5 P's
* TM**P**-SMX (sulfas)
* Allo**P**urinol
* Loops & thiazides (sulfas, except the loop, **ethacrynic acid**)
* Tx: Discontinue agent
152
Only non-sulfa loop diuretic
**Ethacrynic Acid**
153
Scrotal varicoceles are almost always left-sided because
* **L gonadal vein drains into the L renal vein**, which then drains into the IVC
* In contast, R gonadal vein drains directly into the IVC
* Thus, any renal pathology on left side can p/w L varicocele if obstruction is involved (e.g. **RCC**)
154
Left-sided varicocele that does not reduce (empty) when pt is recumbent (lying down)
**RCC**
* Obstruction of venous flow due to L gonadal vein draining into renal vein before IVC
* CT abd
155
Quickest way to lower potassium levels in hyperkalemia
**Insulin** + **Glucose** drip
(creates rapid intracellular shift)
* +beta agonist if no CVD
156
Diabetic w/ urinary retention & high post-void residual volume (\>50 mL)
**Neurogenic bladder**
(from DAN [Diabetic Autonomic Neuropathy]; Overflow incontinence)
* Pt has decreased ablity to sense full bladder
* Can p/w continuous dribbling (day or night), incomplete emptying, distended bladder, overflow incontinence
157
Most common cause of AL amyloidosis (Primary)
**Multiple Myeloma**
* Also seen in Waldenström macroglobulinemia
* Light chain accumulation (Lambda)
158
Most common cause of AA amyloidosis (2o)
Rheumatoid Arthritis
159
RA + nephrotic syndrome
**AA Amyloidosis** (2o)
* Congo Red Apple Amyloid
* Amyloid Apple Green Birefringence under Polarized Light
160
Pelvic pain exacerbated by a full bladder and relieved by voiding
**Interstitial Cystitis**
(Painful bladder syndrome)
* Bladder pain w/ no other cause for _\>6_ weeksChronic pelvic pain
* Urinary urgency & frequency
* Dyspareunia
* Normal UA
* Tx = Palliative: Trigger avoidance, amitryptiline, & analgesics for pain flares
161
Bleeding + very high BUN
**Uremic coagulopathy**
(Platelet dysfunction 2/2 uremic toxins)
* PT, PTT & platelet count **normal**
* **BT prolonged**
* Tx: DDAVP (desmopressin)
* Increases release of Factor VIII:vWF multimers from endothelial storage sites
* Platelet transfusion not indicated b/c transfused platelets become inactive
162
Facilitates kidney stone passage
**Alpha blockers**
(**tamsulosin**)
* Alpha receptors found on _distal ureter_, base of the detrusor, bladder neck, & urethra
163
The magnesium gate protects ____ from being excreted by the kidneys
**Potassium**
* ROMK channels (Renal Outer Medullary Potassium) in collecting tubules inhibit K+ secretion.
* Hypomagnesemia leads to **excessive renal potassium wasting** & **refractory hypokalemia**
* Common in _chronic alcoholics_
164
Hypomagnesemia's effect on potassium & effect on reflexes?
* **Potassium loss by kidneys** (ROMK channels [potassium gate] are held closed by Mg2+) → **Refractory hypokalemia** (common in chronic alcoholics)
* **Hyperactive reflexes**
165
Infraumbilical fullness
**Urinary retention**
* Urinary catheterization & d/c amitriptylene
* \>50mL
* Usually from Anticholinergics (amitriptylene [TCAs]), BPH, post-anesthesia, etc.
166
Intermittent episodes of high-volume urination
**Post-obstructive diuresis**
(2/2 obstructive uropathy due to _nephrolithiasis_)
* Occurs when urinary obstruction (from renal calculi) is overcome by a large volume of retained urine
* Excessive diuresis may lead to potassium wasting (mild hypokalemia) & dehydration
* Pt p/w flank pain, low-volume voids (w/ or w/o occasional high-volume voids), & renal dysfunction if BL
167
Psych patient w/ hyponatremia & low uOsm (\<100 mOsm)
* **Primary Polydipsia** (increased thirst 2/2 central defect in thirst regulation)
* **Malnutrition** (beer potomania--low solute intake 2/2 excessive beer intake)
168
Nephrotic proteinuria, hematuria, dense deposits stained for C3
**MPGN, Type 2**
(aka "Dense deposit disease")
* Caused by IgG Abs against C3 convertase, leading to _persistent activation of the alternative complement pathway_ & kidney damage
169
Horseshoe kidney
**Turner Syndrome (XO)**
170
25M w/ weak urine stream and incomplete emptying of bladder. MCC?
Urethral stricture
(a fibrotic narrowing of the urethra 2/2 trauma, infection, or radiotherapy)
* Dx: Urethrography or cystourethroscopy
* ↑ Postvoid residual volume
* Tx: Urethral dilation or Surgical urethroplasty
171
Severe LLQ abd pain radiating to the groin, vomiting, and soft nontender abdomen on exam
Ureterolithiasis
* Severe flank pain that radiates to the perineum, penis, scrotum, or inner thigh
* Colicky in nature & poorly localized
* Pts often writhing in pain and unable to sit still, but benign abd exam
* Dx: Abdominal U/S
172
Presents similarly to nephrolithiasis but w/ enlarged kidney and ↑LDH
**Acute Renal Vein Thrombosis**
* Dx: CT Angiography (or MR Angiography), Renal venography
* Usually occurs in setting of nephrotic syndrome due to urinary loss of anticoagulant proteins & alteration of hemostatic balance, but can also occur w/ acquired hypercoagulability a/w **malignancy** or trauma.
| (RVT)
173
When giving pt **acyclovir**, always give
**IVF**
due to risk of crystalluria w/ renal tubular obstruction (crystal-induced AKI) due to the drug's low urine solubility and how it easily precipitates in renal tubules causing intratubular obstruction and direct renal tubular toxicity.
* Note: This is more common specifically w/ High-Dose IV Acyclovir, and occurs only rarely with oral acyclovir.
174
Muddy brown granular cast
**Acute Tubular Necrosis**
| (ATN)
175
Red blood cell casts
**Glomerulonephritis**
176
White blood cell casts
**Interstitial nephritis** and **pyelonephritis**
177
Fatty Casts
**Nephrotic Syndrome**
178
Broad & Waxy Casts
**Chronic Renal Failure**
179
When to medically manage ureteral stones (instead of urology consult / lithotripsy)
* **\<10mm**
* No urosepsis (e.g. fever, AMS)
* No acute renal failure
* No complete obstruction
Medical Management:
* Hydration
* Pain control
* Alpha blockers (e.g. **tamsulosin**)
* Strain urine
180
Scars/calluses on the dorsum of the hands
Dental erosions
**Surreptitious vomiting**
* Low urine chloride 2/2 hypochloremia from ↑ vomiting
* In diuretic abuse, Bartter syndrome, & Gitelman's syndrome, urine chloride will be high
181
Hematuria following a URI
**IgA Nephropathy**
| (or PSGN)
