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Flashcards in Renal Deck (54):
1

UTI -

Inflammation and infection involving the kidneys

2

UTI - key symptoms

Dysuria
Frequency
Nocturia
Urgency
Hematuria

3

It hurts when I pee

UTI or STD

4

What is the first test to order for a man with BPH like symptoms?

UA

5

Lower UTI - labs

UA - pyuria > 10
Nitrate - very -
Esterase - very +

6

Esterase by dipstick

+ in UTI is very sensitive

7

LOWER - UTI big gun meds

TMP/SMX
Cipro
Amox/Clav

8

LOWER - UTI during pregnancy

Amoxicillin
Nitrofurantoin
Cephalexin
10 day FULL course

9

Upper UTI symptoms

Flank, low back pain
Fever and chills
N/V
Mental status change in elderly

10

Upper UTI - labs

WBC casts in UA
ESR elevated in pyelonephritis

11

Upper UTI managment

14 day course versus 6 week course
-- TMP/SMX, Cipro, Amox/Clav, aminoglycosides

12

Pyelonephritis - with N/V

should be hospitalized

13

Renal insufficiency - causes

HTN
glomerulonephritis
diabetic nephropathy
nephritis
polycystic kidney disease

14

Renal insufficiency -
symptoms

Often asymptomatic until later stages of disease
< 20-25% normal

15

Renal insufficiency
types (2)

acute
chronic

16

Renal insufficiency -
acute

- Sudden impairment
- BUN increased out of proportion to creat
- Due to obstruction, ATN, contrast
- Reversible with therapy

17

Renal insufficiency -
chronic

- Progressive impairment over months - years
- Steady increase BUN/CR 10:1 ratio
- Damage irreversible

18

Renal insufficiency -
stages (3)

- Diminished Renal Reserve - 50% nephron loss, creatinine doubles
- Renal insufficiency - 75% nephron loss, mild azotemia
- ESRD - 90% nephron damage - azotemia, metabolic alterations

19

Criteria for dialysis
AEIOU

A - Acidosis/Azotemia
E - Electrolyte (K, Ca)
I - Intoxication (weird)
O - Oliguria (< 400/day)
U - Uremia (urine in blood)

20

Oliguria

< 400 ml /day

21

Anuria

< 100 ml /day

22

Renal insufficiency management
acute (1)
chronic (3)

Acute - Determine causes and intervene
Chronic -
-- Control HTN/DM
-- Protein < 40 g/day
-- Modify med dosage for creatinine clearance

23

Renal insufficiency
Treat complications
Overload
Acidosis
Electrolytes
Anemia
Azotemia
Vasoconstriction

Overload - diuretics/dialysis
Acidosis - bicarb/dialysis
Electrolytes - Ca, K
Anemia - erythropoeitin
Azotemia (BUN > 100) - Dialysis
Vasoconstriction - ACE inhibitor

24

Azotemia

BUN > 100

25

Normal BUN creatinine ratio

10 : 1

26

Acute Renal Failure - Categories

Pre-renal
Intra-renal
Post-renal

27

Acute Renal Failure
Pre-renal causes (outside kidneys)

Impaired renal perfusion -
-- shock
-- dehydration
-- burns
-- cardiac failure
-- diarrhea
-- sepsis

28

Acute Renal Failure
Intra-renal causes

Hypersensitivity
Obstruction of renal vessel
Nephrotoxic agents
Mismatch blood
Acute tubular necrosis

29

Acute Renal Failure
Post-renal causes

Mechanical -
-- calculi
-- tumor
-- strictures
-- BPH
Functional -
-- neurogenic bladder
-- diabetic neuropathy

30

Acute Renal Failure
Diagnostics to determine Pre-renal

ratio > 10:1 (DEHYDRATION)
Urine Na < 20 mmol/dL
Specific gravity > 1.015 (CONCENTRATION)
Sediment - few hyaline casts
FEna - < 1

31

Acute Renal Failure
Diagnostics to determine Intra renal

ratio 10:1
Urine Na > 40
Specific gravity < 1.015
Sediment - granular/white casts
FEna >3

32

Acute Renal Failure
Diagnostics to determine Post-renal disease

ratio 10:1
Urine Na > 40 mmol/dL
Specific gravity < 1.015
Sediment - normal
FEna >3 (usually)

33

Which type of renal disease pre, intra, post has an BUN/creat ratio > 10:1

PRE-RENAL

34

Acute Renal Failure - management for Pre-renal

Expand volume
Consider dopamine

35

Acute Renal Failure
management for Intra-renal

Maintain perfusion
Stop nephrotoxic drugs
Dialysis as needed

36

Acute Renal Failure
management Post-renal

Remove obstruction
-- check foley
-- CT
-- Renal ultrasound

37

Nephrolithiasis - 10 % of population will have one in their lifetime

Renal calculi

38

Nephrolithiasis - types

calcium
uric acid
struvite
cystine

39

Nephrolithiasis - s/s

acute, painful colic-like flank pain - with increasing intensity
radiation to groin - lower 1/3
*men testicular pain

40

Nephrolithiasis versus torsion

prehn's test

41

Nephrolithiasis- management trio

IVF
+ trio
- Dilauded
- Toradol
- metoclopramide

42

What is a major side effect of using metoclopramide long term.

Tardive dyskinesia

43

Prehn's sign

lifting testical relieves pain + epididymitis

44

BPH - incidences

affects 50% of men by 50
> 80% of men 80

45

BPH - causes

unknown

46

BPH - s/s

Frequency
Dysuria
Urgency
Nocturia
Incontinence
Hesitancy
Starting and stopping urine flow
Dribbling
Retention

47

BPH - labs/diagnostics

UA - to r/o UTI
PSA > 4 ng/ml = abnormal
Transrectal US if palpable nodule/ Elevated PSA

48

BPH - management

Alpha-blocker
5-alpha-reductase inhibitors
TURP
Saw palmetto
Avoid worsening meds:
-- benadryl
-- sudafed
-- afrin
-- SSRI
-- diuretics
--narcotics

49

5-alpha-reductase inhibitor

BPH - ASTERIDE
finasteride
dutasteride

used to shrink large prostates

50

alpha blocker

BPH - OCIN drugs
terazocin
prazocin
tamsulosin

to relax muscles of bladder and prostate

51

Saw palmetto

Used to decrease PSA values

no evidence to decrease CA

52

Elevated PSA

prostatits
BPH
prostate cancer

53

Prostate screening begins at

50

54

TURP

Transurethral resection of the prostate