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Board Exam > Renal/GU > Flashcards

Renal/GU Flashcards

1
Q

lower UTI: causes

A

cystitis (bladder)
urethritis

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2
Q

upper UTI: causes

A

pyelonephritis
renal abscess

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3
Q

lower UTI: labs/Dx

A

UA: pyuria (>10 WBC/ml)
+ nitrites (very specific but not sensitive for bacteriuria)
+ esterase (sensitive but not specific) –> order ABx

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4
Q

cystitis: management

A

For uncomplicated cystitis, choose one:
- Macrobid PO BID x5 days
- bactrim PO x3 days (avoid if resistance is >20%)
- fosfomycin PO x1

fluoroquinolone if no alternative options

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5
Q

Pyelonephritis: S/Sx

A

flank, low back, abdominal pain
fever, chills
N/V
AMS in elderly

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6
Q

upper UTI: labs/Dx

A

UA: +WBC
ESR elevated w/pyelonoephritis

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7
Q

pyelonephritis: management

A

empiric
- ciprofloxacin PO BID x7 days if uncomplicated
- levofloxacin
- ceftriaxone IV Q24h x14 days

Avoid
- moxifloxacin
- bactrim: high resistance
- Macrobid: does not reach therapeutic concentrations in kidneys

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8
Q

healthcare associated pyelonephritis: management

A

Choose one:
- amoxicillin + aminoglycoside (-mycin)
- cefepime
- imipenem
- meropenem
- pip-tazo

(antipseudomonal agent other than a fluoroquinolone)

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9
Q

renal insufficiency

A

decrease in renal function resulting in a decrease in the GFR and a reduction in the clearance of solutes
GFR decreases naturally with aging

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10
Q

renal insufficiency: causes

A

hypertensive nephrosclerosis
glomerulonephritis
diabetic nephropathy
interstitial nephritis
polycystic kidney disease

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11
Q

RIFLE class: increased serum Cr x1.5

A

risk for AKI

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12
Q

RIFLE class: decreased GFR by >25%

A

risk for AKI

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13
Q

RIFLE class: UOP less than 0.5 ml/kg/hr for 6 hours

A

risk for AKI

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14
Q

RIFLE class: increased serum Cr x 2

A

renal injury

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15
Q

RIFLE class: decreased GFR by >50%

A

renal injury

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16
Q

RIFLE class: UOP less than 0.5 ml/kg/hr for 12 hours

A

renal injury

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17
Q

RIFLE class: increased serum creatinine by x 3

A

renal failure

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18
Q

RIFLE class: decreased GFR by >75%

A

renal failure

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19
Q

RIFLE class: increased serum CR by >0.5 if baseline >4

A

renal failure

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20
Q

RIFLE class: UOP less than 0.3 ml/kg/hr for 24 hrs

A

renal failure

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21
Q

RIFLE class: anuria for 12 hours

A

renal failure

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22
Q

RIFLE class: complete loss of kidney function >4 weeks

A

loss of renal function

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23
Q

RIFLE class: complete loss of kidney function >3 months

A

ESRD

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24
Q

pre renal AKI

A

caused by conditions that impair renal perfusion (e.g. shock, dehydration, cardiac failure, burns, diarrhea, vasodilation/sepsis)

AKI is pre renal only if it is reversed when the underlying cause of hypo perfusion is corrected

No damage to renal tubules

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25
Q

intrarenal AKI: causes, complications

A

caused by disorders that directly affect the renal cortex or medulla:
- nephrotoxic agents (e.g. aminoglycosides, contrast) – most common
- hypersensitivity (e.g. allergic disorders)
- obstruction of renal vessels (e.g. embolism or thombosis)
- mismatched blood transfusion (RBCs hemolyze and block nephrons

Results in nephron damage
- acute tubular necrosis (damage to the tubular portion of the nephron) is the most common cause

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26
Q

post renal AKI

A

results from urine flow obstruction

mechanical: calculi, tumors, urethral strictures, BPH
functional: neurogenic bladder, diabetic neuropathy

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27
Q

Prerenal, intrarenal, or postrenal AKI: BUN/Cr ratio >20:1

A

prerenal

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28
Q

Prerenal, intrarenal, or postrenal AKI: urine sodium <20 mmol/dl

A

prerenal

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29
Q

Prerenal, intrarenal, or postrenal AKI: spec grav >1.015

A

prerenal

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30
Q

Prerenal, intrarenal, or postrenal AKI: urinary sediment normal/bland/few hyaline casts

A

prerenal

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31
Q

Prerenal, intrarenal, or postrenal AKI: FENa <1%

A

prerenal

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32
Q

Prerenal, intrarenal, or postrenal AKI: BUN/Cr ratio 10:1

A

intrarenal, postrenal

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33
Q

Prerenal, intrarenal, or postrenal AKI: urine sodium >40 mmol/dl

A

intrarenal, postrenal

34
Q

Prerenal, intrarenal, or postrenal AKI: spec grav <1.015

A

intrarenal, postrenal

35
Q

Prerenal, intrarenal, or postrenal AKI: urinary sediment w/granular/white casts

A

intrarenal

36
Q

Prerenal, intrarenal, or postrenal AKI: FENa >3

A

intrarenal, postrenal

37
Q

Prerenal, intrarenal, or postrenal AKI: urinary sediment normal

A

postrenal

38
Q

prerenal AKI: management

A

expand intravascular volume

39
Q

Fractional Excretion of Sodium (FENa)

A

amount of sodium that leaves the body through the urine (instead of being filtered and reabsorbed by the kidney)

40
Q

intrarenal AKI: management

A

maintain renal perfusion
stop nephrotoxic drugs
renal replacement therapies as indicated

41
Q

postrenal AKI: management

A

remove source of obstruction – check foley, renal ultrasound, CT, egc

42
Q

criteria for dialysis

A

A: Acidosis (metabolic)
E: electrolyte imbalances
I: intoxication (AMS)
O: Oliguria (UOP <400ml/24 hrs) / anuria
U: Uremia (urine in the blood)

Any criteria: consult nephrology

43
Q

Types of renal calculi

A

Calcium stones: most common, frequently familial
-more common in men

Uric acid stones: half of those developing uric acid stones also have gout
-more common in men

Struvite stones: “magnesium-phosphate stones”; d/t UTIs with urease-producing bacteria
- more common in women

Cystine stones: amino acid that becomes insoluble in urine

44
Q

nephrolithiasis: S/Sx

A

passage of the stone usually produces pain and bleeding

Acute colic-like flank pain
radiation of pain downward toward the groin indicating that the stone has passed to the lower third of the ureter
testicular pain may occur (r/o torsion and epidydmitis)

45
Q

nephrolithiasis: labs/Dx

A

helical CT to identify quickly
ultrasound

UA: hematuria

CBC
BMP

46
Q

nephrolithiasis: management

A

depends on the stone type, location, extent of obstruction, function of the kidneys, progress of stone passage

Analgesia:
- morphine or dilaudid
- toradol
- reglan (to keep gut moving)

IV/PO hydration

Lithotripsy for large stones

47
Q

BPH: S/Sx

A

frequency
dysuria
urgency
nocturia
incontinence
hesitancy
“starting and stopping” urine flow
dribbling
retention

48
Q

BPH: labs/Dx

A

PSA >4: abnormal
Approximately 40% of patients with prostate cancer present with normal PSA values. Trend over time and look for a sudden spike

UA to r/o infx
transrectal ultrasound if there is a palpable nodule or elevated PSA

49
Q

normal PSA: age 40-49

A

<2.5

50
Q

normal PSA: age 50-59

A

<3.5

51
Q

normal PSA: age 60-69

A

<4.5

52
Q

normal PSA: age 70-79

A

<6.5

53
Q

BPH: management

A

Alpha-blockers to relax muscles of the bladder and prostate
-terazosin, prazosin, tamsulosin

5-alpha-reductase inhibitors to shrink large prostates
-finasteride, dutasteride

Saw palmetto: may improve symptoms in some men, but no evidence that it decreases prostate cancer risk

TURP if significant urinary symptoms persist

Avoid meds that worsen signs/symptoms of BPH
-Benadryl, pseudoephedrine, oxymetazoline spray (Afrin), antidepressants such as SSRIs

54
Q

Normal physiologic renal changes in the elderly

A

Diminished renal blood flow up to 10% per decade after age 30-40
Kidneys decrease in size, number and size of nephrons diminish, and number of glomeruli diminish
GFR decreases ~10% per decade after age 30
Reduced hormonal response to vasopressin and impaired ability to conserve sodium (increases risk for dehydration)
Reduced bladder tone, elasticity, and capacity
Increased residual urine and frequency
More nocturnal urine production
Enlarged prostate

55
Q

Normal creatinine clearance in males

A

97-137 ml/min

56
Q

Normal creatinine clearance in females

A

88-128 ml/min

57
Q

Common organisms that cause UTIs in elderly

A

Gram negative bacilli
- e. coli
- p. aeruginosa

Gram positive
- enterococci
- s. aureus

Fungi, esp in those w/Foleys

58
Q

S/Sx UTI in elderly

A

weakness
frequency
urgency
dysuria

Atypical findings:
-incontinence
-lethargy
-decreased appetite
-dehydration
-confusion

59
Q

UTI: labs/Dx in elderly

A

UA:
- WBCs may not be present in large numbers
- leukocyte esterase and nitrites may be negative

C&S:
- high incidence of asymptomatic bacteriuria; only treated in pregnancy, patients undergoing urologic intervention, and perhaps renal transplant patients
- multiple organisms often present

60
Q

allergic interstitial nephritis: S/Sx

A

fever
rash
eosinophilia
leukocyte casts in the urine

61
Q

Prerenal, intrarenal, or postrenal AKI: urinary sediment w/muddy brown casts

A

intrarenal (acute tubular necrosis)

62
Q

Indications for emergent dialysis

A

Symptomatic uremia (including pericarditis, neuropathy, unexplained AMS)
Significant fluid overload
Refractory hyperkalemia
Refractory metabolic acidosis

63
Q

Stage 1 renal disease: eGFR

A

eGFR >90 with evidence of renal damage (e.g. proteinuria)

64
Q

Stage 2 renal disease: eGFR

A

60-89

65
Q

Stage 3A renal disease: eGFR

A

45-59

66
Q

Stage 3B renal disease: eGFR

A

30-44

67
Q

Stage 4 renal disease: eGFR

A

15-29

68
Q

Stage 5 renal disease: eGFR

A

<15 or hemodialysis

69
Q

How do NSAIDs affect the kidneys?

A

NSAIDs inhibit COX enzymes, resulting in the reduction of GFR by inhibiting renal vasodilation

70
Q

Most common cause of acute prostatits (pathogen)

A

E. coli

Typically caused by organisms that cause other genitourinary infections
-sexually active males are more likely to have prostatitis caused by sexually transmitted pathogens (e.g. chlamydia trachoma’s, neisseria gonorrhea)

71
Q

acute prostatitis: S/Sx

A

fever, chills
dysuria
cloudy urine

Exam: edematous, firm, tender prostate

72
Q

first line treatment for chronic prostatitis

A

fluoroquinolones

alternative: bactrim

73
Q

diabetic nephropathy: presentation

A

HTN
proteinuria
eventually microalbuminuria that becomes macroalbuminuria with elevated serum creatinine
often also have diabetic retinopathy

74
Q

hydrocele

A

collection of peritoneal fluid that lies between the parietal and visceral layers of the tunica vaginalis (the layer surrounding the testis and spermatic cord that extends to form the peritoneal lining of the abdomen)

75
Q

hydrocele: S/Sx

A

swelling
Transilluminates on exam

76
Q

hydrocele: management

A

indicated if symptomatic
surgical excision of the hydrocele sac

77
Q

normal urine spec grav

A

1.005-1.030

78
Q

azotemia

A

buildup of nitrogenous products and creatinine in the blood (elevated BUN and Cr)

79
Q

75% nephron loss and mild azotemia

A

renal insufficiency

80
Q

50% nephron loss and doubled creatinine

A

diminished renal reserve

81
Q

90% nephron loss, azotemia, metabolic alterations

A

ESRD

Board Exam (18 decks)

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