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Emergency Medicine > Renal/Urology > Flashcards

Renal/Urology Flashcards

(38 cards)

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1
Q

Acute Renal Failure - Intrinsic

A

Direct damage to kidneys

Eti - nephrotoxic drugs (aminoglycosides), cyclosporine, Tumor lysis syndrome, Vasculitis (SLE, Sarcoidosis), crystals from gout, Myoglobin from rhabdo

Three different types

1. Acute Tubular Necrosis

  • necrosis of renal tubules d/t ischemia or nephrotoxic drugs
  • UA - epithelia cell casts and muddy brown casts*, hyperK, hyperphosphatemia

2. Acute Interstitial Nephritis (AIN)

  • Inflammatory or allergic reaction in the interstitium
  • eti NSAIDs, sulfa, penicillin, bacterial infx
  • UA - WBC Casts**, eosinophilia, Incr IgE

3. Acute Glomerular Nephritis aka NEPHRITIC SYNDROME

  • Immunologic inflammation of the Glomerular = protein and RBG leakage
  • Many ETI - IgA Nephropathy, Post infectious GABHS,
  • UA - hematuria*, coca cola urine (GABHS), proteinuria, oliguria
  • Fever, flank pain

Dx

  • U Na > 40
  • BUN:Cr 15:1
  • FENa high > 2%

Tx - IV fluids to remove drugs, Lasix to get kidneys moving

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2
Q

Acute Renal Failure - Postrenal

A

Obstruction downstream from kidneys

Eti: kidney stones, BPH, tumors, congenital abnormalities

Sxs:

  • Anuria or oligouria
  • pain from hydronephrosis - abd discomfort

Dx:

  • KUB, X ray or CT scan
  • Serum Cr and BUN follows pre-renal pattern of azotemia 20:1

Tx:

  • Bladder cath
  • remove obstruction (stones)
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3
Q

Acute Renal Failure - Pre-Renal

eti, sxs, dx, tx

A

MCC of AKI

usu d/t hypovolemia or hypoperfusion; NSAIDs, IV contrast, ACEI or ARBS

Sxs:

  • decr skin turgor
  • hypotensive
  • ortho hypotension
  • dry mucosa

Dx:

  • Urine osmolality High
  • Urine Na < 20
  • BUN:Cr > 20:1**
  • FENa low < 1%

Tx

  • reversible - correct underlying condition
  • replenish fluids and maintenance
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4
Q

Acute Renal Failure Criteria

A

Sudden change in kidney fx in a day or week

RIFLE Criteria

Risk

  • Incr Cr x 1.5 or GFR decre > 25%;
  • UO < 0.5 ml/kg/hr x 6 hr

Injury

  • Incr Cr x 2 or GFR decr > 50%;
  • UO < 0.5 ml/kg/hr x 12 hr

Failure

  • incr Cr x 3 or GFR decr > 75%;
  • UO < 0.3 ml/kg/hr x 24 hr or anuria x 12h

Loss

  • persistent ARF - complete loss of renal fx > 4 wks

ESRD

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5
Q

Goodpasture’s Syndrome

Acute Glomerulonephritis

A

Autoimmune, production of anti-GBM (basement membrane of endothelial cells in glomeruli)

Type of Rapidly progressive GMN

Sxs:

  • Hemoptysis
  • hematuria - Kidney failure

Dx:

  • UA - nephritic findings
  • RBC casts
  • Mild proteinuria
  • Anti-GBM antibodies
  • Linear IgG deposits

Tx:

  • Plasmapheresis = remove circ abs
  • cyclophosphamide
  • CS
  • remission w/in a few weeks
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6
Q

IgA Nephropathy (Berger’s Syndrome)

Acute Glomerulonephritis

A

MCC GMN world wide’ M>W, 20-40s, Asian pop

IgA complexes deposit in mesangial cell in glomeruli

Sxs:

  • gross hematuria
  • preceded 1-2d w/ URI or GI
  • typically benign

Dx:

  • RBC casts
  • Renal bx - IgA deposit in diffuse pattern in mesangium

Tx:

  • Control BP
  • ACE-I for proteinuria
  • CS if rapid decr in renal fx
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7
Q

Post Infectious Strep Glomerulonephritis​

Acute Glomerulonephritis

A

Eti - GABHS from Strep pharyngitis or Impetigo; MC kids 2-13yo

Sxs:

  • 2 wks post infection
  • Nephritic syndrome
    • coca cola urine
    • rise In CR and BUN
    • Periorbital edema

Dx:

  • Hematuria
  • low C3 complement
  • high ASO titers

Tx:

  • resolves in 4 wks
  • Symptomatic tx - tx HTN and edema with loop diuretics
  • Dialysis if rapid progression to RF
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8
Q

Vasculitis

Acute Glomerular Nephritis

A

Rapidly Progressive GMN

A/w granulomatosis with Polyangitis (Wegeners’s) or microscopy polyarteritis nodosa (vasculitis of small renal arteries)

Sxs:

  • flu like syndrome - fever, arthralgias, anorexia, wt loss
  • +/- hemoptysis or pulmonary hemorrhage

Dx

  • +ANCA Antibodies

Tx

  • cyclophosphamide + corticosteroids (methylprednisolone)
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9
Q

Cystitis

A

Infection of bladder; MC d/t E.coli, ascends up urethra

sxs:

  • dysuria, frequency, urgency, suprapubic tenderness
  • following sexual intercourse
  • unremarkable PE

dx:

  • urine dipstick; nitrite, leukocyte esterase
  • UA - pyuria, bacteriuria, +/- hematuria
  • Urine culture - definitive >10^5 CFU clean catch
    • if epithelial squamous cells = contamination
  • imagine reserved for pyelo

Tx:

  • Uncomplicated - Bactrim DS BID x3d or Nitrofurantoin 100mg x5-7d
  • Increased fluids, prevention
  • hot sitz bath/urinary analgesics - phenazopyridine/Azo - pee orange
    • Lower UTI in pregnancy
      • Macrobid/nitrofuratoin 100 mg PO BID x 7 days
      • Cephalexin/Keflex 500mg PO BID x 7d
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10
Q

Epididymitis

A

Acq’d retrograde spread of organism through vas deferens

  • Men < 35 - G & C
  • Men > 35 = E coli

Sxs:

  • Dysuria
  • unilateral dull aching scrotal pain r-> ipsilateral flank
  • Swollen epididymitis, tender
  • fever/chills
  • Positive (+) Prehn’s sign - relieve w/ elevation
  • Positive (+) Cremasteric sign (normal) - ele of testicle after stroking on inner thigh

Dx:

  • UA - pyuria - bacteriuria + culture
  • scrotal US - increased testicular blood flow

Tx:

  • Supportive care; bed rest, scrotal elevation, analgesics
  • <35 yo
    • Ceftriaxone 250mg IM x1 + Doxycycline/Azithromycin 100 mg PO BID x 10d
    • treat partner as well
  • >35 yo E coli
    • Levofloxacin 500mg PO x 10 days
    • Ofloxacin 300 mg PO BID x 10d
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11
Q

Hemolytic Uremic Syndrome (HUS)

Acute Glomerulonephritis

A

MCC AKI in children 0-5yo;

a/w E.coli O157:H7, Shiga toxins

Sxs:

  • Diarrheal illness - bloody
  • Petechial rash

Dx:

  • UA - Nephritic findings
  • ele Cr BUN
  • Thrombocytopenia
  • incr PTT

Tx:

  • supportive; self limited 2-4 wks
  • Correct e- abns
  • dialysis rare
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12
Q

Hypercalcemia

A

Serum total Ca > 10.5 mg/dL; ionized fraction of Ca > 5.6 mg/dL

MCC - hyperparathyroidism, sarcoidosis, Tb, Paget dz, Mets, Mult myeloma

Sxs:

  • Stones, bones,
  • abd groans - abd pain
  • psychiatric moans (apathy/mood swings)
  • Hyperextensibility
  • Brady
  • Polyuria, constipation, anorexia
  • Renal Stones
  • Muscle weakness, confusion

Dx:

  • ionized Ca level
  • Shortened QT invl
  • Slit lamp - bandkeratopathy
  • Incr PTH - primary
  • decr PTH - malign
  • Bone lytic lesions

Tx:

  • IVF
  • Furosemide - loop diuretic - forces Ca out
  • Bisphosphonate - inhibit bone resorption w/ malignancy
  • Calcitonin
  • If refr to bisphosphonate - Denosumab
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13
Q

Hyperkalemia

A

serum K > 5.0 mEq/L

Eti:

  1. Incr K release from cells - BBs, insulin deficiency, AKI
  2. decr K excretion - aldosterone secreition
  3. Meds - K sparing diuretics

Sxs:

  • muscle weakness or paralysis
  • Cardiac abn
  • decr urinary acid excretion - Metabolic Acidosis

Dx

  • tall peaked T waves => QR Intvl shortening, wide QRS

Tx

  • C BIG K Drop
  • IV Ca gluconate - used for K>6.5
  • Insulin + glucose
  • Kayexalate - GI K excretion
  • B-agonists
  • Bicarbonates
  • Diuretics
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14
Q

Hypermagnesium

A

RARE; Mg > 3.2

2 MCC = 1. Renal insufficiency or 2. Incr Mg intake

Sxs:

  • N/V
  • Skin flushing
  • dizziness
  • hyporeflexia

Dx:

  • HyperMg
  • HyperK and HyperCa
  • EKG - prolonged PR and QT intvl
  • arrhythmias

Tx

  • mild to mod - IV fluids and Furosemide
  • Sev - Calcium Gluconate
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15
Q

Hypernatremia

A

Serum Na > 145 mmol/L

impaired thirst mechanism, Unreplaced water by vomiting or diarrhea, Diabetes inspidus, DKA, HHS,

Sxs:

  • Confusion
  • lethargy
  • Hyperreflexia
  • Seizures, or comas

Tx

  • Hypotonic Fluids - PO preferred
    • IV D5W or D5W 1/2 NS
  • rapid correction causes cerebral edema and pontine herniation
    • Correct = 0.5 mEq/L/h
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16
Q

Hypocalcemia

Study These Flashcards
A

Serum Total Calcium < 8.4 mg/dL; Ionized fraction of Ca < 4.4 mg/dL

Muscles become more excitable = neuromuscular irritability

a/w Ricketts, Osteomalacia, PTH

MCC hypoparathyroidism

Sxs:

  • numbness/tingling
  • tetanus
  • grand mal sz

Signs

  • Incr DTRs
    • Chvostek’s sign - facial m twitch
    • Trousseau’s sign - BP incr x3 systolic carpal spasm

Dx:

  • QT prolongation
  • PTH low

Tx -

  • IV calcium gluconate
  • PTH deficit - calcitrol + High Ca intake
  • Thiazide - decr Ca excretion, lowers urolithiasis
17
Q

Hypokalemia

Study These Flashcards
A

normal is 3.5 to 5 mEq/L; Serum K < 3.5 mEq/L

Eti: V/D, diuretic tx

  1. Decr K intake - malnutrition = Etoh
  2. K+ shift in cells - insulin/hypothermia
  3. Rare disx - hyperaldosteronism

Sxs:

  • Severe m. weakness
  • Rhabdomyolysis
  • Cardiac arrhythmias

Tx:

  • PO or IV potassium chloride
18
Q

Hypomagnesia

Study These Flashcards
A

Mg < 1.3 mEq/L

Eti -

  • GI losses from malabsorption/ETOHics, celiac dz, Small bowel bypass
  • Renal Losses = diuretics (thiazides, loop), meds (PPI, Ampho B, Cisplatin, cyclosporine)

Sxs:

  • AMS, Lethargy, weakness, incr DTR, weakness, tetany
  • HypoCa - impaired PTH secretion (Mg needed to make PTH)

Dx

  • hypoMg, +/- HypoK or HypoCa
  • EKG = prolonged PR and QT intvl, torsades, V-tach (R on T)

Tx

  • mild - PO Mg oxide
  • Severe - IV Mg sulfate
19
Q

Hyponatremia - Euvolemic

Study These Flashcards
A

Normal volume (Na + free water) and Incr free water

UNa > 20 = Aldosterone off aka kidneys NOT reabsorping Na into body circulation

Uosm > 300 = ADH on = water being reabsorped

  1. Renal Tubular Acidosis IV - r/o electrolytes
  2. Addison’s - r/o Cortisol levels
  3. Thyroid (hyper) - TSH
  4. Polydipsia
  5. SIADH - dx of exclusion

Tx - water restriction

20
Q

Hyponatremia - Hypervolemic

Study These Flashcards
A

high volume (Na + free water) and high free water

Edema = third spacing = reducing intravascular volume/perfusion to kidneys =

UNa < 20 = Aldosterone ON

  • Eti - CHF, Cirrhosis, Nephrosis

UNa > 20 = Aldosterone OFF

  • Eti - Acute/Chronic Renal Failure

Tx - H2O or Na restriction

21
Q

Hyponatremia

etiologies

Study These Flashcards
A

Serum Na < 135 mmol/L

  1. Determine serum Osmolality, then
  2. Volume status

HYPERTONIC HypoNa

  • Presence of osmotically active molecules = *decrease free water
    • glucose in hyperglycemia
    • Mannitol infusion

ISOTONIC HypoNa

  • lab artifact or error - free water is normal

HYPOTONIC HypoNa - true hyponatremia

  • a/w Incr free water
  • determine volume (ECF) status

1. Hypovolemic HyperNa

2. Euvolemic Hyper Na

3. Hypervolemic HyperNa

Tx:

  • Acute Tx = 50mL bolus of 3% saline
    • Watch for central pontine myelinolysis - 10-12mm in 1st 24 hrs or >18mm in 1st 48 hrs
22
Q

Hyponatremia - Hypotonic

Study These Flashcards
A

Hypovolemic Hyponatremia = low volume (Na + h2O)

Incre free water loss or decrease access to free water => RAAS activation => ADH release

Sxs:

  • Fever, tachycardia
  • heat exposure
  • Water rescriction

Dx

  • Aldosterone increases Na reabsoption = decr Na in urine = UNa low <20
  • ADH - increases H2O reabsorption = decr H2O in water = Uosm high >300
  • Renal Loss UNa >20 (aldosterone is off)
    • Diuretics (thiazides, K sparing)
    • ACE-I or ARBS
    • Hypoaldosteronism
  • Extra Renal Loss (UNa < 20, FeNa <1) -kidneys functioning properly to HOLD onto Na
    • Bleeding
    • Burns
    • GI - N/V, diarrhea
    • Pancreatitis

Tx - Normal saline 0.9% Saline = correct the volume

beware of central pontine myelitis - dont correct Na by >10-12mM within first 24 hrs or by >18 In first 48hrs.

23
Q

Metabolic Acidosis (high Anion Gap)

Acid-Base Disorders

Study These Flashcards
A

pH < 7.3 and HCO3 < 20

determine Anion Gap = Na - (Cl- + HCO3)

  • Carbon monoxide, cyanide, Congenital Heart Dz
  • Aminoglycosides
  • Toluene/glue sniffing
  • Methanol
  • Uremia
  • DKA/ETOH/Starvation
  • Paracetamol/Acetaminophen, paradelhyde
  • Iron/Isoniazide
  • Lactic acidosis
  • Ethanol/Ethylene gylcol - Antifreeze
  • Salicylates/ ASA/Aspirin
24
Q

Metabolic Acidosis (normal Anion Gap)

Acid-Base Disorders

Study These Flashcards
A

pH < 7.3 and HCO3 < 20

Excess production or ingestion of HCO3

Need to determine whether High Anion Gap Met Acidosis or Normal = 8 to 12 mEq/L

Eti:

  • MCC diarrhea
  • Type 2 Renal Tubular Acidosis
  • Spironolactone

Compensation via hyperventilation = decr CO2

25
Metabolic Alkalosis
**pH \> 7.4 and HCO3 \> 26 mEq/L** _Eti:_ * Loop diuretics * Antacid * Vomiting * Aldosterone * up **Compensation** - increase CO2 = hypoventilation/decrease breathing
26
Nephrolithiasis dx, tx
Dx: * UA - microscopic/gross hematuria, leukocytes/crystals * **non-contrast CT - gold std\*** * Renal US - ID stones in kidney, prox ureter, UVJ Tx: * \<5mm - likely to pass on own, lots of fluid - strain urine, adq analgesics * 5-10mm - can't pass spont., incr fluids & analgesics * elective **lithotripsy/ureteroscopy** * refer to uro w/ 9mm stone * \>10mm - incr complications * tx as inpatient - maintain PO intake, vigorous h20 * **Ureteral stent - percutaneous nephrostomy = gold std** * ample analgesia
27
Nephrolithiasis eti, sxs
50% recurrence w/in 10 yrs of 1s stone Renal Calculi - occur in urinary tract Calcium stones MC \> uric acid \> struvite \> cystine Sxs: * Asymptomatic until inflammation or complete/partial ureteral obstruction develops * Colicky unilateral back/flank pain radiating to groin * **hematuria** * CVA tenderness * N/V * Renal colic - waxes and wanes * **Dysuria, urinary freq, fever, chills**
28
**Nephrotic Syndrome** Glomerulonephritis
Abn glomerular permeability = loss of protein ETI - MCC membraneous GN, DM, SLE, drugs, infx Sxs: * Hypoalbuminemia * Hyperlipidemia - **Fatty casts In urine (**frothy) * **Proteinuria \> 3.5g/24 hr\*\*\*** * **Edema (peripheral) periorbital edema in children** * Increase liver production of clotting factors to balance Albumin loss - decrase in AntiThrombin 3 = high risk of DVT/PE Dx: * UA - oval fat bodies * 24 hr urine collection \>3.5g/d * **Renal bx - definitive** * **Hypoalbumemia \< 3.4 g/dL** * **Hyper lipidemia** Tx: * Corticosteroids + cyclophosphamide/Cyclosporine in minimal change disease * Diuretics for edema * ACEI/ARBS for proteinuria reduction
29
Orchitis
Inflammation of testicles - bacteria or virus ascending through urinary tract 25% postpubertal M **w/ MUMPS** **MCC -** Coxsackie Rubella, Echovirus, Parvovirus Sxs: * Unilateral **swollen testicles** * tenderness w/ erythema and shininess of overlying skin * fever/tachy * usu a/w epididymitis, unless MUMPS Dx: * UA - pyuria, bacteriuria * **positive Prehn's sign** - relieve of pain with elevation of scrotum * **Positive (normal) Cremasteric Reflex** - testicle draws upward w/ inner thigh stroke Tx: * if mumps - tx mumps + ice/analgesia * if bacterial - tx like epididymitis * \< 35 yo * **Ceftriaxone** 250 mg IM **+ doxy 100** mg BID x 10d **\< 35** * If \> 35 (usu E coli) * **Cipro** 500 mg BID 10-14 d
30
Prostatitis (acute and chronic)
Ascending infx of G- rods into prostatic ducts \<35 - Gonorrhea & Chlamydia; \>35 - E. coli **Chronic** - usu E.coli w/ recurrent UTI, structural abn, sxs \> 3mos sxs: * Sudden onset fever, chills, LBP * **Perineal pain w/ acute prostatitis** * Chronic - variable - asymp or acute sxs * **Urinary frequency, urgency, dysuria, some obstruction** * Dx * PE - DRE * Acute tender & enlarged/**boggy** prostate * Chronic - nontender, boggyy prostate * UA - pyuria or hematuria * prostatic fluid = leukocytosis, culture for E coli * chronic = enterococcus * DO NOT massage prostate ACUTE --\> sepsis Tx: * Acute * \< 35 - tx for Chlamydia and Gonorrhea * **Ceftriaxone and Azithromycin/doxy** * **​**\> 35 - tx for E coli and pseudomonas * **FQs or Bactrim for 6 wks** * culture after 1 wk after finish tx * Hospitalized in acute - parenteral FQs * Chronic prostatitis - **Bactrim or FQ** for 6-12 wks * NSAIDs for pain * Chronic, recurrent prostatitis = **Transurethral Resection of Prostate (TURP)**
31
Pyelonephritis dx ,tx
Dx: * CBC - leuks and left shift * \> 10^5 CFU in men * \>10^3 CFU in women * UA - pyuria, bacteriuria, hematuria, WBC casts * **Abd CT - abscess with pyelo** * VCUG for recurrent UTi in men * US - **hydronephrosis 2/2 obstruction** tx: * Outpatient - **Fq (cipro/levaquin) or Bactrim for 1-2wks** * Inpt - IV FQ, 34d or 4th gen Ceph, extended spect PCNs, gentamycin * Failure to respond -\> US/imaging * F/u urine cultures
32
Pyelonephritis eti, sxs
Inflammation of kidney parenchyma and renal pelvis d/t bacterial infx MC in elderly and DMs; MC E coli recurrent d/t progressive inflammation of renal interstitium caused by bacterial infx - anatomical urinary trac abns (vesicoureteral reflux) Sxs: * Irritative voiding sxs * Fever * flank pain + **CVA tenderness** * young childre = fever + abd discomfort
33
Respiratory Acidosis
**pH \< 7.3 and pCO2 \> 45** **_Acute Resp Acid_** * pH - very llow * HCO3 - slightly ele or normal **_Chronic Resp Acid_** * pH - close to nl * HCO3 - very ele \> 30 _Eti: **Hypoventilation**_ * Airway obstruction * Sedative use * Acute lung dz * Chronic lung dz * Opioid * Weakening resp muscle Compensation - **increase HCO3 retention/reabsorption** via kidneys = takes 24 hrs aka decr HCO3 excretion
34
Respiratory Alkalosis
**pH \> 7.4 and pCO2 \< 35** CO2 decr \< 36 mmHg = Decr HCO3 & decr H+ _Eti:_ Hyperventilation * Panic attacks * Anxiety attacks * Salicylates * Tumor * Pulm Embolism * Hypoxia Compensation - decrease HCO3 retention/reabs via kidneys aka incr HCO3 excretion, get rid of more HCO3
35
Testicular Torsion
Twisting of spermatic cord =\> compromised blood flow and ischemia MC in pt w/ cryptorchidism **SURGICAL EMERGENCY** Sxs: * Asymmetric high riding testicle "**bell clapper deformity"** * **Neg Prehn's sign - lifting will not relieve pain** * **Cremaster reflex absent** * Sudden, severe pain and swelling in testicles * N/V * **Blue dot sign** - tender nodule 2-3mm on upper pole * V tender to palp dx: * Testicular doppler - best initial test * **Radionuclide scan = decr uptake in affected testes - gold std** Tx: * **Detorsion and orchiopexy** w/in 4-6 hrs * Elective sx on other testes - risk of torsion
36
Urethritis
Infx of urethra w/ bacteria =\> STI (C, G, Trich, HSV = MCC) Sxs: * Dysuria * Urethral dx - purulent, whitish mucoid Dx - UA and urine culture Tx * If sexually active - tx for STD * **Ceftriaxone 250 mg + Azithromycin 1 g PO QD x 7 days** * **OR Doxy 100mg PO BID x 7d**
37
Hypocalcemia
**Serum Total Calcium \< 8.4 mg/dL; Ionized fraction of Ca \< 4.4 mg/dL** Muscles become more excitable = neuromuscular irritability a/w Ricketts, Osteomalacia, PTH MCC **hypoparathyroidism** Sxs: * numbness/tingling * tetanus * grand mal sz Signs * Incr DTRs * **Chvostek's sign - facial m twitch** * **Trousseau's sign - BP incr x3 systolic carpal spasm** Dx: * **QT prolongation** * **PTH low** Tx - * **IV calcium gluconate** * PTH deficit - calcitrol + High Ca intake * Thiazide - decr Ca excretion, lowers urolithiasis
38
Hypomagnesia
**Mg \< 1.3 mEq/L** Eti - * GI losses from malabsorption/ETOHics, celiac dz, Small bowel bypass * Renal Losses = diuretics (thiazides, loop), meds (PPI, Ampho B, Cisplatin, cyclosporine) Sxs: * AMS, Lethargy, weakness, incr DTR, weakness, tetany * HypoCa - impaired PTH secretion (Mg needed to make PTH) Dx * hypoMg, +/- HypoK or HypoCa * EKG = **prolonged PR and QT intvl,** **torsades**, V-tach (R on T) Tx * mild - PO Mg oxide * Severe - IV Mg sulfate

Emergency Medicine (13 decks)

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