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LMCC > Uro/Nephro > Flashcards

Uro/Nephro Flashcards

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1
Q

Tamm-Horsfall protein

A

Inhibits attachment of type 1 fimbriae E.coli to uroepithelial cells –> mitigates against infection

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2
Q

Staghorn calculi

A 
Struvite calculi 
Phosphate + ammonium + magnesium 
Very large and branched 
Pts often asymptomatic 
Infection and hematuria 
Most a/w infections w/ Proteus, Klebsiella, ureaplasma 
Formed in alkalotic environment
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3
Q

Most common type of renal stone

A

Calcium oxalate or calcium phosphate

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4
Q

Preferred imaging method to detect renal stones

A

NCCT KUB

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5
Q

2 stones that are not radio-opaque

A

Uric acid

Indinavir

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6
Q

Irritative urinary symptoms

A 
FUND 
Frequency
Urgency 
Nocturia 
Dysuria
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7
Q

Voiding urinary symptoms

A 
Weak stream 
Intermittency 
Splitting, spraying, straining 
Hesitancy 
Terminal dribble
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8
Q

Drugs often a/w urinary incontinence

A 
Alpha adrenergic agonists 
Alpha adrenergic antagonists 
Anticholinergics
Antipsychotics 
Bromocriptine 
CCB 
CLonazepam
Diuretics 
Ethanol
Lithium 
Metoclopramide 
Misoprostol 
Phenytoin
Sedatives
Skeletal muscle relaxants
Sympatholytics (ie. methyldopa)
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9
Q

Treatment for stress incontinence

A 
In postmenopausal women where intrinsic sphincter deficiency is suspected cause, try estrogen replacement therapy +/- alpha agonists (ie.pseudoephedrine) 
Pelvic floor physio 
Weight loss
Pessaries
Retropubic suspensions/slings
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10
Q

Treatment for urge incontinence

A

Anti-cholinergic to inhibit bladder contraction (Oxybutynin, solifenacin)
Beta-3 adrenergic receptor agonists to cause bladder relaxation (Mirabegron)
Botox, percutaneous tibial nerve stimulation, sacral neuromodulation

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11
Q

Main cause of nephrotic syndrome in peds

A

Minimal change disease

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12
Q

Goodpasture syndrome

A

AKA anti-GBM disease
Formation of antiglomular basement membrane antibodies –> renopulmonary disease –> hematuria, hemoptysis
Tx: PLEX, steroids, cyclophosphamide

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13
Q

Most common cause of primary nephrotic syndrome in adults

A

Membranous glomerulonephritis (recently more FSGS)

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14
Q

Wegener’s granolomatosis

A

AKA granulomatosis with polyangiitis

Vasculitis affecting small vessels –> hematuria, hemoptysis

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15
Q

Minimal change disease etiology

A

Often idiopathic

Can be a/w lithium, NSAIDs, hypersensitive rxn to bee sting, viral URTI in children , heme malignancies

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16
Q

Cockcroft-Gault formula

A

Estimates CrCl
Considers age, gender, serum creatinine, weight but does not include race
Overestimates GFR when renal function severely impaired

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17
Q

MDRD formula

A

Esimates GFR
Considers age, gender, serum Cr, and race but not weight
Underestimates GFR at near norma values

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18
Q

Hypokalemia seen in metabolic acidosis or alkalosis?

A

Metabolic alkalosis

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19
Q

Hypokalemia ECG

A

Initially: U waves, St depression, inverted/flattened T waves, QT prolongation, sinus brady
Severe: PR prolongation, wide QRS, increased risk of digitalis toxicity
VFib, VTach

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20
Q

HypoMg, HypoCa, HypoK which to correct first?

A

HypoMg

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21
Q

Hyperkalemia ECG

A 
Peaked T waves
Eventual loss of P wave 
Prolonged PR interval
WIdening QRS 
AV block 
Vfib, asystolice
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22
Q

K+ level at which you start treatment with insulin

A

6.5

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23
Q

1st line treatment when K>7 and ECG changes

A

Calcium gluconate to protect heart

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24
Q

Fludrocortisone

A

Synthetic mineralocorticoid

Use if suspect adrenal insufficiency

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25
Phosphate and calcium
Phosphate binds to calcium | Hyperphosphatemia --> hypocalcemia --> secondary hyperPTH with advanced CKD on dialysis
26
Tx for acute hyperphosphatemia
Hemodialysis if symptomatic Aluminum hydroxide (careful in renal failure) Chronic: low po4 diet (initial), then calcium carbonate binder if not resolves with PO4 diet
27
Hypercalcemia treatment
IV NS
28
AG value
AG < 12 is normal
29
AG and albumin
For each 10g/L fall in albumin, AG lowered by 3
30
Osmolar gap
Calcualte if AG is elevated Measured osmolality - calculated osmolality Calculated = 2xNa + urea + glucose Normal <10
31
Causes of increased osmolar gap
Poisonous alcohols
32
Common causes of AGMA
``` MUDPILES CAT Methanol Uremia DKA Paraldehyde Iron/Ibuprofen/Indomethacin/Isopropyl alcohol Lactic acid Ethylene glycol Salicylates Cyanide/Carbon monoxide Alcoholic ketoacidosis Toluene ```
33
2 most common causes of NAGMA
Diarrhea RTA involves increased bicarb excretion that is replaced with Cl
34
Renal tubular acidosis
``` I = Distal; inability to secrete H+ in collecting duct --> impaired excretion of ammonium into urine II = Proximal; impaired HCO3- reabsorption III = Combo Type I and II (Rare) IV = Defective ammoniagenesis due to decreased aldo, hyporesponsiveness to aldo or hyperkalemia (most common) ```
35
Urine AG formula
(Na + K) - Cl <0 = adequate NH4 excretion in urine (likely nonrenal cause) >0 = lack of NH4 in urine (ie. distal RTA)
36
Most common tx for metabolic alkalosis
Volume repeltion +/- carbonic anyhydrase inhibitor (acetazolamide) to facilitate loss of HCO3 in urine
37
Hyperphosphatemia
>1.45
38
Hypophosphatemia
<0.8
39
HyperMg
>1.05
40
HypoMg
<0.7
41
Gold standard for proteinuria screen
24h urine protein
42
Fanconi's Syndrome
Inadequate reabsorption of proximal renal tubules of kidney Albumin not affected Edema secondary to salt and water retention Leads to proteinuria
43
Glomerular disease edema secondary to
Hypoalbuminemia (plus Na/H2O reabsorption) Ie. Minimal change, Membranous, FSGS
44
Most common type of primary glomerular disease
IgA Nephropathy (Berger's disease) Most commonly after viral URTI in 2nd/3rd decade of life A/W cirrhosis, HIV, celiac Tx: RAAS Blocker if proteinuria, steroids, or steroid sparing agents (azathioprine, cyclophosphamide, mycophenolate mofetil, rituximab)
45
Alport Syndrome
``` Hereditary nephritis X-linked Leads to Type IV collagen mutation A/w sensorineural hearing loss, misshapen lens More severe in males ```
46
Membranoproliferative glomerulonephritis vs membranous glomerulonephropathy
Membranoproliferative GN = thickening of GBM and mesangium | Membranous GN = thickening of GBM only
47
Nephrotic syndromes
FSGS Membranous glomerulopathy Minimal change
48
Nephrotic/nephritic syndromes
Membranoproliferative GN | Focal proliferative GN (IgA, hep B, hep C, SLE)
49
Nephritic syndromes
Diffuse proliferative GN | Crescentic GN
50
Granulomatosis with polyangiitis
AKA Wegener's granulomatosis c-ANCA+ RF+ Inflammation of blood vessels in kidneys, lungs, nose, throat, sinuses
51
Eosinophilic granulomatosis with polyangiitis
AKA Churg Strauss p-ANCA+ Systemic necrotizing vasculitis affecting small and medium sized vessels Asthma, eosinophilia, pulmonary infiltrates Tx: steroids mostly
52
Most common renal complication a/w SLE
Nephrotic syndrome
53
Cyclophosphamide
Immunosuppressant
54
Acute tubulointerstitial nephritis
Acute decline in renal function, typically due to drugs, infections, AI or idiopathic (5Is) Tx: tx underlying cause, steroids Good prognosis
55
Acute tubular necrosis
Abrupt and sustained decline in GFR within minutes to days after ischemic/nephrotoxic insult Typically toxins or ischemia Most common cause of non-prerenal AKI Muddy browncasts/pigmented granular casts
56
CKD duration
>3mo
57
Calcitriol, hypocalcemia and hyperphosphatemia in CKD
Calcitriol can be used to tx hypocalcemia BUT if pt has hyperphosphatemia don't use it b/c it causes increased absorption of Ca and PO4
58
Tx of hypercalcemia and hyperphosphatemia in CKD pts
Sevelamer (phosphate binder)
59
Electrolyte abnormalities in ESRD
Hyper: K+, PO4, uric acid Hypo: Na, Ca, HCO3
60
Indications for dialysis
``` AEIOU Acidosis Electrolyte imbalance (K) Intoxication (AKI) Overload (fluid) Uremia (encephalopathy, percariditis, urea) ```
61
GFR at which to initiate dialysis
10mL/min
62
Prostate CA risk factors
``` >50yo African descent High dietary fat (2x) Fam hx (1st degree relative 2x; 1st and 2nd degree relative 9x) +ve BRCA mutation ```
63
Most common type of prostate CA
Adenocarcinoma
64
PSA values
<4 = normal 4-10 = equivocal >20 = likely CA Half life of 2.2d
65
Type of GN that cannot present as RPGN
Minimal change disease
66
Prostate CA treatment - very low risk, localized
Active surveillance with serial monitoring
67
Prostate CA treatment - clinically localized, low - intermediate risk, >10yr life expectancy
Definitive therapy with radical prostatectomy, brachytherapy or external beam RT OR active surveillance
68
Prostate CA treatment - high -very high risk, clinically localized
RT with external beam combined with brachytherapy and androgen deprivation therapy OR radical prostatectomy +/- lymph node diessection
69
Prostate CA treatment - disseminated disease
ADT +/- chemotherapy
70
Prostatitis tx
Empiric abx: Septra OR Cipro or Levo x 6wks Change abx based on urine C&S SEPTRA IS A SULFONAMIDE

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