Urology/Nephrology/ocular Flashcards by nancy Gillcrist

HIV associated nephropathy is what kind of kidney disease…

collapsing focal and segmental glomerulosclerosis

=proteinuria with renal failure

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protein to creatinine ratio versus 24 hr urine protein

ratio can be more accurate and is easier/faster

if have to choose, do the ratio

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if patient has microalbuminuria, next step

microalbuminuria can worsen renal function over time

start patient on an ace i or arb

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if eosinophils are found on UA, 2 possible conditions?

acute interstitial nephritis or allergic interstitial nephritis

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false positives for hematuria on dipstick are caused by what 2 factors?
confirm dipstick with?

hemoglobin or myoglobin

confirm with urine microscopy

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intravenous pyelogram is always ____

wrong

it is slow and contrast is toxic

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“dysmorphic” red cells on UA =

glomerulonephritis

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types of cast = ....
1 rbc cast
2 wbc cast
3 eosinophil cast
4 hyaline cast
5 broad way cast
6 granular muddy brown cast

1 glomerulonephritis
2 pyelonephritis
3 acute (allergic) interstitial nephritis
4 dehydration (normal tamhorsfall protein)
5 chronic renal disease
6 ATN

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types of AKi

prerenal azotemia (dehydration/hypotension, or renal artery stenosis)
postrenal (obstruction - must obstruct both kidneys for Cr to rise)
intrinsic renal disease

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UNa and FeNa for PRERENAL

UNa <20

FeNa<1%

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urine osmolality in ATN is….

inappropriately LOW because the tubule cells are damaged and cant resorb water correctly

isosthenuria (osm of U = osm of serum) indicated ATN

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lab values seen in CONTRAST induced renal failure/injury

UNa, FeNa, and specific gravity

what about for normal ATN?

UNa LOW
FeNa <1% (afferent arteriole spasm)
U spec grav very high

normal ATN shows high UNa( >20), Fena >1%, and low spec grav

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after chemo, Cr rises 2 days later….
cisplatin or hyperuricemia?

what could have prevented this?

hyperuricemia due to tumor lysis syndrome
cisplatin would not produce a rise in Cr for 5-10 days

give allopurinol, hydration, and rasburicase prior to chemo to prevent renal failure from TLS

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you see ingestion hx plus renal failure 3 days later + low calcium level and envelop crystals

toxic ingestion?

ethylene glycol

oxalate crystals (calcium oxalate) lead to low ca

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rhabdomyolysis UA and dipstick findings

what happens to electrolytes?

UA no cells
dipstick positive for large amount of blood (myoglobin spilling into urine)
CPK high

hyperK and hyperuricemia (both from lysis of cells)
and hypoCa (ca bound to damaged muscle)

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tx for rhabdomyolysis

saline hydration
mannitol as osm diuretic
(saline and diuretic to increase flow through tubular cells and prevent damage)
\+
bicarbonate to drive K back into cells

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first step if someone comes in w seizure from suspected rhabdo?

EKG to make sure there isnt a like threatening hyperK

dipstick and cpk can wait

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diuretic that can cause ototoxicity?

furosemide

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indications for dialysis?

fluid overload
encephalopathy
pericarditis
met acidosis
hyperK

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hepatorenal syndrome

kidney failure d/t liver dz

cirrhosis + prerenal picture

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blue/purple lesions in fingers toes + livedo reticularis + AKI

cholesterol emboli

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meds that cause acute (allergic) interstitial nephritis and drug rash (SJS/TEN)

penicillins
cephalosporins
sulfa (diuretics like furosemide and thiazide)phenytoin
rifampin
quinolones
allopurinol
PPI

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what stain to see if eosinophils are in urine?

hansel or wright stain

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papillary necrosis
presentation
dx
tx

sloughing of renal papillae
(extra nsaid use, sickle, DM)

looks like pyelo = sudden onset flank pain, fever, hematuria
UA with necrotic tissue and culture is normal (no growth)
CT scan shows loss of papillae

no tx

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drugs AKI occurs in what structure

tubules | glomerulus is not damaged from drugs

goodpastures

lung and kidneys (no upper resp involvement or systemic signs which differentiates it from wegeners) anti GBM ab = linear deposits tx plasmapheresis and steroids

berger disease (iga nephropathy) vs post strep glomerulonephritis

gross hematuria 1-2days after URI post strep is dark urine/periorbital edema ~ 1-2 weeks after strep

alport syndrome

defect of collagen leading to glomerular disease and hearing loss + vision disturbance

polyarteritis nodosa

fatigue, weight loss, arthralgias/myalgias glomerulonephritis + GI abd pain + other organ systems aneurysmal dilatiation on angiography or biopsy tx cyclophosphamide and prednisone + treat for hep B if present

amyloidosis biopsy? tx?

large kidneys --> green birefringence on congo red staining melphalan and prednisone

nephrotic syndrome

proteinuria (>3.5 g/24 hrs) so large that liver can no longer compensate with production protein loss leads to edema, hyperlipidemia, and thrombosis (urinary loss of natural anticoagulants like protein S, C, and antithrombin)

what kind of nephrotic syndrome occurs with injection drug use and AIDS? cancer? kids?

focal segmental cancer --> membranous kids --> minimal change

WHAT CAN BE GIVEN TO bind phosphate in end stage renal disease with hyperphos?

``` ca acetate or ca carbonate or sevelamer or lanthanum ```

in HUS and TTP what happens to PT and aPTT tx?

they are NORMAL HUS willresolve spontaneously TTP requires plasmapheresis or FFP (NOT steroids)

features of a benign simple kidney cyst

echo free, smooth thin walls, sharp demarcation, and good transmission to back no aspiration needed!

mc cause of death in polycystic kidney disease?

renal failure

water loss from insufficient or ineffective ADH

which responds to ADH: central or nephrogenic DI

central

if water deprivation test shows decreased U volume....if it shows continued high volume U? next test?

dec: psychogenic polydipsia stays high: DI next test: ADH administration

addison disease which is loss of ___fxn causes ______ due to loss of _____

adrenal fxn hyponatremia aldosterone

demeclocycline

tx for chronic SIADH blocks ADH action at tubules

correction of Na must occur ____ if it is too ___, you risk increases of....

slowly less than 0.5 -1 meq per hr or 12-24 meq per day central pontine myelinolysis (osmotic demyelinization)

insulin and K relationship

insulin usually drives K into cells

ekg shows peaked t waves and wide qrs

hyperKalemia

tx for hyperkalemia

if there are ekg changes --> calcium cl or gluconate will protect the heart (but doesnt lower K level) insulin/gluc and bicarb redistribute it kayexylate will remove it from body over days

u waves or flat T waves

hypokalemia

calculate anion gap (norm 12 or less)

Na - (Cl + bicarb)

distal renal tubule acidosis (type 1)

distal tubule makes new bicarb if damaged, UA ph will be >5.5 since acid cant be excreted tx give bicarb

proximal RTA (type 2)

proximal tubule is damaged and kidney cant resorb all the filtered bicarb pH is low <5.5 chronic met acidosis leaches ca out of bones = osteomalacia tx thiazide diuretics

type 4 rta

urine salt loss (hyperenin, hypoaldosterone) tx with flucortisone

type of rta with nephrolithiasis

type 1 distal

first steps for someone with acute kidney stone and pain

ketorolac /analgesics then get CT

kidney stones that are 0.5 - 2 cm are tx w

lithotripsy | surg for 2 cm

man w ca oxalate stone gets lithotripsy has hyperca in urine what med?

HCTZ

Uveitis v glaucoma v abrasion

Uveitis- W autoimmune diseases, photophobia, dc w slit lamp, Tx topical steroids Glaucoma - pain, fixed midpoint pupil, dx w tonometry, Tx acetazolamide or mannitol Abrasion - trauma, sand in eyes, dx w fluorescein stain, tx none

Tonometry is used to dx...

Glaucoma

Sudden onset painful red eye that is hard, no reaction of pupil to light

Acute angle closure glaucoma

Red swollen eye w pain Dendritic pattern seen in fluorescein stain

Herpes keratitis DONT GIVE STEROIDS Tx w oral acyclovir (or famicyclovir or valacyclovir)

Nonproliferation retinopathy is treated w

Controlling glucose

Proliferative retinopathy in diabetics is treated with

Laser photocoagulation

Sudden onset monocular vision loss Dx? Tx?

Retinal artery or vein occlusion Retinal examination Artery occ will have cherry red macula and pale retina Vein occ will have blood extravasation into retina (red image) Tx for artery occlusion is 100oxygen, ocular massage, acetazolamide, and thrombolytics

Sudden onset painless unilateral loss of vision like curtain coming down

Surgical reattachment

Best tx for macular degeneration

Vegf inhibitor | Like ranibizumab or bevaciumab

vitreous hemorrhage

onset of loss of vision suddenly and floaters!

Urology/Nephrology/ocular Flashcards

(64 cards)