UWORLD REnal

Question 1

Diagnostic testing urethral diverticulum

Answer 1

UA, culture
MRI of the pelvis
Transnational Ultrasound

Question 2

TX urethral diverticulum

Answer 2

Manual decompression, needle aspiration or surgical repair

Question 3

Post operative urinary retention risk factors

Answer 3

Age >50
Surgery >2 hours duration
>750ml intraoperative fluids
regional anesthesia
Neurological disease
Underlying bladder dysfunction
Previous pelvic surgery

Question 4

Post operative urinary retention clinical features

Answer 4

Decreased urine output
Abdominal dissension
Suprapubic pressure/ pain

Question 5

Diagnosis and management of post operative urinary retention

Answer 5

Urinary catheter is both diagnostic and therapeutic large volume of urine is evacuated and prevents continued over dissension

Patients undergo an outpatient voiding trail within a week, after which the catheter is removed

Question 6

Mechanism of post operative urinary

Answer 6

Anesthesia causes bladder stretch receptor dysfunction and decreases detrusor contractility which along with large fluid volumes results in rapid overdistension.

Question 7

Child with acute onset of edema and hypoalbuminemia and hyperlipideamia and proteinuria.

Answer 7

Nephrotic syndrome most common: minimal change.

Caused by cytokine-mediated podocyte injury.

Question 8

Treatment minimal change disease

Answer 8

Diagnosis is clinical and management is empiric immunosuppressive therapy with corticosteroids to counter T-cell dysregulation and cytokine-mediated damage

Question 9

Long term effects of relapsing MCD requiring prolonged steroid use.

Answer 9

Common adverse effects include adrenal suppression, decreased bone density, weight gain, and hypertension. Impair linear growth. Glucocorticoid-induced changes to lens epithelial cell gene transcription can lead to cataract formation requiring frequent ophthalmologist examination for early detection.

Question 10

WBC casts

Answer 10

Acute interstitial nephritis

Due to antigen hypersensitivity leads to tubulointerstitial mononuclear cell infiltration

Question 11

Most common cause of Acute Kidney INjury

Answer 11

Antibiotics (especially beta-lactate such as cefazolin)
NSAIDs
PPI

Question 12

Muddy brown casts

Answer 12

Acute tubular necrosis

Caused by renal ischemia

Question 13

Tubulointestinal invasion by neutrophils vs mononuclear cells

Answer 13

Neutrophils is indicative of pylonephritis

Mononuclear is indicative of AIN

Question 14

UTI in pregnancy

Answer 14

-Amoxicillin* or amoxicillin-clavulanate for 5-7 days
-Cephalexin for 5-7 days
-Fosfomycin as a single dose
-Nitrofurantoin for 5-7 days (avoid in 1st trimester & at term)
-No fluoroquinolones in any trimester
-No trimethoprim-sulfamethoxazole in 1st trimester or at term

Question 15

Treatment of asymptomatic bacteriruria in pregnancy vs non pregnancy

Answer 15

Nonpreganant patients do not require treatment

Preagnancy increases risk for acute pylo due to the effects of progesterone on the upper urinary tract (eg smooth muscle dilation, ureteral enlargement, visicoureteral valve dysfunction). In addition to fetal complications (preterm birth, low weight, perinatal mortality)

Question 16

TMPSMX in pregnancy

Answer 16

Use in first trimester has been associated with neural tube defects due to the folate antagonist properties of temp. Use at term is avoided due to a possible association with neonatal kernicterus.

Question 17

Diagnosis of posterior urethral valve

Answer 17

Diagnosis is confirmed using a voiding cystourethrogram (VCURG).

Shows visualization of dilated proximal urethra when the catheter is removed (the catheter keeps the valve open and must be removed before the ending of imaging)

Question 18

Management of Posterior urethral valve

Answer 18

Once confirmed infants should have a Foley catheter placed to temporarily relive the obstruction.

Once stabilized, cystoscope allows direct visualization and ablation of the valve (curative)

Question 19

pathophys of AIN

Answer 19

tubulointerstitial mononuclear infiltration (t lymphocytes, macrophages)

This results in the tubular accumulation of WBCs (ie, pyuria, WBC casts) and, often, mild proteinuria and/or hematuria

Question 20

presentation of AIN

Answer 20

Urinalysis: WBCs & WBC casts ± mild RBCs & proteinuria
Peripheral eosinophilia ± urine eosinophils

Question 21

causes of AIN (acute interstitial nephritis)

Answer 21

-Medications (eg, antibiotics (b-lactams), NSAIDs, PPIs)*
-Rheumatologic disease (eg, SLE, Sjögren syndrome, sarcoidosis)
-Infections (eg, Legionella, tuberculosis, CMV)

Question 22

pharmacological tx for reccurent stones that do not respond to diet

Answer 22

Thiazide diuretics are the first-line pharmacotherapy for patients with hypercalciuria and recurrent calcium stones.

Question 23

asymptomatic bacteriuria in pregnancy

Answer 23

increased risk for acute pyelonephritis due to the effects of progesterone on the upper urinary tract

associated with fetal complications, including preterm birth, low birth weight, and perinatal mortality.

Question 24

tx of asymptomatic bacteriuria in pregnancy

first line

Answer 24

First-line antibiotic choices

-cephalexin for 5-7 days,
-amoxicillin-clavulanate for 5-7 days, –fosfomycin as a single dose.

Question 25

tx of asymptomatic bacteriuria in pregnancy abx to avoid

Answer 25

-Nitrofurantoin for 5-7 days (avoid in 1st trimester & at term) -No fluoroquinolones in any trimester -No trimethoprim-sulfamethoxazole in 1st trimester or at term

Question 25

sxs of SIADH

Answer 25

-Mild/moderate hyponatremia: nausea, forgetfulness -Severe hyponatremia: seizures, coma -Euvolemia (eg, moist mucous membranes, no edema, no JVD) -Hyponatremia -Serum osmolality <275 mOsm/kg H2O (hypotonic) Urine osmolality >100 mOsm/kg H2O

Question 26

SIADH post operative

Answer 26

Postoperative SIADH is common due to prominent nonosmotic stimuli for ADH secretion (eg, pain, nausea, physical and emotional stress).  Worsened by postoperative administration of IV fluids which, in the setting of SIADH, can lead to further water retention.

Question 27

tx of severe SIADH

Answer 27

tonic-clonic seizure with severe hyponatremia = cerebral edema and risk of brainstem herniation Urgent increase in their serum sodium = hypertonic (3%) saline.

Question 28

pathophys mechanism of Iga

Answer 28

Mesangial deposition of abnormal IgA (eg, synthesized in response to a mucosal respiratory infection)

Question 29

clinical presentation of IgA

Answer 29

Onset: spontaneous or several days after URI Episodic gross hematuria (isolated or recurrent) ± (Flank pain, low-grade fever, ↑ BP) Asymptomatic: microscopic hematuria can occur

Question 30

poor prognostic factors of IgA nephropathy

Answer 30

-Elevated serum creatinine -Hypertension (>140/90 mm Hg) -Persistent proteinuria (>1 g/day)

Question 31

Risk of BPH causing acute urinary retention

Answer 31

Increased with bladder/urethral infection, genitourinary trauma, certain medications (eg, baclofen, anticholinergics).

Question 32

nepholithisis in pregnancy sxs

Answer 32

abdominal pain that is paroxysmal, severe nausea and vomiting inability to find a comfortable position radiating to the labia in the context of a normal abdominal examination

Question 33

diagnostic test for nepholithiasis in pregnancy

Answer 33

Renal and pelvic ultrasonography Even no direct visualize a stone, the presence of hydronephrosis and/or hydroureter is consistent with ureteral obstruction due to nephrolithiasis. 

Question 34

nocturnal enuresis child >5

Answer 34

1. behavioral nodification 2. motivational therapy 3. enuresis alarm therapy, a first-line treatment that has the best long-term outcome and a low risk of relapse

Question 35

suspicion for renal cell carcinoma

Answer 35

common (all 3 present <9%): flank pain, hematuria palpable abdominal mass   Paraneoplastic syndromes: erythropoietin production (erythrocytosis)