Term
| define proteinuria, nephrotic, trace, and 1-4+ protein |
|
Definition
trace 50-150mg
>150 proteinuria
>3.5 nephrotic
1+ 150-500
2+ 0.5-1.5g
3+ 2-5g
4+ >5g |
|
|
Term
|
Definition
|
|
Term
| what is the best test for renal function |
|
Definition
|
|
Term
| best to test obstruction, masses, cysts |
|
Definition
|
|
Term
| best to detect pyelonephritis |
|
Definition
|
|
Term
| treatment of uncomplicated and complicated pyelonephritis |
|
Definition
uncomplicated: TMP-SMX 10d, amoxicillin in GPC suspected
complicated: hospitalize, IV fluids, ampicillin with gentamycin or cpiro |
|
|
Term
| complications of pyelonrphritis |
|
Definition
preterm labor
low birth weight
sepsis and shock |
|
|
Term
| treatment of uncomplicated, pregnancy, male, recurrent, and asymptomatic UTI |
|
Definition
uncomplicated: TMP-SMX 3d
pregnancy: ampicillin, amoxicillin, or ceph 7-10d
male: treat as uncomplicated once, if recurs do full urological work up
recurrent: culture, if >2y, TMP-SMX before intercourse
asymptomatic: treat if pregnancy or undergoing urological procedure |
|
|
Term
|
Definition
pyelonephritis
seosis
prostatis
preterm labor
low birth weight
spontaneous second trimester abortion
preeclampsia
amnionitis |
|
|
Term
| signs of CaO, CaP, urate, struvite, and cystine stones |
|
Definition
CaO/P: radiodense, bypyrmidal or biconcave
Urate: pH <5.5, flat squares, radiolucent
Struvite: staghorns, alkaline urine, coffin lid, radiodense, rectangle prism
Cystine: hexagon, staghorns |
|
|
Term
| most sensitive test for finding renal stones |
|
Definition
|
|
Term
| when and how to pass renal stone |
|
Definition
<9mm
strain urine
3L/d fluids during night too
tamsulosin to relax smooth muscle
nifedipine
repeat CT in 4wk |
|
|
Term
| what to do with large renal stones |
|
Definition
5mm-2cm: extracorporeal shock wave lithotropsy
uteroscopy: larger
percutaneoous nephrostolithotomy: super large, stagnorn stones |
|
|
Term
| best way to diagnose urine obstruction |
|
Definition
US shows dilation, sensitive and specific
IVP is gold standard but invasive |
|
|
Term
| signs adult polycystic kidney disease, treatment |
|
Definition
AD, berry aneurysms, subarachnoid hemorrhage, flank pain, UTI, hematuria, large kidneys, HTN, kideny, stones, MVP, liver cysts, aortic dissection
tx: vasporessin antagonist and amiloride prevent fluid collection in cysts |
|
|
Term
| signs child polycystic kidney disease |
|
Definition
| AR, portal HTN, cholangitis, often biliary dysgenesis, hepatic fibrosis, large kidneys, abdominal distension, HTn, pulmonary insufficiency, potter syndrome (oligohydraminos, lung hypoplasia, club feet, abnormal facies) |
|
|
Term
|
Definition
renal cell carcinoma
hepatocellular carcinoma
pheochromocytoma
hemangioblastoma
high altutudes
lung disease / hypoxia |
|
|
Term
| renal cell carcinoma: risk factors, signs, diagnosis |
|
Definition
smoking, cadmium, asbestos, polycystic kidney disease, von-hippel lindau
flank pain, weight loss, HTN, fever, hematuria, scrotal vericocele, polycythemia
biopsy can lead to peritoneal seeding, just CT/MRI |
|
|
Term
| staging and treatment of bladder cancer |
|
Definition
0: superificial mucosa only, CIS: intravesical chemo
A: lamina propria, tends to recur: transurethral resection
B: muscle invasion: radical cystectomy, hysterectomy, vaginal removal, node dissection
C: perivascular fat: same
D: mets to nodes, organs, distand: cystectomy, chemo, radiation |
|
|
Term
| postinfectious glomerulonephritis |
|
Definition
cant prevent with antibiotics
brown urine
anti-streptolysin O
bumpy IgG/C3 on BM subepithelial, hypercellular glomeruli, PMN |
|
|
Term
|
Definition
assoc with UTI, henoch-scholen purpura
gross hematuria
IgA/C3 in mesangeal cells, mesangeal proliferation |
|
|
Term
| crescentric proliferative glomerulonephritis |
|
Definition
anti-glomerular GM
linear IgG/C3 on BM
lower respiratory disease and renal failure
needs plasmaphoresis |
|
|
Term
|
Definition
XR/AD collage IV BM defect
cataracts, hematuria, high frequency hearing loss
split BM |
|
|
Term
| rapidly progressive glomerulonephritis |
|
Definition
1) anti-GM Ab (crescentric proliferative)
2) immune complexes (IgA nephropathy, post-infectious, lupus)
3) p-ANCA+
sudden renal failure, weakness, weight loss, fever, oliguria
inflammatory cells, fibrous deposition in bomans, crescent formation (BM wrinkeling) |
|
|
Term
|
Definition
kids
flat BM, fusion of foot processes
systemic T cell dysfunction |
|
|
Term
| granulomatosis and polyangiitis |
|
Definition
c-ANCA
upper and lower respiratory disease
renal failure
immune complexes in renal vessels |
|
|
Term
|
Definition
adults, HIV, AA
sclerotic changes, segmental |
|
|
Term
| membranous glomerulonephritis |
|
Definition
hepB, syphilis, malairia, gold, penicillamine, neoplasm, SLE
spike and dome BM thickening, subendothelial |
|
|
Term
| myeloproliferative glomerulonephritis |
|
Definition
hepC, SLE, syphilis, bacterial endocarditis, cyroglobinemia
IgG on BM subendothelial humps, BM thickening, double layer tram track appearance |
|
|
Term
|
Definition
BM and mesingeal thickening due to DM vascular changes
round kimmelsteil wilson nodules in glomeruli |
|
|
Term
|
Definition
| expansion of mesangeal matrix, apple green bifringence using congo red stain under polarized light |
|
|
Term
| best way to diagnose renal artery stenosis |
|
Definition
renal artery duplex: best initial
renal arteriogram: gold standard |
|
|
Term
|
Definition
| TMP-SMX 4-6wk, treat for STDs, if chronic add fluoroquinolone |
|
|
Term
| how is a vericocele diagnosed |
|
Definition
|
|
Term
| treatment options for BPH |
|
Definition
a1-blocker: doxazosin, terazosin
a1-selective blocker: tamsulosin (less SE)
5a-reductase inhibitor: finasteride
isoflavones
saw palmeto
TURP if refratory |
|
|
Term
| when do you do a transrectal US and biopsy with gleason stain |
|
Definition
PSA >10
PSA increasing >0.75/y
DRE abnormal |
|
|
Term
| treatment of prostate cancer |
|
Definition
found early, refuses prostatectomy: radiation bea or branchytherapy seeds
localized to prostate: radical prostatectomy, nothing if life expectancy <10y
locally invasive: radical prostatectomy, radiation, androgen deprivation
metastastic: radical prostatectomy, radiation, orchiectomy, antiandrogens, LH agonists (leuprolide), GnRH antagonists to suppress testosterone |
|
|
Term
| prostate cancer screening |
|
Definition
| DRE in all men annually >50yo (>40yo in AA or family hx) |
|
|
Term
| treatment of epididmyitis |
|
Definition
<35 ceftriaxone and doxycycline x10d
>35 or anal intercourse fluoroquinolones 10d |
|
|
Term
| treatment of testicular tosrion |
|
Definition
manual immediate detorsion, surgical detorsion, orchidoplexy BL
within 6h |
|
|
Term
|
Definition
most common
slow growing, late invasion
clear cytoplasm, round nuclei, fried egg look
bhCG
hyperechoic on US
radiosensitive |
|
|
Term
|
Definition
malignant potential, hemorrhage, necrosis
mets to abdominal lymph and lungs
AFP, bhCG |
|
|
Term
| testicular choriocarcinoma |
|
Definition
most agressive, hemorrhage, necrosis
mets by time of diagnosis
b-hCG |
|
|
Term
|
Definition
rare mets in kids, common if adult
seen in infants
endo/ecto/mesoderm tissue |
|
|
Term
| testicular yolk sac tumor |
|
Definition
endodermal sinus tumor
young boys
AFP
schiller duval bodies |
|
|
Term
| meds that cause impotence |
|
Definition
SSRI
spironolactone
clonidine
methyldopa
guanethidine
thiazides
BB
ketoconazole
cimetidine
antipsychotics |
|
|
Term
|
Definition
DOC is intracaernosal injection of phenylephrine (a-agonist)
if refractory: oral terbutaline or pseudophedride
still refractory: bupivacine penile nerve block and needle aspiration of cavernosum and saline irrigation |
|
|
Term
|
Definition
WAGR (wilms, aniridia, GU abnormalities, MR)
neurofibromatosis
abdominal pain
hematuria
HTN, fever
weight loss, N/V, dysuria, polyuria
palpable flank mass |
|
|
Term
| what is epispadius associated with |
|
Definition
|
|
Term
| how is cryptoorchidism treated |
|
Definition
| bring into scrotum by 8-12mo for optimum function, can try hCG for descent before that |
|
|
Term
| how are posterior urethral valves diagnosed |
|
Definition
| voiding cystogram showing elongation and filation of posterior urethra |
|
|
Term
|
Definition
decreased affinity of Hb for Od
CNS depression
decreased pulmonary flow
arrhythmia
impaired myocardial function
hyperkalemia |
|
|
Term
|
Definition
increased affinity of Hb for O2
decreased cerebral flow
arrhythmia
tetany
seizure |
|
|
Term
|
Definition
anion gap -12
indicates anion gap metabolic acidosis |
|
|
Term
|
Definition
Na = (Cl + HCO3)
high indicates metabolic acidosis |
|
|
Term
| how to determine acid base disorders |
|
Definition
1) anion gap, if there is gap then it is metabolic acidosis
2) delta gap then add bicarb, if >26 then metabolic alkalosis, if <22 then metabolic acidosis
3) look at pH/CO2, if in same direction it is metabolic
4) apply winters formula |
|
|
Term
| causes and treatment of metabolic acidosis with anion gap |
|
Definition
methanol, uremia, DKA/starvation, paraldehyde/propylene glycol, isoniazid/iron, lactic acid, ethanol/ethylene glycol, salicylates
tx: bicarb |
|
|
Term
| causes and treatment of metabolic acidosis without anion gap |
|
Definition
hyperkalemia: addisons, RTA4, TPN
hypokalemia: RTA1/2, diarrhea, fanconi, acetazolamide
tx: bicarb |
|
|
Term
| cause and treatment of metabolic alkalosis |
|
Definition
saline sensitive (Cl<10): vomiting, NG suction, diuretics, diarrhea
saline resistant (Cl>10): hyperALD, cushings, barters, diuretics, hypoK
tx: treat cause, NS/K if saline sensitive |
|
|
Term
| causes and treatment of acute respiratory acidosis |
|
Definition
COPD exacerbation, narcotics, anesthetics, sedatives, respiratory muscle fatigue
verify airway, O2, naloxone, bronchodilators, ventilate, intubate |
|
|
Term
| causes of chronic respiratory acidosis |
|
Definition
| COPD, mysathenia gravis, brainstem injury |
|
|
Term
| causes and treatment of acute respiratory alkalosis |
|
Definition
hyperventilation, anxiety, asthma exacerbation, aspirin toxicity, PE, altutude, sepsis, mechanical ventilation
tx: inhaled CO2, breathing into bag |
|
|
Term
| causes of chronic respiratory alkalosis |
|
Definition
| pregnancy, chronic asthma, living at high altutude, liver cirrhosis |
|
|
Term
| determining mixed acid base disorders |
|
Definition
1) Determine anion gap, if you have anion gap you have metabolic acidosis
2) Determine delta gap, add delta gap to the bicarb, this is what the bicarb would be without the metabolic acidosis, if this level is high there is also metabolic alkalosis
3) Determine which is stronger, the metabolic acidosis or alkalosis, based on current pH
4) Apply winter’s formula to the stronger metabolic condition, if the rule is followed then there are no further conditions, if CO2 raises or drops more than expected there is an additional condition |
|
|
Term
| distribution of body water |
|
Definition
60% total body weight in kg
40% ICF
20% ECF = 5% plasma + 15% interstitial |
|
|
Term
|
Definition
>1mL/kg/h in infant
0.5-1 mL/kg/h in adult |
|
|
Term
| calculating maintenance fluids |
|
Definition
4mL/kg for 1st 10kg
2mL/kg for 2nd 10kg
1mL/kg for every 1kg more
provides hourly rate |
|
|
Term
| calculating water deficit |
|
Definition
|
|
Term
| hypovolemic hypernatremia causes and treatment |
|
Definition
renal loss: diuretics, glucosuria, renal railure
extra renal: diarrhea, diaphoresis, respiratory loss
isotonic NaCl until hemodynamically stable then replace free water deficit |
|
|
Term
| isovolemic hypernatremia causest |
|
Definition
|
|
Term
| hypervolemic hypernatremia causes and treatment |
|
Definition
iratogenic (TPN #1)
exogenous steroids
cushings
salt water drowning
primary hyperALD
tx: furosemide, D5W, dialysis |
|
|
Term
|
Definition
altered mental status
weakness
lethargy
confusion
seizure
coma
oliguria, thirst, dry |
|
|
Term
| causes of hypertonic hyponatremia |
|
Definition
| hyperglycemia, mannitol, sorbitol, glycerol, contrast |
|
|
Term
| causes of isotonic hyponatremia |
|
Definition
|
|
Term
| causes of hypotonic euvolemic hyponatremia |
|
Definition
| SIADH, psychogenic, post-op free water, hypothyroid, oxytocin, haloperidol, cyclophosphomide, antineoplastic drugs |
|
|
Term
| causes of hypotonic hypervolemic hyponatremia |
|
Definition
urine Na <10: CHF, cirrhosis, nephrotic
urine Na >10: renal failure |
|
|
Term
| causes of hypotonic hypovolemic hyponatremia |
|
Definition
urine Na <10: diarrhea, vomiting, NG suction, third spacing, burns, diaphoresis, pancreatitis
Urine Na >10: diuretics, Na wasting renal disease, urinary obstruction, hypoALD, addisons, ACEI, ATN |
|
|
Term
|
Definition
headache
delirium
irritable
muscle twitch
increased DTR
increased ICP
seizure
nausea/vomiting/ileus
salivation and lacrimation
HTN
oliguria and anuria |
|
|
Term
| complication of overcorrection hyper and hyponatemia |
|
Definition
reduction of Na faster than 12/d can cause cerebral edema
addition of Na >12/d can cause central pontine myelinosis |
|
|
Term
| what paraneoplastic syndrome causes hypercalcemia |
|
Definition
| squamous cell lung cancer |
|
|
Term
| signs and treatment of hypercalcemia |
|
Definition
easy fracture, deep bone pain, weakness, osteofibrosis cystica, nephrolithiasis, nephrocalcinosis, renal failure, nausea, vomiting, constipation, peptic ulcers, change in mental status, polyuria, HTN, weight loss
short QT interval
tx: hydrate, calcitonin, bisphosphonates |
|
|
Term
|
Definition
| chovsteks, trosseaus, seizure, long QT, dyspnea, arrhythmia, numbness and tingling in fingers and does |
|
|
Term
|
Definition
| ionized Ca = total Ca - (albumin x 0.8) |
|
|
Term
| signs of hypophosphatemia |
|
Definition
| encephalopathy, confusion, seizure, numbness, paresthesia, weakness, bone pain, rickets, osteomalacia, hemolysis, RBC/WBC/platelet dysfunction, cardiomyopathy, myocardial depression, rhabdomyolysis, anorexia, difficulty to wean from ventilator |
|
|
Term
| signs of hyperphosphatemia |
|
Definition
| metastastic calcification, soft tissue calcification, hypocalcemia signs |
|
|
Term
| what makes K go into cells |
|
Definition
| insulin, B-agonists, alkalosis |
|
|
Term
| what makes K come out of cells |
|
Definition
| less insulin, BB, acidosis, digoxin, cell lysis |
|
|
Term
|
Definition
| peaked T waves when >6.5, weakness, flaccid paralysis, dereased DTR, respiratory failure, nausea, vomiting, colic, diarrhea, metabolic alkalosis |
|
|
Term
|
Definition
C BIG K
Ca gluconate
B agonist
Insulin
Glucose
Kayexelate |
|
|
Term
|
Definition
fatigue, weakness, paralysis, arrhythmia, hyporeflexia, paresthesia, ileus, polyuria, polydypsia, nausea, vomiting, constipation, exacerbates digitalis toxicity
T wave flattening or inversoin, U waves |
|
|
Term
|
Definition
| muscle twitching, tremor, hyperreflexia, vomiting, diarrhea, mental status change, seizure, hypocalcemia, hypokalemia, prolonged QT, U waves, torsades |
|
|
Term
|
Definition
nausea, weakness, facial paresthesia, loss of DTR, somnolence, coma, paralysis, respiratory failure, cardiac death, death
increased PR, wide QRS, elevated T waves |
|
|
Term
| type 2 RTA: patho, cause, tx, signs |
|
Definition
NaH pump in PCT does not work, bicarb stays in urine, K stays in urine, H and Cl stay in blood
urine is pH <5.3 because CT intercalated later can acidify it
causes: myltiple myeloma, fanconi, wilsons, amyloid, low vitamin D, lead, nephrotic syndromes
signs: bone lesons, non-gap metabolic acidosis
treatment: bicarb, Na restriction, thiazides, loops, K |
|
|
Term
| type 1 RTA: patho, cause, tx |
|
Definition
CT intercalated cells ATP K/H pump does not work, bicarb isn't made, H and Cl stay in blood, CaP form in urine, Na and K stay in urine
urine is pH >5.3
cause: myltiple myeloma, sjogerns, amphotricin B, analgesics, infection, SLE, obstruction
signs: non-gap metabolic acidosis, calcium kidney stones
tx: bicarb, thiazides, K, P salts to excrete tetratable acid |
|
|
Term
| type 4 RTA: patho, cause, treatment, signs |
|
Definition
low ALD stops ATP Na/K pump and Na/K channels in CT principal cells, K and H stay in blood, Na stays in urine
urine pH <5.3
cause: low ALD or ALD resistance
signs: non-gap metabolic acidosis
Tx: fludrocortisone, K restriction |
|
|
Term
| hartnup syndrome: cause, signs, treatment |
|
Definition
AR defect in AA transport decreases reabsorption of tryptophan causing nicotinamide deficiency
signs: pellagra (dermatitis, diarrhea, ataxia, dementia)
tx: nicotamide if symptomatic |
|
|
Term
| fanconi syndrome: cause, signs, treatment |
|
Definition
PCT defect in transport of glucose, AA, Na,K, uric acid, bicarb, inherited or acquired (Tetracycline expired)
glocusuria, proteinuria, polyuria, dehydration, hypercalcuria, hyperkalemia, RTA2, phosphaturia (rickets, impaired growth, osteomalacia, oseoperosis, fractures)
tx: P, K, alkali, salt, hydration |
|
|
Term
| define kidney risk, injury, failure, loss, and ESRD |
|
Definition
risk: 1.5xCR or 50% GFR
injury: 2xCR or 50% GFR
failure: 3xCR or 75%GFR
loss: complete loss of kindey function for >4wk
ESRD: complete loss of kidney function for >3mo |
|
|
Term
| signs and causes of pre-renal failure |
|
Definition
renal artery stenosis, hypovolemia, CHF, cirrhosis, NSAID, ACEI, sepsis, drug toxicity
oliguria, BUN:CR>20, urine Na<20, urine osmol >500, hayline casts |
|
|
Term
| signs and causes of intrarenal failure |
|
Definition
ATN (drugs, toxins), glomerular disease, vascular disease (TTP, HUS), AIN
BUN:CR<20, urine Na>40, urine osm <350 |
|
|
Term
| causes and signs of acute tubular necrosis |
|
Definition
shock, hemorrhage, sepsis, DIC, heart failure, aminoglycosides, vanco, contrast, poisons, NSAID, rhabdo, multiple myeloma, displatin, hemolysis, amphotericin, ACEI, sulfa
oliguria 10-14d <500mL/d and azotemia
then duiretic <500mL/d
then recuvery
increased FeNa, BUN, CR, muddy brown granular casts, renal rubular casts, low urine osm |
|
|
Term
|
Definition
pericarditis with normal EKG
encephalitis
fatigue
anorexia
metallic taste
puritis
vomiting
weight loss
change in mental status
platelet dysfunction |
|
|
Term
| what electrolyte imbalances does renal failure cause |
|
Definition
hyperkalemia
metabolic acidosis with anion gap
hypocalcemia
hyponatremia
hyperphosphatemia
uremia |
|
|
Term
| causes and signs of chronic kidney disease |
|
Definition
#1 DM, #2 HTN, chronic GN, interstitial nephritis, polycystic kidney
uremia, brown skin, secondary renal osteodystrophy, normochromic anemia (no EPO), decreased testosterone, amenorrhea, calchyphylaxis percipitation
hypocalcemia, hyperphosphatemia, hyperkalemia, hyperMg, metabolic acidosis |
|
|
Term
|
Definition
| CR>12, BUN>100, uremia symptoms, fluid overload, AKI, CKD, pulmonary edema, electrolyte disturbance, metabolic acidosis, drug toxicity |
|
|
Term
| complications of dialysis |
|
Definition
EPO and vitamin D deficiency
hypotension: MI, fatigue
hypoosmolality of ECF compared to brain: nausea, vomiting, headache, seizure, coma
first use syndrome: CP, back pain, anaphylaxis
anticoagulation: hemorrhage, hematoma
infection and sepsis
amyloidosis of B2 microglobin in bones and joints
fluid overload and dyspnea
hyperglycemia and hyperTG (peritoneal)
inguinal hernia (peritoneal) |
|
|
Term
|
Definition
PCN, sulfa, aminoglycosides, NSAIDs, allopurinol, PPIs, diuretics, cadmium, lead, copper, murcery, mushrooms, infection, sarcoidosis, amyloidosis, rhabdo
rash, fever, nausea, vomiting, hematuria, increased CR, eosinophilia, eosinophils in urine and casts, renal biopsy with inflammatory lymphocytes, renal tubular necrosis |
|
|
Term
| causes and signs of renal papillary necrosis |
|
Definition
analgesic nephropathy, DM, sickle cell, urinary obstruction, UTI, chronic alcoholism, renal transplant rejection
flank pain, fever, abdominal pain, hematuria, excretory urogra with change in papilla, CT or IVP with medullary ring shadows and hydronephrosis |
|
|
Term
| torsion of appendix testis cause, sx, tx |
|
Definition
appendix testis is remnant of paramesonephric duct (mullerian duct) in superior testicular pole
torsion is benign, kids 7-14yo, acute pain at superior or inferior pole, normal cremasteric reflex, tenderness to palpation, gangrenous testies (blue dot through scrotum)
tx: snalgesics, scrotal support, bed rest |
|
|
