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86 Cards in this Set
- Front
- Back
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tubules are supposed to reabsorb: (if it's inthe urine then disfunction)
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sodium, water, calcium, phosphorus
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fanconi's syndrome
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prox tubule disorder,
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sx of fanconi's
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cystinosis, glucosuria, phosphaturia, aminoaciduria, bicarbonate wasting
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what's cystinuria
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cystine absorbtin impaired
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what does cystinuria commonly form
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calculi - radiopaque
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what do kids with cystinuria have
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commonly no thumbs
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what's aminoaciduria
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all amino acid spillage, cystine stones, chronic renal failure, cystine crystals on UA
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Wilson's DZ?
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high copper - deposited in tubules, liver, brain, erythrocytes.
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What else about Wilson's?
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Hepatitis, Favser-Fleischer ring, may have fanconi's concurrently.
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Tubular Dzs
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Renal glucosuria, renal tubular acidosis, proximal tubular acidosis, distal tubular acidosis, Bartter's Syndrome, Liddles's syndrome, nephrogenic diabeties insipidus
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What's renal glucosuria?
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n/low blood glucose, inherited, pregnancy, normal GITT, positive glucosuria in AM after fast
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Whats Renal tubular acidosis
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impaired ability to excrete H+, or to reabsorb bicarbonate, leading to chronic acidosis, K depletion, osteomalacia
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What's proximal tubular acidosis
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Fanconi’s, Wilson’s, multiple myeloma, rickets, heavy metal deficiency
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What's distal tubular acidosis
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urine pH always >6, K wasting, muscle weakness, paralysis, rickets, osteomalacia
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What's Bartter's syndrome
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K, Na, CL wasting, hypokalemia, hyperaldosteronism, hyperreninemia, normal BP
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What's Liddle's syndrome
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hyperaldosteronism, hypertension, hypokalemic alkalosis
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Nephrogenic Diabeties Insipidius?
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collecting tubule does not respond to ADH, polydipsia, polyuria, appears after birth, severe water depletion, no thirst response, fever, hypernatremia, vomiting, convulsions, brain damage
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Diabetic Nephropathy
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complication of Dm
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what increases the odds of occuring
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the longer you've had dm and the more ketoacidosis
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sx of diabetic nephropathy
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microvascular destructin of the glomerulus
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stage 1 of Dn
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increased glomerular filtration rate, mild proteinuria
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Age at stage 1
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15-20 yo
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stage 2 of DN
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decrease GFR, proteinuria, edema, HTN, pooorer perfusion
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stage 3
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azotemia, GFR< 1/3 normal, massive proteinuria, rising HTN, retinopathy occurs with this
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age of stage 3
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20 - 25
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sx of DN
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UTI, pyelonephritis, incontinence due to neuro damage
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what to check for DN
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Hgb A1C
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What's plycystic Kidney DZ?
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Bilateral cysts that increase kidney size, but reduce functional tissue. Inherited condition.
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Sx of polycystic kidney dz
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often asx, or lumbar pain, hematuria, UTi, stones
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other sx set fo PKD
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Mild proteinuria, hematuria, pyuria (no infx), seen on U/S, may end in renal failure
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Acute Noninfectious Tubulointerstitial Nephritis - What is this?
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Acute renal failure from drug hypersensitivity, or drug toxicity affecting tubules and interstitial tissues
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Sx of ANTN? - you get really sick, really fast
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Fever, dysuria, pyuria, flank pain, renal failure with or without oliguria, rashes, photosensitizing dermatitis, polyuria, hyperkalemia, acidosis
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More sx of ANTN?
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Eosinophila (with hypersensitivity -ie to drugs, not toxicity), proteinuria, RBC, WBC in urine, occ gross hematuria
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MORE!!!?
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Kidneys palpable
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What happens during the years after ANTN?
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Chronic - disorders which extend past glomerulus for many years
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What is a nephrotoxic disorder?
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Change of kidney produced by drug, chemical , or biologic agent
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Some exmaples of drugs?
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Antibiotics (25% of acute renal failure), allergy, radiographic contrast, NSAIDs, heavy metals (Pb, Hg, bismuth, Cd, Fe
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Signs and sx of Lower UTI
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Lower UTI: urethritis, cystitis, prostatitis, dysuria, urgency, frequency, suprapubic pain, cloudy urine, strong odor, hematuria
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Upper UTI?
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pyelonephritis, high fever, chills, N/V, tender kidney, rarely diarrhea
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UTI may be ASX. In males....
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infectin usually ascend formthe bladder
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Bodies reaction to UTI?
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WBC, urine acidity, voiding
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What can cause a UTI?
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Predisposing factors: anatomical malformations, DM, preg, intercourse, hygiene, high pH urine, catheterization, dehydration
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Sx of UTI?
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Pain on costovertebral angle, radiating to ureter, groin, suprapubic, testicle, fullness sensation:
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Also:
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Nocturia, enuresis, incontinence
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What is cystitis - females?
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Ascending infx from vagina, following intercourse often, imbalance of vaginal flora
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What is cystitis in males?
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can be from chronic prostatitis
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Sx of cystitis?
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Burning painful urination, frequency, nocturia, suprapubic or low back pain, hematuria, pyuria
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Where is cystitis?
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Bladder!
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What is acute pyelonephritis?
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Pyogenic kidney infection, ascending from urethra, catheterization, 75% from Ecoli,
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Sx of acute pyelonephritis?
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chills, fever, flank pain, N/V
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Frequency/ urgency in acute pyelonephritis?
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rare
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more sx of acute pyelonephritis?
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enlarged kidneys, alkaline urine, proteinuria, bacteriuria, WBC casts
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What is chronic pyelonephritis?
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Many years, patchy bilateral infection with kidney atrophy,
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what can this lead to?
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kidney failure
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Sx of chronic pyelonephritis?
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Repeat acute episodes, vague and inconsistent fever, flank pain, abdominal pain
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what to look for to confirm chronic pyelonephritis?
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HTN, edema, palpable kidneys
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What is interstitial cystitis?
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Disruption of interior lining of bladder, accumulation of mast cells (autoimmune, allergy), dysregulation of GAG layer “leaky bladder”, non infx
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What is GAG layer
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makes up the connective tissue in the bladder lining
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Diagnosis of Interstitial cystitis?
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Takes several years and urologist to Dx 4-5yrs, r/o bladder infx (UA),
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Sx of interstitial cystitis?
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irritative voiding, pelvic pain
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To diagnose interstitial cystitis, you need to run tests. One is....
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Cystography - bladder wall biopsy reveales tiny hemorrhages, ulcerations, called Hunner’s patches (small destructive areas)
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What about the U/A for Interstitial Cystitis?
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negative for bacteria, no growth in cultures so no help form antibiotics
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Sx of Interstitial Cystitis?
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decreased capacity, frequency, nocturia, pain, urgency, dyspareunia
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Possible causes of Interstitial Cystitis?
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food sensitivities, smoking
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What helps Interstitial Cystitis?
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Antihistimines, exercise
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Where are urinary calculi more common?
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3-4 times more comon in men
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What % of the population and how old?
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5-12% population, usu in 3rd decade
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Possibel sx of urinary calculi?
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75% idiopathic, 5% hyperparathyroid, excess vitamin D, 20% uric acid abnormalities, familial tendency
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Types of stones?
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Calcium oxalate/phosphate
Struvite uric acid cystine |
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Characterisitcs of Calcium oxalate/phosphate
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75 - 85% they are radiopaque
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Characteristics of struvite (magnesium ammonium phosphate)
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usu with UTI, radiopaque, with Abx, incontinence with neurological issues
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Characteristics of uric acid calculi?
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radiolucent - wont see on xray dye works here
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Characteristics of cystine calculi?
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rare, radiopaque
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Sx of urinary calculi?
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Hematuria, extreme pain, unilateral starts on flank, moves down around abdomen to inner thigh
Colicky, spasmodic pain, N/V |
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Sx of a stone in the bladder?
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dysuria, frequency, urgency, usu with UTI, asx in geriatrics
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diagnostic methids for Urinary claculi?
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X-Ray, IVU
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Ddx for urinary calculi?
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DDx - appendicitis, cholecystitis, ulcer, pancreatitis, bowel obstruction, UTI, peritonitis, hernia, ectopic pregnancy(run an hcg for this)
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Risky behavior that leads to UTI?
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dehydration, no exercise, excess Vitamin C, excess antacids, osteomalacia, low Mg/B6, anesthesia, heredity, IBD, high oxalate dietTypes of
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Types of Kidney tumors?
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Adenocarcimoma, Wilm's tumor
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Characteristics of Adenocarcinoma?
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hematuria, colic, possible anemia
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Who gets it?
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usu male 60’s.
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From what?
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drugs, heavy metals, radiation, viruses, smoking
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characteristics of Wilm's tumor?
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palpable mass, abd pain, hematuria, fever, anorexia, N/V
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Who gets it?
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mostly pediatric - 2yo, - possibly hereditary
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Chromosome nvolvement in Wilm's?
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yes - Chromo 11
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TITS - think when you have abdominal pain.
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Trauma, injury, tumor, stone
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