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86 Cards in this Set

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