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105 Cards in this Set

  • Front
  • Back
3 or more RBC per high power field
Chromagen stick turns green
hematuria
Hematuria False positives
Myoglobin
Menses
Povidone
Peroxidase
Dehydration
Vitamin C
Hematuria False negatives
pH < 5.1
Air exposure to dipstick
Glomerular causes of hematuria?
Ig A nephpropathy
NSAID induced
Non-glomerular causes of hematuria?
BPH,UTI,Papillary necrosis
Urothelial tumors/stones
Found on PE of hematuria pt?
HTN,Afib
BP enlargement
Bruits, swelling, masses
Occupational toxicity
Nitrates
UTIs
APCs
Shistosomiasis
If Isomorphic RBC or WBC clots are found in urinalysis then?
Repeat, if positive = treat
if negative = screening exams
What screening exams are used post urinalysis?
CBC, electrolyte, PT/PTT
BUN/Creatinine
If screening tests are negative then?
IVP-asseses anatomy and fxn
Risks of IVP usage?
Cardiac, renal failures
Allergies
Dehydration
IHOCM reaction
Renal insufficiency
If screening labs are positive then?
Treat abnormality
If IVP finds mass?
Ultrasound
Simple cyst = watch
Complex cyst = CT
If IVP is negative, contraindicative, or obstruction?
Retrograde pyelography if negative BX
positive CT
W/u for glomerular dz is?
Renal bx
2 special considerations for hematuria
Coumadin- anticoag
Extreme exercise
NL specific gravity level
1.007-1.010
SG <1.007
Hydrated state
DI
Hypothenuria
SG fixed at 1.010
Problems with renal tubules
Isothenuria
SG > 1.010
SG 1.007-1.0010
Dehydration
Renal failure
SG > 1.035
contamination
glucose
dyes
NL protein level
150
3 types of cells seen in proteinuria
Bence jones
Albumin
Tamm-Horsfall
BJ protien
M-proteins
Inc'd Scalcium
Hyperurcicemia
Recurrent infxn
Rouleax formation
Multiple Myeloma
NL glucose level
False +
False -
130
air exposure
vitamin C
Present in ketoacidosis,starvation,ASA toxicity
False -
Ketones
Exlax,Ldopa
Help detect UTI
nitrates
Positive with WBC, pyurea
Leukocyte esterase
Examined under Microscopic urinalysis?
WBC,RBC,Lipiduria,Epithelial cells
Cast seen in high concentrations, febrile disease
Hyaline
Cast seen in glomerulonephritis?
RBC
Cast seen in acute pyelonephritis?
WBC
Broad, waxy casts are indicative of?
CRF
Sns of glomerular damage? (5)
Dec'd GFr
Protein/hematuria
Edema
HTN
Abnl cellular proliferation w.in glomerulus?
Proliferative Glomerular DZ
Inc'd Glomerular matrix?
Mesangial cell glom. dz
Membrane thickens and cellular proliferation?
Combination glomerular dz
1. ONly few glomeruli effected
2. All glomeruli affected
3. Part of glomerulus affected
4. Entire glomerulus affected
Focal
Diffuse
Segmental
Global
5 clinical presentations of Glomerular DZ?
1. asymptomatic
2. acute GN
3. Chronic GN
4. RPGN
5. Nephrotic syndrome
Children age 2-6
Nephrotic
Atopic disease
Presents with URI
EM shows foot processes of BM
What?
Tx?
Minimal change disease
Steroids
Immunosuppressant(cyclosporine)
Adult nephrotic syndrome
Deposition of immunoglobins
Some FP on BM, HIV assoc.
What?
Tx?
Focal Segmental GN
Cyclosporine,cyclophosphamide
Transplant
Cast seen in acute pyelonephritis?
WBC
Broad, waxy casts are indicative of?
CRF
Sns of glomerular damage? (5)
Dec'd GFr
Protein/hematuria
Edema
HTN
Abnl cellular proliferation w.in glomerulus?
Proliferative Glomerular DZ
Inc'd Glomerular matrix?
Mesangial cell glom. dz
Membrane thickens and cellular proliferation?
Combination glomerular dz
1. ONly few glomeruli effected
2. All glomeruli affected
3. Part of glomerulus affected
4. Entire glomerulus affected
Focal
Diffuse
Segmental
Global
5 clinical presentations of Glomerular DZ?
1. asymptomatic
2. acute GN
3. Chronic GN
4. RPGN
5. Nephrotic syndrome
Children age 2-6
Nephrotic
Atopic disease
Presents with URI
EM shows foot processes of BM
What?
Tx?
Minimal change disease
Steroids
Immunosuppressant(cyclosporine)
Adult nephrotic syndrome
Deposition of immunoglobins
Some FP on BM, HIV assoc.
What?
Tx?
Focal Segmental GN
Cyclosporine,cyclophosphamide
Transplant
Most common nephrotic in adults.
40-50 y/o males
idiopathic or secondary to infxn, SLE,neoplasm,drugs.
"moth eaten,swiss cheese" BM.
Proteinuria,micro hematuria.
What?
Tx?
Membranous GN
Steroids,cytotoxic agents
50% --> ESRD
Adult nephrotic.
Young females.
Follows URI
Associated with SLE and cryoglobulinemia
What?
Tx?
MEmbranoproliferative GN
Glucocorticoids,cytotoxics
Dx: ANA,anti-dsDNA present.
becomes focal/diffuse lupus nephritis.
malar rash.
Membranoproliferative GN with SLE association
Most common GN
Young men, macro. hematuria.
IgA deposition.
What?
Tx?
IgA nephropathy
ESRD, transplant, but transplant will get ig A
School aged children.
Post Group B hemolytic strep infxn or CMV
Deposition of C3.
What?
Tx?
Diffuse proliferative GN
Treat HTN,fluid overload
Dx: ASO titer
CH50,CH3 measures low
Diffuse proliferatie GN
Major Causes of SBE
1. native (congential,rheumatic fever, calcinosis)mitral valve prolase
2. prosthetic
3. IV drug users
Bacterial causes of SBE
Staph aureus, Strep viridins, Staph epidermis
Endogenous routes to get SBE
Tooth work, GI endoscopies,GU(TURP), catheters
Sns of SBE
night sweat, anorexia,fatigue,weight loss
Inc'd ESR,WBC
RF factor
Tx:SBE
abiotics
nafcillin and aminoglycoside
DX:SBE
Blood culture
Middle age men
Triad of Dyspnea,Illness,Glomerulonephritis.
Nasal perforation.
Granulomas in kidney by necrotizing vasculitis.
What?
Tx?
Wegners Granulomatosis
Steroids(prednisone)
Cyclophosphamide
Dx: ANCA
Wegners Granulomatosis
Children under 10
Pinpoint purpuric rash
Nephrotic sns
What?
Tx?
Henoch-Schonlein
Self-limited
Dx: renal biopsy looks like Ig A nephropathy
Henoch schonlein
Crescent shaped macrophages accumulate.
Affects lungs = hemoptysis,dyspnea.
W/u includes chest xray,PFT,pulse ox,bx.
What?
TX?
Goodpastures/Crescentric GN
Plasmapheresis
Steroids, immunosuppressant
Dx: anti-GBM
Goodpastures
Precipates in cold weather.
Purpuric rash, Hep c. associateion.
Peripheral neuropathy.
What>
Tx?
Cryoglobulinemia
Plasmapharesis
Crescentric macrophage build up.
L/t alveoli hemorrhages.
Antibodies against kidney and lung, reacts against basement membrane.
Hemoptysis
What?
Tx?
Goodpastures
Plasmapheresis
Steroids,cyclosporine
Dx:Anti-GBM
Goodpastures
Peripheral neuropathy
Arthralgia
Purpuric vascular rash
What?
Tx?
Cryoglobulinemia
Plasmapheresis
Pt post surgery,trauma,burn,or drug toxicity.
Sns:oliguria,sudden dec'd GFR
What?
Tx?
ARF
Tx underlying,electrolyte balance, volume stats, monitor CO, Hg, ventilation,caloric intake.
Most common cause of ARF
Pre-renal
Associated with Pre-renal causes of ARF
dec'd volume
(GI/blood loss,dehydration,diuresis)
inc'd vasodilation (sepsis,anti-htn)
inc'd renal resistance(surgery)
cardiac conditions
prostaglandin inhibition
Associated with Post-renal causes of ARF
Obstructions
Associated with Intrinisic causes of ARF?
NSAIDS,HUS, TTP
Most common cause of ARF in children
E.coli associated with diarrhea/UTI.
Eating undercooked meat.
Shistocytes,
WHAT?>
Tx?
Hemolytic uremic syndrome
hydration,plasma exchange
Adult cause of ARF.
Associated with platlet congregation and causing microthrombi.
Shistocytes.
What?
Tx?
Thrombocytopenia purpura
Hydration,plasma exchange
Tests for ARF:
Blood,Urine,U/s,doppler,immuno, bx
Pt has gross hematura and oliguria.
GN
Pt has hemoptysis and ARF
Good pastures
Throat infxn and ARF
Post-infectious GN
Pt with urinary freq, noctura,poor urinary stream, hesistancy in urination, dribbling.
BPH = post renal disease
Hematuria with ARF
Rhabdomyolysis
Loss of nephrons = ESRD
Chronic renal failure
35-50% dec'd GFR(60)
S/s underlying disease
Stage 1 CRF
30-35% dec'd GFR (20-50)
Bun>20
Creatinine > 1.5
PCP finds
Renal insufficiency
Stage 2 CRF
20-25% dec'd GFR (20)
Bun > 20
Creatinine > 5
Renal failure
Metabolic acidosis, everything associated with renal failure
Stage 3 CRF
<20% dec'd GFR (<20)
Creatinine>8
Uremia,ESRD
Dialysis/transplant
Stage 4 CRF
Hypocalemia,dec'd Vit.D
Hyperphosphatemia
Fluid overload - edema
Metabolic acidosis
N/v, anemia,anorexia
Polyuria
Concentrated urine
Stage3 and 4 CRF
UOsm - >500
UNa - <10
FEna- <1
Cast - Hyaline
Pre-renal failure
Uosm < 250
Una - >20
Fena >1
Cast - Brown,granular
Post-renal failure
Cardiac Rub
Uremic Frost
Asterexis
Uremic factor
Uremic syndrome
Most common cause of Uremia
Diabetes
Restricted diet
Hypervolemia
Control BP
Erythropoeitin inj.
Monitor albumin
Dialysis
Transplant - best
Control/Tx CRF
Autosomal dominant
Multiple cysts in kidney
Inc'd ICp
C/o pain in flank area with hematuria
MGA used to DX
Polycystic kidney
TX:dialysis/transplant
Microalbuminurea
What?;
Tx:
diabetes associated kidney disease
ACE-I
control sugar levels
REgulated by ADH.
Control of sodium excretion.
Angiotensin 2,ADH,renin, work together with feedback to control fluids.
Electroylytes control
Lo NA level.
Edema,delerium,muscle cramps,dec'd DTR,seizures
Seen in burn pts.
What?
Hyponatremia
REstrict fluids
Sodium replacement if needed
High Na
water level low, DI
Aldosterone mechanisms
Pt is irritable, twitching, spastic
What?
Tx:
Hypernatremia
Water replacement
Low K
Loss from gut
Hyperaldosterone,loop diuretics
Vomiting
MI
Insulin overdose,Mg depletion,digitalis tox.
Pt has muscle weakness,contstipation.
What?
TX:
Hypokalemia
Oral K or Iv KCL
Inc'd K
Diabetic ketoacidosis,rhabdomyolysis,metabolic syndrome, low aldosterone
What?.
Tx:
Hyperkalemia
Insulin,diuretics,hydration
Sns:right testicular enlargement,hematuria,lose weight,nightsweats, anemia,myosisitis, polyneuritis.
Renal cancer
CHildhood cancer
Abdominal mass
Genitourinary malformation.
Mental retardation.
What?
Tx?
Wilms tumor
Nephrectomy, chemo