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53 Cards in this Set
- Front
- Back
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GERIATRIC NEPHROLOGY
- what are 7 concerns & conditions associated with Geriatrics |
(CO HEADS)
- CKD - Obstructive Uropathy - HTN - Episodes of ARF - Adjustment in Drug dosing (bc GFR) - Dialysis - Salt-Water Nephropathy |
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GERIATRIC NEPHROLOGY
- Describe the HTN in geriatric pts |
- Systolic BP is high
- Diastolic BP is low (thus expect increased pulse pressure) |
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GERIATRIC NEPHROLOGY
- what physiology predisposes geriatrics to CKD? - what does this affect renal functionality? |
- Nephron mass decreases with age
- Each remaining Nephron has to Increase GFR to compensate |
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GERIATRIC NEPHROLOGY
- what nephropathy is a consequence of CKD? - what is the etiology of this nephropathy? |
- Salt-Water Nephropathy
- Decreased Tubular Reabsorption of Na+ |
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GERIATRIC NEPHROLOGY
- what aspects of CKD contribute to Salt-Water Nephropathy? x3 - describe the connection btw the above contributions of CKD and the etiology of Salt-water nephropathy |
- Decreased overall GFR
- Decrease in total Nephron mass - Increase in GFR per single nephron - the hyperfunctioning nephrons hyperfilter Na+, but they can NOT hyper reabsorb it |
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GERIATRIC NEPHROLOGY
- Salt-water nephropathy signs and symptoms? x2 |
- Dehydration
- Loss of Na+ and water in Urine |
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GERIATRIC NEPHROLOGY
- Salt-water nephropathy (induced by CKD) can lead to what health condition for geriatrics? - what is the etiology of this condition? |
- Episodes of ARF
- Reduced ECF (volume depletion) (intra- and extravascular) |
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GERIATRIC NEPHROLOGY
- how does Salt-Water Nephropathy cause Episodes of ARF? |
- Salt Water Nephropathy pts pee out salt and water, so volume depleted.
- This leads to Episodes of ARF |
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GERIATRIC NEPHROLOGY
- what is the problem associated with treating geriatrics with drugs? - what causes this problem? |
- Dosages need to be adjusted
(reduced to avoid toxicity) - Due to decreased GFR |
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GERIATRIC NEPHROLOGY
- Geriatric Obstructive Uropathy usually presents with what pathologic conditions? x 2.5 |
- BPH
- Malignancy (Bladder, Prostate, Kidney) |
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GERIATRIC NEPHROLOGY
- what Dialysis issues exist with geriatrics? x2 |
- Vascular Access problems
- CV disease complicating dialysis |
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GERIATRIC NEPHROLOGY
- why is there an added benefit for geriatrics in renal transplantation? - why is there an added concern for geriatrics in renal transplantation? x3 |
- Pre-existing IS means less graft rejection
IS Drugs on top of Pre-existing IS can lead to (MCI) - Malignancy - CV Disease - Infection |
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GERIATRIC NEPHROLOGY
- in giving geriatrics dialysis, what is the 2 major issues? |
- Access problems
(hard to create AV Fistulas / Grafts) - Bacteremia / Sepsis (b/c of predisposing IS) |
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URINARY TRACT INFECTIONS
- what are 2 general UTI categories? - what is another categorization of UTIs? x2 |
- Asymptomatic UTI
- Symptomatic UTI - Complicated UTI - Uncomplicated UTI |
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URINARY TRACT INFECTIONS
- how would you DX an Asymptomatic UTI without SX? |
Bacteruria > 100,000 CFU/mL
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URINARY TRACT INFECTIONS
- Symptomatic UTI can be categorized into what 2 categories? |
- Upper Tract
- Lower Tract |
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URINARY TRACT INFECTIONS
- Upper Tract UTI disease(s)? - Lower Tract UTI disease(s)? |
- Pyelonephritis
- Cystitis - Urethritis - Prostatitis |
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URINARY TRACT INFECTIONS
- what are the 2 categories of Acute Pyelonephritis? |
- Emphysematous Pyelonephritis
- Xanthogranulomatous Pyelonephritis |
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URINARY TRACT INFECTIONS
- list 4 complications of UTI's |
- Renal (intraparenchymal) abscess
- PERI-renal abscess - Bacteremia - Sepsis |
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URINARY TRACT INFECTIONS
- what are the diseases of Uncomplicated Pyelonephritis? x3 - Uncomplicated Pyelonephritis is associated with what type of patients? |
- Pyelonephritis
- Cystitis - Urethritis - otherwise healthy people (no pre-existing conditions) |
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URINARY TRACT INFECTIONS
- Complicated UTI criteria x4 |
- 3 or more infections per year
- Organism resistant to multiple Abs - Patients with Indwelling Foley Catheers - Patients with abnormalities functionally or anatomically in the kidney |
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URINARY TRACT INFECTIONS
- what are the Pathogenetic Risk Factors for UTIs? x10 |
(TB F-DOPA COIN)
- Decreased Tissue Resistance - Increased Bacterial Virulence - Female - DM - Old age - Pregnancy - Abnormalities (anatomical/functional) - Chemo - Organ transplant - Injuries to spinal cord - Neurogenic bladder |
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URINARY TRACT INFECTIONS
- besides the commonly suspected GNB and GPB, what other bacterial organisms can cause UTIs. x2 |
- Mycobacteria
- Chlamydia |
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URINARY TRACT INFECTIONS
- you can catch a UTI for what fun fungis? x5 |
(CATCH)
- Candida albicans - Aspergillosis - Torulpsis Glabrata - Crypto - Histoplasmosis |
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URINARY TRACT INFECTIONS
- what 2 viruses are associated with UTI etiology? - what 2 parasites are associated with UTI etiology? |
(BCU)
- BK virus - CMV - Bilharziasis - Schistosomiasis |
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URINARY TRACT INFECTIONS
- what is the most common UTI organism & what % of UTIs does it cause? - is this gram neg. or pos.? |
- E.coli
- 79% - E. coli is gram negative |
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URINARY TRACT INFECTIONS
- besides e.coli, list the other bacterial organisms responsible for UTI in order and give % |
- Staph. Saprophyticus (GP) - 11%
- Mixed - 3% - Klebsiella (GN) - 3% - Proteus (GN) - 2% - Enterococcus (GP) - 2% |
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URINARY TRACT INFECTIONS
- DX clinically with what symptoms (7) and blood labs (1)? x8 |
(FFF Nv DSL)
- Fever - Flank pain - Frequency - N/V - Dysuria - Suprapubic tenderness - Leukocytosis |
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URINARY TRACT INFECTIONS
- what would you see in UA? x5 |
(WWLLN)
- WBC - WBC casts - LE prep + - Low Specific Gravity - Nitrite + |
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URINARY TRACT INFECTIONS
- what radiological imaging would you get? x3 - what additional tests would you get? x2 |
(RAX)
- Renal US - Abdominal CT - X-ray studies |
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URINARY TRACT INFECTIONS
- what would you see on biopsy? x2 |
- Tubulointerstitial infiltration with Neutrophils (PMN)
- WBC Casts in Tubular Lumen) |
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URINARY TRACT INFECTIONS
- Biopsy of kidney may allow for what additional study? |
- Special staining showing for specific organisms.
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URINARY TRACT INFECTIONS
- Tx strategy for Uncomplicated UTI |
- Ab for 3 to 5 days
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URINARY TRACT INFECTIONS
- what Ab would you give in Uncomplicated UTIs with E.coli etiology? x3 - what about UTI with Chlamydia etiology? x2 |
- Bactrim
- Ampicillin - Quinalones - Zithramax - Tetracyclines |
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URINARY TRACT INFECTIONS
- what is the approach/strategy in Complicated UTI's? x4 |
- Antibiotics for 7-14 days OR more
- Correct Fluid/Electrolyte disorder - Correct Acid Base disorder - Underlying Risk factor treatment |
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URINARY TRACT INFECTIONS
- what Ab would you give in Complicated UTI? x5 |
(QuiZy CIA)
- Quinalones - Zosyn - Cephalosporins - Imipenum - Aminoglycosides |
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URINARY TRACT INFECTIONS
- List 4 types of Treatment of Underlying Risk Factors? |
(DURA)
- Drainage of Intra-renal ABSCESS - Ureteral Reimplantation for UV Reflux - Releif of Obstruction (BSS) - Avoidance of Prolonged catheter drainage |
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URINARY TRACT INFECTIONS
- for complicated UTI, relief of what obstructions? x4 |
(BSS)
- BPH - Strictures - Stones |
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URINARY TRACT INFECTIONS
- what are the 2 types of Acute Pyelonephritis? |
- Emphysematous Pyelonephritis
- Xanthogranulomatous Pyelonephritis |
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EMPHYSEMATOUS PYELONEPHRITIS
- this is a UTI associated with? - commonly seen in what pts? |
- Gas formation
- Diabetic patients with Obstruction of UT |
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EMPHYSEMATOUS PYELONEPHRITIS
- this type of UTI is seen in Diabetics with Obstruction of the UT most likely caused by what? x3 |
(SSS)
- Stricture - Stone - Sloughed papillae |
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EMPHYSEMATOUS PYELONEPHRITIS
- common organisms responsible? x2 |
- E. coli
- Klebsiella |
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EMPHYSEMATOUS PYELONEPHRITIS
- DX made by? x2 |
CT of Abd
CT of Pelvis |
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EMPHYSEMATOUS PYELONEPHRITIS
- Tx strategy? x3 - Tx in extreme cases? |
- Ab
- Relief of Obstruction - Percutaneous drainage of gas/abscess - if extreme, Nephrectomy (rare) |
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XANTHOGRANULOMATOUS PYELONEPHRITIS
- what type of Pyelonephritis is this? - usually is seen in what type of pts? - associated type of lithiasis in XGP? |
- Chronic Variant of Pyelonephritis
- Middle aged women w/ Recurrent UTIs - Struvite stone |
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XANTHOGRANULOMATOUS PYELONEPHRITIS
- what type of symptoms are associated XGP? x5 |
(FF MAW)
- Fever - Flank pain - Malaise - Anorexia - Weight Loss |
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XANTHOGRANULOMATOUS PYELONEPHRITIS
- what is the associated Lithiasis? - above lithiasis is surrouned by what pathalogically? x2 |
(SGL)
- Struvite stones - Granulomatous inflammation - Lipid laden molecules |
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XANTHOGRANULOMATOUS PYELONEPHRITIS
- what color surrounds the Struvite stone? - why? |
- Yellow
- due to Lipids ( Lipid Laden macrophages ) |
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XANTHOGRANULOMATOUS PYELONEPHRITIS
- involves which parts of the kidney? |
- upper and lower poles
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XANTHOGRANULOMATOUS PYELONEPHRITIS
- DX made by? - what would you see? |
- CT with Contrast
(CNP) - Calyces Dilated & Lined with Necrotic Tissue & Extending into Parenchyma |
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XANTHOGRANULOMATOUS PYELONEPHRITIS
- organisms responsible? x4 |
(E - PEP)
- E. coli - Proteus - Enterococcus - Pseudomonas |
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XANTHOGRANULOMATOUS PYELONEPHRITIS
- Treatment strategy? |
(CIA)
- Consult urologist - IV fluids - Ab |
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XANTHOGRANULOMATOUS PYELONEPHRITIS
- why consult Urology in treatment? x2 |
- Stone removal
- Partial or Total Nephrectomy |
