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125 Cards in this Set
- Front
- Back
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azotemia
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elevated BUN and Cr
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drugs causing ATN
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aminoglycosides
NSAIDS cisplatin |
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bodily causes of ATN
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neprhotoxic
- myoblobin - light chains ischemic - shock - hemorrhage |
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FENa <1
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prerenal failure
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urine osmolality > 500
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prerenal failure
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urine sodium >40 intrinsic renal fialure
urine sodium < 20 |
prerenal failure
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causes of intrinsic renal failure
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ATN
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hyaline casts
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prerenal failure
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causes of GN
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goodpasture
wegener post strep lupus |
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causes of vascular intrinsic renal failure
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renal artery occlusion
TTP HUS |
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causes of interstitial intrinsic renal failure
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hypersensitivity to Rx
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why does urine/plasma Cr go up in prerenal failure
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because much of filtrate is reabsorbed, but Cr isn't
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RBC casts
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glomerular disease
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WBC casts
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renal parencymal inflammation
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fatty casts
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nephrotic syndrome
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muddy brown casts
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ATN
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granular casts
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ATN
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dysmorphic RBCsss
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acute GN
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main causes of chronic renal failure
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diabetes (30%)
HTN (25%) |
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decreased GFR stimulates
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RAS and aldosterone secretion
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GFR formula
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[solute]urine x urine flow / [solute]plasma
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lethargy
confusion tetany |
hypoglycemia
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Cr 1.5-3
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chronic renal insufficiency
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BUN for uremia to develop
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usually >60
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calciphylaxis
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because of CRF - hyperphos - Ca+ phos preciptiation - necrotic skin lesions
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necrotic skin lesions in CRF
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calciphylaxis
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hypocalcemia and hyperphosphatemia
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secondary hyperparathyroidism
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small kidneys
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Chronic Renal Failure
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effect of ACEis
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dilate efferent arteriole
slow progression of proteinuria BUT can cause hyperkalemia |
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undesirable effect of ACEi
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hyperkalemia
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how to correct hyperphosphatemia in CRF
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Ca citrate
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how to correct anemia in CRF
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EPO
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how to correct pruritis in CRF
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capsacin
cholestyramine |
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indicators for dialysis
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AEIOU
Acidosis Electrolytes (K) Intoxications (methanol, ethelyne glycol, lithium aspirin) Overload Uremia |
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is elevated Cr an indication for dialysis?
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no
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dialyzable substances
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salicylic acid
lithium ethylene glycol magnesium-containing laxatives |
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what prophylaxis has to be given to dialysis patients
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heparin
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bruit in a dialysis fistula
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good thing -- it means it's patent
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risks of peritoneal dialysis
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the dialysis fluid is high in glucose and can cause:
hyperglycemia hypertriglyceridemia |
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what can't dialysis fix?
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production of EPO, Vit D
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how does dialysis fluid of regular dialysis differ from that of peritoneal dialysis?
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regular is hypoosmolar
peritoneal is hyperosmolar |
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aveage urine pH
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6
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nephrotic range proteinuria
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3.5
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nitrites +
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bacteria
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ketones in urine
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DKA
starvation |
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LE in urine
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WBCs
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specific gravity is proportional to
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osmolality
(nl is 1.002 to 1.035) |
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most common nephrotic in adults
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membranous
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most common nephrotic in children
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minimal change
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systemic diseases associated with nephrotic
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diabetes
collagen vascular disease SLE RA Henoch-Schonlein purpura PAN Wegeners Amyloidosis cryoglobulinemia |
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microalbuminuria
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early sign of diabetic nephropathy
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microscopic vs gross hematuria
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micro is glomerular
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hematuria
no infection normal shaped RBCs no casts no proteinuria culture negative |
check for coagulation
if negative, cxr of kidney, ureter, bladder. hope to see stones. if not, further evaluation needed |
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hematuria
HTN azotemia |
nephritic syndrome
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what nephrotic syndrome accompanies Hodgkins
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minimal change
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pathogeneis of nephritic vs nephrotic
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nephrItic is Inflammation
nephrOtick is hOle (permeability) |
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typical cause of membranoproliferative glomerulonphritis
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hep C, cryoglobulinemia
also hep B, syphilis, lupus |
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renal disease with cryoglobulinemia
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membranoproliferative
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hematuria
edema HTN hypocomplement proteinuria |
PSGN
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proliferative GN (crescentic)
pulmonary hemorrhage anti GBM |
Goodpastures
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tx for HIV nephropathy
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prednisone
ACEi antiretrovirals |
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immune complex formation is involved in what category of kidney diseases
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glomerulonephritis
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eosinophils in urine
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Acute Interstitial nephritis
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increased BUN and Cr
eosinophiliuria mild proteinuria or microscopic hematuria |
AIN
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what SNAIDS can cause in kidneys
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interstitial nephritis
renal papillary necrosis |
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cuases of renal papillary necrosis
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analgesics
diabetic nephropathy sickle cell UT obstruction/infection chroinic alcoholism renal transplant rejection |
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decreased ECF volume
hypokalemia renal stones rickets in children |
RTA I
inability to secrete H+ at distal tubule |
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pathophys or RTA 1,2,4
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1 - inability to secrete H+ at distal tubule
2 - inability to reabsorb bicarb proximally 4 - hypoaldosteronism or resistance to aldosterone |
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treatment for RTA 1
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correct acidosis with sodium bicarb
administer phosphate salts (to increase excretion of titratiable acid) |
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treatment for RTA 2
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treat underlying cause
restrict sodium (which increases sodium and therefore bicarb reabsorption) don't give bicarb because it will just be excreted |
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which RTAs have hypokalemia
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1 and 2 only
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Hartnup syndrome pathology
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AR
defective amino acid transporter |
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nicotinamide deficiency
dermatitis diarrhea ataxia psychiatric disturbance |
Hartnup
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defective AA transporter
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Hartnup
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RTA associated with Fanconi's syndrome
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RTA 2
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pathology in Fanconi's
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defective transport of
glucose amino acids sodium potassium phosphate uric acid bicarb |
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glucosuria
phosphaturia skeletal issues in kids or adults proteinuria polyuria dehydration type 2 RTA hypercalciuria hypokalemia |
Fanconi's
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tx for Fanconi's
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phosphate, K, alkali, salt supplements
hydration |
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cause of medullary sponge kidney
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hyperparathyroidism
parathyroid adenoma |
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most common cause of secondary HTN
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RA stenosis
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berry aneurysm
MVP diverticula hernia |
PKD associations
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which patients should not take ACEi
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those with renovascular HTN
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malignant HTN
sudden onset HTN HTN that suddenly worshes HTn that does not respond to standard medical therapy... what to suspect? |
renovascular HTN
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diagnosis of renovascular HTN
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renal arteriogram -- UNLESS person has renal failure, in which case do MRA
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what do these cause...
gout crohns hyperPTH Type I RTA |
stones
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second most common cause of ESRD
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HTN induced nephrosclerosis
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most kidney stones are
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calcium
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which kidney stones are radiodense
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calcium
struvite |
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which kidney stones are radiolucent
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uric acid
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causes of struvite stones
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recurrent UTIs from urease-producing organisms (proteus, klebsiella, serratia, enterobacter)
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kidney stones caused by cystinuria
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cystine stones
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hexagonal kidney stones
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cystine
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flat square kidney stones
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uric acid
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bipyramidal/biconcave oval kidney stones
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calcium
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sudden onset of colicky flank pain radiating to groin
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nephrolithiasis
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acidic urine and flank pain
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uric acid sone
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alkaline urine and flank pain
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struvite stone
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tx for kidney stones
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pain meds (morphine, ketorolac)
vigorous fluids abx if uti |
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what size stones can be lithotripped
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5mm-2cm
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what size stones usually pass spontaneously
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<5 cm
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what drugs reduce calcium stones
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thiazides
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what drugs reduce uric stones
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allopurinol
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diagnosis of urinary tract obsruction
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initial renal ultrasound
IVP (intravenous urogram) is the gold standard |
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when is IVP contraindicated?
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pregnancy
contrast allery renal failure |
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next step if PSA >10
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TRUS with biopsy (transrectal u/s)
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positive DRE, low PSA
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TRUS
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PSA <4, DRE neg
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annual follow up
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PSA 4-10, DRE -
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noone knows what to do
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bound vs free PSA
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Bound is Bad
malignant PSA tends to be bound by plasma proteins |
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PSA stages
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A - nonpalpable, confined
B - palpable, confined C - extends, no mets D - mets |
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tx for localized prostate ca
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prostatectomy
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tx for locally invasive prostate ca
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radiation and androgen deprivation
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tx for metastatic prostate ca
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orchiectomy
antiandrogens leuprolide |
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polycythemia
hypercalcemia renin Cushings feminizaiton/masculization |
can all be caused by paraneoplastic effects of Renal Cell Carcinoma
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tx for RCC
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radical nephrectomy (including adrenals and Gerota's fascia
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toxins causing bladder cancer
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aniline dye
Azo dyes coffe artifical sweeteners radiation cyclophosphamide |
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painless hematuria
possible dysuria and frequency |
bladder cancer
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tumors in testes vs scrotum
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testes almost always malignant
scrotum almost always benight |
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risk factors for testicular cancer
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cryptorchidism, whether or not corrected
klinefelters |
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testicular cancer stages
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A - confined to testis/cord
B - retroperitoneal lymph below diaphragm C - distant mets |
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beta hCG elevated
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choriocarcinoma
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AFP elevated
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embryonal tumors
(never choriocarcinoma, seminoma) |
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HPV types in penile cancer
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18 and HSV
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bug for kids epididymitis
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e coli
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bug for young man's epididymitis
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gonorrhea
chlamydia |
