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111 Cards in this Set
- Front
- Back
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all diuretics cause __________ except?
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hypoK but not w/ K sparers (Sprinolactone)
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name that diuretic
works at the pct |
CAI
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name that diuretic
works at the dct |
thaizides
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name that diuretic
works at the loop (ascending) |
loop diurectics
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name that diuretic
works at the ct alone |
K sparing
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name that diuretic
works at Ct, pct, loop |
manitol osmotic agent
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causes a metabolic acidosis, kidney stones and , hypokalmeia (with all diurectics)
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CAI
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causes a dilutional hypo natreima, (early) and a hypernatremia late, what test you want? and indications f use for this drug?
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indications - elevated icp, acute RF
test - sreum na osmols - look for hypoosmolality ** can cause pulm edema |
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adverse effects with loops:
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ototoxicity, hyper urecemia (not for ppl with stones)
hypOkalemia (always), hypocalcemia |
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which diuretic(s) is bad for gout pts?
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hyperurecemia seen w/ thiazides and loops
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guy comes in with cirrhotic ascites needs rapid fluid removal, tx?
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loop + thiazides
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CHF, diuretic of choice?
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loop
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diuretic used for altitude sickness, acute angle galucoma and met alkalosis (alt sickness)
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CAI
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diuretic of choice in a chf, pt or someone with ascites and DI and hypercalcuria
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thiazides
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advefx of thazides
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hypoK (always), hyperurecemia,hypercalcuria
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works at the CT has anti androgenic affects is often prescribed for PCOS and or acne, and works as an aldosterone blockers inhibits the Na/K exchange at the CT, main adverse effect to worry about?
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Spirinolcatone - K sparing diuretic or aldosterone antagonist = GYNECOMASTIA
NOT SEEN WITH EPLERNONE also see obv hyperK |
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which K sparing diuretics work at the aldosterone R, which do not?
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eplerenone and spirionolactone - aldosterone R blocker
Triamterene + Amiloride - non aldosterone blocker. |
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if one has a sulfa allergy which diuretics can be used?
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osmotic agents and ethacrynic acid (loop, only non sulfa loop) and lastly, K sparing diuretics
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advefx
HYPOCALCEMIA |
LOOPS LOOSE CALCIUM
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advefx
HYPERCALCEMIA |
THIAZIDES
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H/P shows flank pain, cva tenderness, dysuria, nv urinary frequency, fever >101.5, labs show: 10^5 bacteria in urine, bandemia and elevated esr, crp wbc casts
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dx - pyelonephritis
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tx for pyelo?
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IV FLQ , aG or cephs for 1-2 days and then antibiotics outpt orally
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acute severe collicky pain, radiates into thighs and genitals and nv, dysuria, gross hematuria also plasuible, based on this h/p what is going on?
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nephrolithiasis
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hemauria ddx?
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idiopathic
neoplasm of bladder, kidney, prostate exercise pckd trauma glomerular disease nephritic nephrotic uti nephrolithiasis |
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what kind of stones cant be seen with XR?
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uric acid stone, gall stones (use US)
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shockwave litho indicated for stones sized
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<3cm
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h/p shows dull inermittient flank pain with hx of uti, has anuria what is first thing you want to do?
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assume bilateral urinary obstruction, cath them to see for bladder or uretheral obst
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hydronephrosis go to tests for imaging?
tx? |
us or ivp shows dilation of renal calcyces
tx - J stent in ureter, drainage nephrostomy tube into renal pelvis |
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hematuria some causes that arent bloody?
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rifampin use or rhabo
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hydronephrosis is usually
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unilateral
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if a stone has calcium in it that means it will show up on XR, its ________
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radioopaque
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most common type of renal stone
what diuretic can exacerbate it? |
calcium oxalate stone
thiazides |
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struvite stone is the staghorn stone composed of? (3)
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nh4, mg, po4
d/T uti a/w proteus and or klebsiella infection a/w staghorn caliculi |
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stone a/w hyper PTH
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caPO4 stone
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tx for uric acid stone?
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alkalanize urine
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pckD adult varierty is a/w
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berry aneurysms which lead to subarachnoid hemorrhage
AD -inheritence |
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rcc and ________ have the same presenting symtptoms?
what are those symptoms? |
RCC and APCKD
HTN, flank pain, hemturia, ca- will have wt loss, and ,palpable abd mass RCC uniquely has scrotal varicocele |
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MVP common in pts with
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rcc or APCKD
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in RCC labs will show
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polycythemia, elevated EPO
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biggest risk factors for RCC
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age and tobacco use
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pain after awakening in shoulder, hips and neck a/w temporal arteritis
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polymyalgia rheumatica
tx- prednisone |
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3 drugs that make kidney stones worse
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allopurinol
acetazolamide loops |
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UA shows granular casts and eosiniphilia , CR elevated and pt has hx of lead , cadmium ingestion and has since broken out into rash and fever, nv malaise , what other agents can cause this disease?
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AGs, NSAID, PPI, B-lactam abs, sulfonamides
AIN |
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cancers or syndromes that have increase EPO
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RCC
HCC (hepatic adneoma has surface neovasc) hemangioblastoma |
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h/p of strep 103 wks prior, brown urine and htn, kid
labs show bumpy deposits of IgG andC3 on renal basement mebrane on electron microscopy, ASO titer is high along w/ igG and c3 |
post infectious GN - "lumpy bumpy"
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h/p deposition of IgA ab's in mesangial cells IgA in serum is elevated, aka. IgA nephropathy, histology looks like henoch scheloin perpura.
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BERGER'S DISEASE
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recall henoch scholien perpura h/p
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the 6 sx:
KIDS WITH RENAL DISEASE PERPURA. PURPLE BLOTCHES OF THE EXTREMITIES RECENT URI IGA VASCULITTIS ABDOMINAL PAIN ARTHRITTIS |
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nephropathy involves the lungs and kidneys and no uri sx, antiGBM and antialveolar membrane ab's present involved and dyspnea, hemoptysis and hematuria on exam. serum IgG antiGBM ab's, pulmonary infiltrates and linear IgG ab depot
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good pasture's +cANCA
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nephritis + cataracts + high frequency hearing loss
h/p heamturia, gbm inconsistency, red cell casts, and hematuria, mild proteinuria, gbm splitting, |
alports syndrome
tx -ace i, statins, steroids (for most nephritic syndromes) |
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rapidly progressive RF
+ cANCA inflammatory cell depot in bowman's capsule and crescent formation, basement membrane wrinkling on electron microscopy. |
cresnteric GN = cANCA
can be a progression of Wegener's |
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antiDSDNA +
complication if a disease process, possible htn, asymptomatic, or RF may develop nephrotic syndrome. ANA + hematuria posisble tx cocktail? |
lupus nephropathy
ace - renoprotective statins steroids - reduce inflammation |
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recent uri, c-ANCA+ depot on renal vv. respirtatory symptoms common and hematuria and fever
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wegener's Granulomatosis
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list the well known nephrotic syndromes
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minimal change
FCGS membranous membranoproliferative diabetic or kimmel-weilstein GN |
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GN causes edema in kids and you see flattening of the foot processes, effects kids, and tx w/ steroids
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minimal change dis
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gn caused by ivda or hiv co infection, see w. blacks can lead to cresenteric disease which is end stage, see sclerotic change on glomruli
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fsgs
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most common nephrotic disease in adults
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membranous gn
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spike and dome pattern seen on bx and bm thickening seen w/ lupus, neooplasm, drugs or co infection
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adult type = membranous gn
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see bm thickening, w/ double layer tram track appearance on em, gn sx -hx of systemic infection like hep b,c or lupus or subacute bacterial endocardits
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membranoprolifrative gn
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see basement thickening and kiimmelstein nodules, seen w/in nodular type
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dm nephropathy
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ARF TYPES?
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pre-renal - hypovolemic, drugs, raa stenosis, or toxins
renal - atn, drugs, toxins,gn, renal vasc disease postrenal - obstruction - stone |
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most common cause of a sudden increase in bun cr?
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arf - drugs
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common causes of arf?
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vasculuttis
obstruction infection drugs raa stenosis gn glomerular disease hypovolemia embolus interstitial nephropathy |
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muddy brown waxy casts, granular
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atn
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prerenal > ____ means RF of what cause?
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2% - suggests ATN
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postrenal < ___________ means RF what cause?
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1% - prerenal cause
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bun:cr ration of ____________ shows prerenal cause of arf
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>20
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indications for dialysis
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uremic syndrome - ams, gi bleed, neuropathy, nv, uremic frost, anorexia, htn
severe hyperK severe met acidosis ckd w/ bun>100 or cr>12 |
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HIGH URINE PH > 5.3 (alkalotic)
low K, possible stones, chronic infections, sle and cirrhosis are the cause of the condiiton, impaired H+ secretion leading to 2ndary hyperaldosteronism ( not conn's) |
RTA type 1 - distal
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urine pH <5.3
low K bone lesions causes: MM, wilson's, amyloidosis, vitD def, autoimmune disease, fanconi hco3 absp issue |
proximal type - type2 rta
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high k, urine ph <5.3 looks like k sparing diuretic excess ( or aldosterone def)
d/t primary or secondary aldosterone def dm or addisons, scd, interstitial disease |
rta type 4- low renin type (a/w strongly DM)
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fanconi syndrome brought on by
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dm, wilsons, amyloid, vitD def
it is a Proximal tubule absp defect |
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normal values
pH pCo2 Po2 HCo3 |
7.3-7.4
40 100 24 |
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met acidosis mcc's (nonaG)
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diarrhea
rta tpn - hyperalimentation |
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high AG met acidosis
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methanol
uremia dka paraldehyde INH Lactic acidosis etoh/etglycol salicylates MUDPILES |
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met alkalosis
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vomit, diuretics, cushing's syndrome, hyperaldosteroneism, adrenal hyperplasia
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resp alkalosis mcc
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high altitude, asthma, asa toxicity, pe, hyperventilation
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resp acidosis mcc
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copd, resp depression, nm disease
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hypernatreimia causes OF IT?
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diuretics
dehydration DI docs (iatrogenic) diarrhea (+vomitting) disease of the kidney (hyperaldosteronism) |
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6D's of hypernatremia
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diuretics
dehydration DI iatorgenic Diarrhea, vomit kidney disease hyperALD |
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SIADH, MCC'S?
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"HYPONATREMIA, EUVOLEMIC STATE"
CNS PATH - PARANEOPLASTIC PSYCH DRUGS SURGERY HIV <280 USOM |
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TX FOR SIADH?
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LOOPS + FLUIDS + HYPEERTONIC SALINE
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MCC HYPERKALEMIA
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RF
TISSUE CATABOLISM ALDOSTERONE DEF MET ACIDOSIS PSEUDOHYPERKALEMIA- RBC LYSIS K SPARERS INSULIN DEF RTA4 |
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MCC HYPOKALEMIA
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RTA 1,2
HYPERALDOSTERONEISM - CONNS K WASTERS - ALL DIURETICS BUT SPIRNIOLACTONE INUSLIN EXCESS IN TX OF DKA ALKALOSIS - MET OR RESP VOMIT, DIARRHEA - GI LOSS PERIODIC PARALYSIS HYPOTHERMIA LOOPS AND THIAZIDES ESPECIALLY B-B ACTIVITY |
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HYPERCALCEMIA MCC''S
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>10.5
CALCIUM SUPP HYPERPTH MILK-ALKALAI SYNDROME PAGET' S DISEASE ADDISONS DISEASE NEOPLASMA ZOLINGER ELLISON DISEASE EXCESS VIT A D SARCOID |
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recall sx w. hypercalcemia
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bones, groans, stones, and psych overtones
fractures, gi issues, ams, stones. |
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hypocalcemia <8.5
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hypoPTH, hyperphosphatemia, vitD def, loop diuretics, pancreatitis, etohism
<8.5 |
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LOOPS DO WHAT TO CALCIUM
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HYPOCALCEMIA
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THIAZIDES DO WHAT TO CALCIUM
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HYPERCALCEMIA
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CALCIUM DECREASE CAUSE WHAT EKG FINDING
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HYPOCA - PROLONG qt
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CALCIUM INCREASE CHANGE CAUSE WHAT EKG FINDING
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HYPERCA - SHORTEN QT
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WHAT SAFE TO TX UTI IN PREGNANCY?
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AMOXICILLIN
AMP GENT NITROFURANTOIN ALL COVER GRAM - |
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RISK FACTORS TRANSITIONAL CELL CA OF THE BLADDER
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TOBACCO, SCHISTOSOMIASIS, ANILINE DYE, PETROLEUM PDTS, RECURRENT UTI MALE x3
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SX OF BLADDER CA
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GROSS PAINLESS HEMATURIA
SUPRAPUBIC PAIN FREQ DYSURIA URGENCY PALPABLE SUPRAPUBIC MASS |
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MCC OF URETHRITIS
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N. GHONORRHEA - G- DIPLOCOCCI GROWN ON THAYER MARTIN CULTURE
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KEEP IN DDX IF >35 AND HX OF CHRONIC PURULENT DISCHARGE
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THINK ECOLI OR ANAL SEX
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KEEP IN DDX IF <35 AND HX OF CHRONIC Purulent DISCHARGE
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THINK GC
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PROSTATTITIS CAUSE, SX?
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CAN COME FRO UTI COMPLICATION OR MCC - NON BACTERIAL
FEVER, TENDER PROSTATE ON DRE, TX - TMPSMX |
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BPH DX IS BASED ON
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SYMPTAMATOLOGY
URGENCY, URGE INCONTINENCE, WEAK CALIBER OF STREAM, DIRBBLING, HESITANCY, MILD OR NON PSA INCREASE AND DRE- ENLARGED RUBBERY PROSTATE. |
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BPH DEVELOPS IN ___________ ZONE OF THE PROSTATE
PROSTATE CA DEVELOPS IN THE ________________ ZONE OF THE PROSTATE |
CENTRAL
PERIPHERAL |
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PROSTATE CA RISK FACTORS
LABS? H/P? |
HIGH FAT DIET, INCREASED AGE, PREVIOUS PROSATITIS
HIGH PSA, ALKPHOS ELEVATED, BACK PAIN FELT AND IF MASS FELT ON DRE THEN DO TRANSRECTAL US |
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CANCER RISK IN MEN - TOP 3 FREQUENCY
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PROSTATE
LUNG COLORECTAL |
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CANCER MORTALITY- TOP 3 KILELRS
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LUNG
PROSTATE COLORECTAL |
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causative agents for epididmyttis
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stds, prostatitis, esp - chlamydia, keep in mind the >35 and <35 rule
scrotal support helps, may have uretheral discharge |
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most common ca in males 15-35?
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testicular
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complications of curative surgery for prosate ca
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incontinece and impotence
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torsion dx?
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made by sx and usa findings - rush to OR
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TESTICULAR cancer markers
if germ cell origin if stromal origin |
"a painless mass on the testicle"
hi bhcg, afp hi etrogen |
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main male dx testing for infertility
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semen analysis
cant dx infertlity unless you have gone 1 yr w/o use of contraceptive kartegener and cf are a.w male infertility |
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mc ca renal - in kids <4 yo
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wilm's tumor
a/w neurofibromatosis |
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for enuresis
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use alarms and education first
for refractory cases - ddavp then impirmaine most cases resolve by 4 |
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risk factor for testicular cancer
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undesended testes,= cryptochordism
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