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131 Cards in this Set
- Front
- Back
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First sign tubule cell dysfunction
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inability to concentrate urine
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Fixed specific gravity
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chronic renal failure; cannot concentrate or dilute urine
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Negative urine bilirubin + trace urobilinogen
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normal urine
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Positive urine bilirubin, absent urobilinogen
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obstructive jaundice
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Positive urine bilirubin + increased urobilinogen
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hepatitis
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Negative urine bilirubin + increased urobilinogen
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extravascular hemolytic anemia
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Positive urine nitrite + positive urine leukocyte esterase
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urinary tract infection
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Sterile pyuria
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positive urine leukocyte esterase but negative standard culture; TB, C. trachomatis
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Prerenal azotemia
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inc BUN and creatinine; dec renal blood flow (e.g., heart failure, hypovolemia)
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Renal azotemia
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inc BUN and creatinine due to intrinsic renal disease (acute tubular necrosis)
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Postrenal azotemia
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inc BUN and creatinine due to obstruction to urine flow
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Serum BUN:creatinine ratio
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< 15:1 (renal failure); > 15:1 (prerenal or postrenal azotemia)
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BUN 80 mg/dL:creatinine 8 mg/dL
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ratio 10/1- renal failure
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BUN 80 mg/dL:creatinine 2 mg/dL
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ratio 40/1- prerenal azotemia or postrenal azotemia
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Creatinine clearance
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measures GFR
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Proteinuria
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important sign of renal dysfunction
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RBC casts
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nephritic type of glomerulonephritis
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WBC casts
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acute pyelonephritis, acute tubulointerstitial nephritis
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Fatty casts with Maltese crosses
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nephrotic syndrome
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Hyaline casts
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normal unless associated with proteinuria
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Renal tubular cell casts
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acute tubular necrosis
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Waxy or broad casts
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chronic renal failure
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Cystinuria
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hexagonal crystals
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Horseshoe kidney
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Turner's syndrome; lower poles fused
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Renal dysplasia
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MC childhood cystic disease; abnormal development; flank mass
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MC childhood cystic disease; abnormal development; flank mass
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fetal juvenile polycystic kidney disease; Potter's facies in newborn
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fetal juvenile polycystic kidney disease; Potter's facies in newborn
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AD; hypertension MC sign; cerebral berry aneurysms
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Visceral epithelial cells
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synthesize basement membrane
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Glomerular BM
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negative charge due to heparan sulfate
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Nephritic syndrome
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oliguria; RBC casts; hypertension; mild to moderate proteinuria
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Nephrotic syndrome
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proteinuria > 3.5 g/day; ascites and pitting edema; fatty casts; fusion of podocytes
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Immunofluorescence
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linear (anti-glomerular BM antibodies); granular (IC deposition)
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IgA GN
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MC GN; usually nephritic; episodic hematuria; mesangial IC (IgA-anti-IgA) deposits
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Post-streptococcal GN
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nephritic; subepithelial deposits; skin/pharyngeal infections; anti-DNAase B SLE
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type IV GN
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nephritic; subendothelial deposits; anti-DNA antibodies
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Crescentic GN
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crescents from parietal cell proliferation; worst GN; Goodpasture's, Wegener's
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Goodpasture's:
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nephritic; anti-BM antibodies (glomerular + pulmonary capillary); crescentic GN
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S/S of Goodpasture's:
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young male with hemoptysis progressing to renal failure
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Minimal change disease (lipoid nephrosis)
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MCC childhood nephrotic syndrome
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Lipoid nephrosis
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podocyte fusion; loss of negative charge in glomerular BM
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Focal segmental glomerulosclerosis
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nephrotic syndrome; AIDS and IV heroin abuse
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Membranous GN
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MCC adult nephrotic syndrome; subepithelial deposits; epimembranous spikes
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Causes of membranous GN
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HBV, ACE inhibitors, cancer
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Type I Membranoproliferative GN
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nephrotic; subepithelial deposits; HCV association; tram tracks
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Type II Membranoproliferative GN:
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nephrotic; C3 nephritic factor; intramembranous ICs (dense deposit disease)
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DM nodular glomerulosclerosis
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microalbuminuria first sign
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DM glomerulosclerosis
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nodules with collagen in mesangium; hyaline arteriolosclerosis of arterioles
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ACE inhibitors DM glomerulosclerosis
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inhibit angiotensin II vasoconstriction of efferent arterioles
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Alport's syndrome
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XD hereditary nephritis with sensorineural hearing loss
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Ischemic ATN
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prerenal azotemia MCC; renal tubular cell casts; BUN:creatinine ratio < 15:1
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Ischemic ATN
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disruption of BM in proximal tubule and thick ascending limb
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Nephrotoxic ATN
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aminoglycosides, IVP dye, Pb/mercury poisoning
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aminoglycosides, IVP dye, Pb/mercury poisoning
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proximal tubule dysfunction; intact BM
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Oliguria
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prerenal azotemia, ATN, glomerulonephritis, postrenal azotemia
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Acute pyelonephritis
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vesicoureteral reflux with ascending infection; WBC casts, fever, flank pain
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Chronic pyelonephritis
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U-shaped scars overlying blunt calyces
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Drug-induced tubulointerstitial nephritis
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type I/IV reaction; e.g., penicillin
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S/S of Drug-induced tubulointerstitial nephritis
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ARF, fever, rash, eosinophilia, eosinophiluria, WBC casts
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Analgesic for nephropathy
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aspirin plus acetaminophen; renal papillary necrosis; IVP with ring defect
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Myeloma kidney
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BJ protein produces foreign body reaction in tubules
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Urate nephropathy
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prevent by giving allopurinol prior to chemotherapy
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Chronic renal failure
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fixed specific gravity; BUN:creatinine < 15:1; waxy and broad casts
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Renal osteodystrophy Chronic renal failure
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hypovitaminosis D (no 1-a-hydroxylase) produces osteomalacia
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Renal osteodystrophy Chronic renal failure
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osteoporosis from metabolic acidosis
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Renal osteodystrophy Chronic renal failure
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secondary HPTH with increased osteoclastic activity
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S/S of Chronic renal failure
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pericarditis, prolonged bleeding time, normocytic anemia, pathologic fractures
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Benign nephrosclerosis
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kidney of hypertension; shrunken kidneys due to hyaline arteriolosclerosis
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Malignant hypertension
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renal failure; encephalopathy; BP >210/ >120 mmHg; IV nitroprusside
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Renal findings in malignant hypertension
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necrotizing arteriolitis; "flea bitten" kidney; hyperplastic arteriolosclerosis
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Renal infarction
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pale infarcts; hematuria; common in polyarteritis nodosa
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Hydronephrosis
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renal stone MCC; atrophy of cortex/medulla; postrenal azotemia
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Renal stones
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most contain calcium (calcium oxalate/phosphate); hypercalciuria MC risk factor
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S/S of renal stones
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colicky pain radiating into groin, hematuria; x-ray usually shows stone
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Staghorn calculus
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due to urease producing organisms (Proteus); alkaline urine pH; ammonia smell
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Angiomyolipoma
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hamartoma; associated with tuberous sclerosis
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Renal cell carcinoma
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smoking MCC; invasion renal vein/vena cava; lung, bone mets; yellow colored
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S/S of Renal Cell carcinoma
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flank mass, hematuria; ectopic hormones (EPO, PTH related peptide), left-sided varicocele
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Renal pelvis transitional cell carcinoma
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smoking MCC, phenacetin, aniline dyes, cyclophosphamide
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Wilm's tumor
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hypertension, unilateral abdominal mass in child; aniridia/hemihypertrophy in AD types
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Urine draining from umbilicus
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persistent urachus
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Retroperitoneal fibrosis
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produces hydronephrosis
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Bladder extrophy
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abdominal wall defect + epispadias
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Bladder diverticula
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most commonly due to prostatic hyperplasia with urethral obstruction
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Acute cystitis
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E. coli; females > males; no fever, flank pain, or WBC casts
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Bladder transitional cell carcinoma
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smoking MCC, aniline dyes, cyclophosphamide; papillary
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S/S of Bladder transitional cell carcinoma
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hematuria; hydronephrosis
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Bladder adenocarcinoma
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risk factors- persistent urachus, extrophy
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Bladder squamous cell carcinoma
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Schistosoma hematobium infection
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Hypospadias
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ventral opening on penis due to failure closure of urethral folds
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Epispadias
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dorsal opening on penis due to defect in genital tubercle
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Peyronie's disease
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painful curvature penis due to fibromatosis
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Priapism
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persistent/painful erection; HbSS
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Squamous cell carcinoma penis
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HPV and lack of circumcision most important risk factors
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Cryptorchidism
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undescended testis; risk for seminoma applies to cryptorchid testis and normal testis
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Orchitis
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mumps usually unilateral (infertility uncommon)
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Epididymitis
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< 35: N. gonorrhoeae, C. trachomatis; > 35 E. coli, P. aeruginosa
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S/S of Epididymitis
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scrotal pain relieved by elevation of scrotum (Prehn's sign)
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Varicocele
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left-sided scrotal mass; spermatic vein drains into left renal vein; infertility common
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Varicocele
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may be due to invasion of left renal vein by renal cell carcinoma
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Hydrocele
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persistent tunica vaginalis; scrotum transilluminates
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Torsion of testicle
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testicle high in canal; absent cremasteric reflex
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Testicular cancer
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unilateral painless mass that does not transilluminate
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Risk factors for Testicular cancer
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cryptorchid testis, Klinefelter's, testicular feminization
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Seminoma
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MC testicular cancer; radiosensitive; large cells with lymphoid infiltrate; small percentage have hCG
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Spermatocytic variantm of seminoma
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> 65 yrs of age
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Embryonal carcinoma
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hemorrhage/necrosis; hematogenous spread before lymphatic; inc AFP, hCG
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Yolk sac tumor
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MC testicular cancer in boys; inc AFP
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Choriocarcinoma:
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most aggressive testicle cancer; inc hCG
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Teratoma
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more often benign in children than adult
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Teratocarcinoma
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teratoma + embryonal carcinoma
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Malignant lymphoma in testicles
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MC type in elderly; metastasis not primary cancer
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Prostate
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DHT derived stimulation embryo; periurethral area- hyperplasia; peripheral area- cancer
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Prostatitis
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perineal pain, fever; WBCs at end of voiding
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Benign prostatic hyperplasia
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DHT/estrogen-mediated; glandular/smooth muscle hyperplasia
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S/S of Benign prostatic hyperplasia
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all men develop; urethral obstruction MC (hesitancy, dribbling, nocturia), hematuria, dysuria
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Rx for BPH
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a-adrenergic blockers, 5-a-reductase inhibitors
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Prostate cancer
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DHT-mediated; palpable with rectal exam; osteoblastic metastasis (inc AP)
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PSA
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sensitive but not specific for prostate cancer; inc in hyperplasia
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Kallmann's syndrome
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absent GnRH, anosmia, absence of taste
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Impotence
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failure to sustain an erection; psychogenic in most cases (erections present at night)
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Erection
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parasympathetic response
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Ejaculation
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sympathetic response
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Leydig cell failure
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inc LH; dec testosterone, sperm count; normal FSH
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Seminiferous tubule failure
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inc FSH (dec inhibin); dec sperm count; normal LH and testosterone
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Leydig and seminiferous tubule failure
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inc FSH and LH; dec testosterone and sperm count
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Y chromosome
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Y chromosome
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Testosterone
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develops seminal vesicles, epididymis, vas deferens
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Dihydrotestosterone
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develops prostate and male external genitalia
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Male pseudohermaphrodite
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genetic male; phenotypically female
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Testicular feminization
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XR; deficient androgen receptors; MCC male pseudohermaphrodite
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Klinefelter's syndrome
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XXY; 1 Barr body; female secondary sex characteristics
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