Term
| The ____ kidney is slightly higher than the other |
|
Definition
|
|
Term
| kidney's are ___ (location) organs |
|
Definition
|
|
Term
| what organs are of most concern for being injured during a hysterectomy? |
|
Definition
bladder and ureters
ureters pass underneath the abdominal vein/artery |
|
|
Term
| process of sperm transportation from where they are made to where they're stored |
|
Definition
| seminiferous tubules --> rete testes --> epididymis --> vas |
|
|
Term
| 5 main functions of the kidneys |
|
Definition
regulate fluid volume
regulate acid-base balance
help control electrolyte concentration
excrete nitrogenous breakdown products
excrete toxic substances & drugs
These fxns will suffer during renal failure |
|
|
Term
| to control fluid volume, you must control the concentration of ____ |
|
Definition
sodium
too little sodium: hypotension, cardiovascular collapse,d eath
too much sodium: hypertension, pulmonary edema, death |
|
|
Term
The functional unit of the kidney is the ____, which is composed of what 3 things?
Normal urine output is ___ ml/min
kidneys represent 1% of body weight but use __% of O2 and ___% of resting Cardiac output |
|
Definition
nephron: glomerulus, bowman's capsule, collecting tubules
urine: 1 ml/min
7% of O2, 20-25% CO |
|
|
Term
estimated rate of kindey filtration
- number of ml of ultrafiltrate produced per min by both kidneys
- is typically 125 ml/min
- best measured by ___ clearance test
- usually measured by ___ or ___ |
|
Definition
glomerular filtration rate (GFR)
- inulin = best
- creatinin or cystatin C = usual |
|
|
Term
|
Definition
|
|
Term
| Things that can influence BUN/Creatinine other than renal failure |
|
Definition
BUN:
- low BMI = low BUN
- GI bleed = high BUN
Muscle breakdown = high creatinine |
|
|
Term
| how are BUN and creatinine affected by renal failure? |
|
Definition
|
|
Term
| compensation for acidosis |
|
Definition
respiratory: rising CO2 levels trigger increase in ventilation rates so PaCO2 levels fall
renal: kidneys conserve HCO3 and excrete H+
both happen at the same time |
|
|
Term
| important parts of the abg reports |
|
Definition
1. pH: should be 7.35-7.45
2. PaO2: 70-100mmHg
3. PaCO2: 35-45
4. Bicarbonate concentration: 22-30 nm/ml |
|
|
Term
| Metabolic v. Respiratory acidosis & alkalosis-- causes |
|
Definition
metabolic acidosis: renal failure, diabetic ketoacidosis, ingestion of acidic compounds (aspirin overdose)
Respiratory acidosis: resp failure (severe asthma) - high PaCO2
metabolic acidosis: prolonged vomiting
respiratory alkalosis: hyperventilation - low PaCo2 |
|
|
Term
| Compensation for alkalosis |
|
Definition
Respiratory: ventilation rate falls - PaCO2 rises
Renal: kidneys excrete HCO3- and retain H+
|
|
|
Term
ABG:
1. What does low pH + low PaCO2 imply?
2. Low pH + high PaCO2?
3. High pH + low PaCO2?
4. high pH + high PaCO2?
5. Normal pH + high PaCO2? |
|
Definition
1. low pH + low PaCO2 = metabolic acidosis w/ resp compensation
- renal failure or ingestion of acidic compounds
2. Low pH + high PaCO2 = resp acidosis
- resp failure
3. high pH + low PaCO2 = rep alkalosis
- hyperventilation
4. high pH + high PaCo2 = metabolic alkalosis with resp compensation
5. Normal OR if HCO3- is increased = compensated resp acidosis
- kidneys ar holding onto bicarbonate to compensate the acidosis |
|
|
Term
|
Definition
lower: acute cystitis
upper: acute pyelonephritis |
|
|
Term
dx?
irritative voiding sx - urinary frequency, urgency, pain
hematuria (microscopic or gross)
fever (esp in kids)
UA:
- cloudy or bloody
- increased WBC, RBC, bacteria |
|
Definition
|
|
Term
fever, nausea, vomiting, diarrhea
flank pain
+/- voiding symptoms
UA:
- cloudy or bloody
- increased WBC, RBC, bacteria
- casts |
|
Definition
|
|
Term
| female <5 y/o with unexplained fever, think? |
|
Definition
|
|
Term
|
Definition
clean catch = 100,000 (10^5)
catheter: 100-10,000 (10^2 - 10^5)
|
|
|
Term
Pathogenic microbes for UTIs
1. most common for UTI. protists and fungi
2. "regular" bacteria -- mycoplasma, chlamydia, rickettsia
3. viruses and prions |
|
Definition
1. eubacteria 2. prokaryotes 3. non-living
|
|
|
Term
| what color are gram + and gram -? |
|
Definition
|
|
Term
what gram classification?
1. staph, strep, enterococcus
2. bacillus antrhacis, corynebacterium diphteriae, clostridium
3. neisseria gonorrhea & meningitidis
4. e. cli, proteus mirabilis, salmonella, klebsiella |
|
Definition
1. gram + cocci
2. gram + bacilli
3. gram neg cocci
4. gram neg bacilli
|
|
|
Term
__ are most common organisms for UTI, especially ___
next most common are ___ or ___
organisms are often atypical in ___ settings |
|
Definition
gram neg - coliform
staph saprophyticus and enterococcus
atypical in hospital-acquired |
|
|
Term
|
Definition
supportive - hydration, vit C, cranberry juice
abx - usually for cystitis, ALWAYS for pyelonephritis
hospitalization possible for pyelo |
|
|
Term
first choice tx for uncomplicated UTI
tx for more complicated pts? |
|
Definition
uncomplicated: co-timoxazole/trimethoprim-sulfamethoxazole /bactrim
complicated: fluoroquinolones (cipro) |
|
|
Term
UTI complications:
1. acute UTI will require delay in ___ surgery
2. untreated cystitis can become ____
3. untreated pyelonephritis or frequent infections can become ____ |
|
Definition
orthopedic
pyelo
kidney damage |
|
|
Term
| prevention of recurrent UTI in young women |
|
Definition
hydrate well
empty bladder before and after intercourse
abx before IC
long term low dose abx |
|
|
Term
anatomical variant in which the ureter inserts on the bladder incorrectly so that urine goes back up into the ureter
can cause frequent UTI in peds |
|
Definition
|
|
Term
supersaturation of urine with insoluble materials/minerals
commmon when urine flow is low, mineral production is high, urine mineral concentration is high |
|
Definition
|
|
Term
| 2 kinds of nephrolithiasis |
|
Definition
nephrocalcinosis
kidney stones |
|
|
Term
uncommon disorder w/ extensive diffuse parenchymal renal calcifications. typically due to inherited metabolic disorders. may be significant enough to cause renal failure
on xray or CT:
- diffuse calcifications throughout both kidneys.
- calcifications in glomeruli instead of calices |
|
Definition
|
|
Term
| urate, cystine, or struvite stones that are too large to pass adn fill up renal pelvis |
|
Definition
|
|
Term
afebrile + colicky pain + hematuria --> think?
complication of this? |
|
Definition
ureteral stone
complication: ureteral occlusion leading to hydronephrosis |
|
|
Term
dilation of renal collecting system due to outflow obstruction
coudl cause renal failure if not relieved
causes: stones, BPH, malignancy |
|
Definition
|
|
Term
|
Definition
supportive - spontaneous passage
- analgesia + IV fluids to enhance flow
ureteroscopic retrieval
surgical removal
lithotripsy -- extracorporeal shock wave lithotripsy to break up the stone |
|
|
Term
most common method of renal and ureteral stone removal
non-invansive but may require sedation and analgesia
is capable of causing renal damage
sends shock waves to break up stones into smaller sizes that can be ecreted |
|
Definition
|
|
Term
|
Definition
hydration + good urine flow
- urate: regulate uric acid (allopurinol)
- calcium: treat hypercalcemia - thiazides |
|
|
Term
Common cause of urge incontinence in both men and women
involves detrusor overactivity - usually idiopathic
- occasionally due to bladder stone or lesion
tx? |
|
Definition
intrinsic bladder dysfunction
txx: cholinergic blockers (antimuscarinic)
or bladder training - voiding every 1-2 hours |
|
|
Term
anatomic urinary incontinence:
- gynecological problem: ____
- loss of normal vesico-urethral angle (prolapsed uterus, cystocele)
- contributing factors: vaginal deliveries, estrogen deficiency, chronic increased intraabdominal pressure (obesity, cough, constipation)
typical pt: >10 years post-menopausal + several vaginal deliveries
often brought on by a cough, laugh, or sneeze
tx? |
|
Definition
stress incontinence
tx: pelvic relaxation (kegels)
- estrogen replacement
- reduced abdominal pressure
- surgery |
|
|
Term
surgeries to correct incontinence:
1. repairs cystocele. good initial response rate, high recurrence
2. suture or sling procedures to keep urethra up |
|
Definition
anterior colporraphy
urethropexy |
|
|
Term
urinary incontinence seen in women > 40 y/o
may be difficult to dx - need urodynamic testing
caused by coughing that causes spasming |
|
Definition
| combined stress and urgency incontinence |
|
|
Term
common cause of urologic referral - more common after age 40
women >> men
uknown cause
bladder cauess pain as it fills, relieved w/ voiding
urgency + frequency
simulates UTI
urge incontinence may be present
cystoscopy: submucosal hemorrahge "glomerulations"
tx? |
|
Definition
interstitial cystitis
tx:often spontaneously resolves
amitriptyline - first line
nifedipine - adjunct
hydrodistention - releive sx
intravesicular instillation for resistent cases |
|
|
Term
most common benign tumor in men
- 50% by age 60
- 80% by age 80
about half are asymptomatic
- somehow related to the androgen Dihydrotestosterone (DHT)
- somehow related to estradiol (obese men have more, and have higher risk)
sx:
- obstructive - decreased force and caliber of sream, hesitancy, sensation of incomplete emptying, double voiding (twice w/in two hours), straining to urinate, post-void dribbling
- irritative - urgency, frequency, nocturnal voiding
main long term concern?
dx?
tx? |
|
Definition
BPH
long term concern: hydronephrosis due to obstruction of flow
dx: sx + enlarged prostate on DRE
+ transrectal ultrasound
tx:
observation - some will improve
, herbs/dietary - saw palmetto
, medical - alpha blockers, 5-alpha reductase inhibitors
, surgical |
|
|
Term
| process of converting androgens to estrogens |
|
Definition
|
|
Term
| BPH is or is not a precancerous condition? |
|
Definition
|
|
Term
| autonomic influences on detrusor vs. bladder sphincter |
|
Definition
detrusor: parasympathetic
- cholinergic drugs: urgency and frequency
- anticholinergic drugs: urinary retention
sphincter: sympathetic
- alpha blockers improve urine flow by relaxing sphincter |
|
|
Term
| what are some alpha blockers used to treat BPH? |
|
Definition
tamsulosin (flowmax)
Prazosin (minipress)
all end in -osin |
|
|
Term
| What are some 5-alpha reductase inhibitors used to treat BPH? |
|
Definition
finasteride (propecia)
dutasteride (avodart)
also used for male pattern baldness |
|
|
Term
|
Definition
transurethral prostatectomy
uses cystoscope w/ resectoscope
75-96% chance of improvement
complications: 0.5-1% risk of death,
- incontinences, impotence, retrograde ejaculation |
|
|
Term
| good alternative for pts wtih significant problems from BPH r who aren't surgical candidates |
|
Definition
|
|
Term
| second leading cause of male cancer deaths behind lung |
|
Definition
|
|
Term
| Two kinds of prostate cancer |
|
Definition
1. isolated malignant foci. stable, controlled, restricted. essentially CIS. may be considered "normal"
2. progressive cancer -capable of local extension and distant metastasis
|
|
|
Term
|
Definition
early stages: none
often sx of BPH
late stages: pain, urinary obstruction |
|
|
Term
prostate ca dx
75% occur in ___ zone of prostate |
|
Definition
DRE
trans-rectal ultrasound w/ needle biopsy
PSA screening
75% in peripheral zone |
|
|
Term
increased levels of PSA are seen in what diseases?
what are the cut off values? |
|
Definition
BPH
Prostate cancer
prostatitis
cut offs:
- Normal <4ng/ml
- moderate: 4.1-10ng/ml - 18-30% chance of cancer
- high: >10 ng/ml - 50-70% chance of cancer |
|
|
Term
|
Definition
radical prostatectomy
- stages T1 & T2
excise prostate, seminal vesicles, vas + sample lymph nodes
radiation
medical: endorine and cytotoxic chemo |
|
|
Term
enocrine tx for prostate cancer
goal?
surgery
medicals tx |
|
Definition
goal: eliminate effects of T and DHT
surgery: bilateral orchiectomy
medical: GnRH agonist (lupron), anti-adrogens, estrogens |
|
|
Term
| ___ can be used as a guide to tell if prostate cancer has returned. However, 20% of cancers don't make this. |
|
Definition
|
|
Term
- often due to smoking or exposure to industrial dyes/solvents
- most have multi-centric origin (multiple lesions) wiht villus-like projections
- most are transitional cell carcinoma
sx:
- hematuria is most commonly presenting symptom
- irritative voiding sx
- pain and masses may be noted with advanced disease
dx?
tx/ |
|
Definition
bladder cancer
dx: cystoscopy w/ biopsy
filling defect on IVP
tx: transurethral resection - early disease
- cystectomy
- chemo - something about bacille calmette guerin
radiation |
|
|
Term
| pt with iron deficiency anemia with no explanation -- think? |
|
Definition
|
|
Term
|
Definition
10 year:
T1-T2: 81-90%
T3: 60-70%
T4: 40-50%
ANY stage w/ pos nodes: 30-35% |
|
|
Term
peak incidence 50-70 y/o
- men:women 2:1
- smoking is cause of 20-30%, obesity is risk factor
- most commonly _____ carcinoma
sx:
- hematuria
- flank pain
- weight loss
- anemia
- palpable mass
dx?
tx? |
|
Definition
renal cancer
renal cell carcinoma
dx: cystoscopy
CT of abdomen and chest
UA
tx: surgery if no distant spread
- radiation, chemo, and immunotherapy not very effective
|
|
|
Term
|
Definition
5 year survival:
stage I & II: 65-70%
Stage III: 42%
- IV: 11% |
|
|
Term
- Peak incidence age 15-40
- 1/3 are ___, 2/3 are ___
- risk factors: cryptorchidism, DES exposure intrauterine
- biochemical markers: HCG, AFP, LDH
sx:
- PAINLESS TESTICULAR MASS
- rarely systemic sx: malaise, weightloss, fever
dx?
tx? |
|
Definition
testicular cancer
1/3 seminoma, 2/3 non-seminoma
dx: ultrasound
tx: unilateral orchiectomy, retroperitoneal lymph node dissection, CT
radiation for seminomas
chemo |
|
|
Term
| Testicular cancer prognosis |
|
Definition
stage 1: 95-98% long term survival
II: 90%
III: 55-80% |
|
|
Term
| 30 y/o male w/ pos home pregnancy test |
|
Definition
| HCG-secreting testicular cancer |
|
|
Term
most common in men >40 y/o
sx: fever, perineal/sacral/suprapubic pain, irritative voiding sx
classic triad: urgency, frequency, dysuria
CBC: leukocytosis w/ left shift
UA: pyuria, bacturia, hematuria
cultures: pos growth from urine and blood
tx?
Caution?
common organisms? |
|
Definition
acute prostatitis
caution: perform DRE very gently. excessive palpation can result in septicemia
organisms: gram neg rods (e. coli, pseudomonas) or gram + cocci (enterococcus)
tx:
- outpt: fluoroquinolones (cipro)
- inpt: IV abx: ampicillin + aminoglycoside (gentamycin) |
|
|
Term
- most common in men 40-60 y/o
sx:
irritative voiding
low bain/perineal pain
NO FEVER
intermittent, recurrent pattern
- usually due to non-specific inflammation, some due to chronic low grade infection
IF bacterial (gram neg rods):
UA and CBC neg
Prostatic secretions: leukocytes + bacteria
tx? |
|
Definition
chronic prostatitis
tx: bactrim from 6-12 weeks
|
|
|
Term
- prostatitis that is non-responsivle to abx
- cultures and prostatic fluid are normal
- do cystoscopy to r/o bladder ca
tx? |
|
Definition
inflammatory prostatitis
- maybe alpha blockers for tx |
|
|
Term
|
Definition
| >3 rbc per high powered field |
|
|
Term
common causes of hematuria
1. dx of exclusion
2. fever, pain, irritative voiding sx. bacteria on UA
3. hematuria + flank pain
4. HTN + hematuria + casts on UA
5. hx of smoking/exposure. labs normal |
|
Definition
1. benign transient hematuria - dx of exclusion
2. infection - UTI or prostatitis
- fever, pain, voiding sx
3. ureteral stone - hematuria + flank pain
4. glomerulonephropathies - nephritic syndrome - need kidney fxn test
5. urologic cancer - labs are normal. hx of exposure/smoking |
|
|
Term
sudden decrease in renal fxn over appx 48 hours
- inability to maintain fluid and electrolyte balance
- inability to excrete nitrogenous waste
___ is most immediately dangerous problem
Signs:
- creatine increase by 0.5 mg/dl if normal pt (no kidney dz) or >1.0 if kidney dz
- Oliguria: urine output <400-500 ml/day
- Hyperkalemia
- metabolic acidosis
Sx:
- nausea, malaise, altered mental status, dyspnea, edema
UA: hematuria, proteinuria, casts
US: hydronephrosis, masses
RAPID RISE IN BUN/CREATININE + OLIGURIA |
|
Definition
acute renal failure
hyperkalemia - most immediate danger |
|
|
Term
A common etiology for acute intrinsic renal failure is:
1. tubulointerstitial disease.
2. diabetic nephropathy.
3. decompensated congestive heart failure.
4. obstructing renal calculi. |
|
Definition
| 1. tubulointerstitial disease |
|
|
Term
cysteine protease inhibitor produced by all nucleated cells and secrete into bloodstream
- freely filtered by kidney, not reabsorbed
- not affected by body habitus, comorbid conditions, or nutritional state
- elevated in kidney injury
- possibly superior to creatinine as GFR proxy
RARELY USED IN CLINICAL PRACTICE |
|
Definition
|
|
Term
Causes of ARF:
1. sudden severe drop in blood pressure (Shock) or interruption of blood flow to the kidneys from severe injury or illness. 55%. Little old lady who has n/v/d and lost fluids so kidneys cant work.
2. direct damage to kidneys by inflammation, toxins, drugs, infection, or reduced blood supply. 40%
3. sudden obstruction of urine flow due to prostate enlargment, kidney stones, bladder tumor, injury. kidneys cant work due to blockage down the line. 5% |
|
Definition
1. prerenal
2. intrarenal
3. postrenal |
|
|
Term
Due to hypoperfusion (dehydration) or hypotension: low BP or poor CO
4 causes:
1. fall in intravascular volume (diarrhea, diuretics, hemorrhage)
2. fall in intravascular resistance (hypotension, shock, sepsis, ACE and ARBs)
3. renal artery vasoconstriction (NSAIDS, radiocontrast)
4. Low CO |
|
Definition
|
|
Term
|
Definition
| loss of fluids into tissue space |
|
|
Term
| common drug cause of prerenal ARF. how could it be fixed? |
|
Definition
|
|
Term
#3 cause of in-hospital ARF
- occurs 24-48 hours after exposure
- prevention is key: give pt with kidney disease IV fluids before doing this |
|
Definition
| contrast induced nephropathy |
|
|
Term
| most common cause of intrinsic renal failure |
|
Definition
|
|
Term
| 4 causes of intrinsic ARF |
|
Definition
vascular causes
glomerular
tubular
interstitial |
|
|
Term
composed of:
- post-strep glomerulonephritis
- IgA nephropathy
- Wegener's
- Antiglomerular basement membrane disease
- autoimmune disease
sx:
hematuria, proteinuria, refractory htn (190/100), systemic diseases, RBC casts |
|
Definition
| acute glomerulonephritis-nephritic dissease |
|
|
Term
a pt is started on abx, NSAIDs, or PPI and 5 days later, their creatinine starts rising and they get a rash.
UA: eosinophils >2%, WBC casts |
|
Definition
| allergic interstitial nephritis |
|
|
Term
#1 cause of ARF requiring dialysis
- most commonly from prolonged hypoperfusion (ischemia)
- also from toxic injury - aminoglycosides, rhabdomyolysis, IV contrast)
UA: creatinine goes up 4 days after giving bactrim
3 phases: initiation, maintenance (pt on dialysis), recovery (overcompensation of kidneys) |
|
Definition
| acute tubular necrosis (ATN) |
|
|
Term
ATN
multiple myeloma
uric acid
all are causes of ___ injuries causing ARF |
|
Definition
|
|
Term
| caused by ureteral occlusion (stones, cancer, fibrosis) or outflow obstruction (BPH, neurogenic bladder, urinary retention meds) |
|
Definition
| obstructive renal failure |
|
|
Term
| What will BUN/Creatinine and UA show in ARF? |
|
Definition
BUN/Creatinine - up
UA:
- sodium, creatinine, urea, eosinophils, sediment, casts, protein |
|
|
Term
| BUN:Creatinine ratio is >20, think ___ |
|
Definition
|
|
Term
| what are some conditions which might have increased and decreased BUN |
|
Definition
increased: intravascular volume depletion (prerenal failure), catabolic states, high protein diets, GI bleed, glucocorticoids, tetracycline
decreased: liver dz, malnutrition, sickle cell, inappropriate ADH secretion |
|
|
Term
| based on FeNa & FeUrea, how can you tell prerenal and intrinsic causes of ARF |
|
Definition
FeNa <1% or FeUrea <35% -- prerenal
FeNa >2% or FeUrea >50% -- intrinsic |
|
|
Term
What do these casts indicate?
1. hyaline
2. granular or renal tubular
3. RBC
3. WBC |
|
Definition
hyaline - prerenal ARF
granular: ATN
RBC: acute glomerulonephritis
WBC: AIN or pyelo |
|
|
Term
| pt with unidentified cause of oliguria. what do you NOT want to give them? |
|
Definition
|
|
Term
| When do you need dialysis for ARF? |
|
Definition
AEIOU:
A: acidosis (bicarb <15)
E: electrolyte abnormalities - hyperkalemia
I: intoxication
O: overload - urine <400cc x 3 days
U: uremia - confusion, asterixis, pericaridal rub |
|
|
Term
evidence of structural or functional kidney abnormalities that persist for at least 3 mos w/ or w/o a decline in GFR
Decreased GFR and proteinuria are both important diagnostic abnormalities |
|
Definition
|
|
Term
| Stages of chronic kidney disease: description and GFR |
|
Definition
1. kidney damage w/ near normal GFR. Polycystic disease. GFR of 90
2. Kideny damage w/ mildly reduced GFR: 60-89
3. Moderately reduced GFR: 30-59
4. severely decreased GFR: 15-29
5. renal failure and dialysis: GFR <15 |
|
|
Term
What is normal GFR?
At what point should medical intervention occur? |
|
Definition
Normal: 90-100
intervention at 30-59 (moderate delcine)
GFR is a good indication of renal function. If you have a GFR of 20, your kidneys are functioning at about 20% |
|
|
Term
MDRD
in what populations is this an over- or under- estimation? |
|
Definition
estimation of GFR
good for stable renal function. not good for ARF
increased GFR = increased renal function, decreased = decreased
overestimation: elderly, malnourished, liver disease
under: normal renal fxn, large muscle mass |
|
|
Term
| most common causes of ESRD |
|
Definition
diabetes
HTN
glomerulonephritis
cystic disease |
|
|
Term
most common cause of ESRD
- proteinuria (albuminuria) - increases as kidney function decreasesdo
- usually accompanied by retinopathy
- needs close monitoring of BP |
|
Definition
|
|
Term
| complications of Chronic kidney disease |
|
Definition
mineral bone disorder - renal osteodystrophy
anemia
HTN
increased cardio events
electrolyte abnormalities
metaoblic acidosis
endocrine abnormalities |
|
|
Term
changes in bone mineral metabolism and structure that occur when GFR < 30%
high phosphorous --> low ca --> elevated parathyroid hormone --> secondary hyperparathyroidism
decreased Vit D production
tx? |
|
Definition
renal osteodystrophy
tx:
keep Ca x Phos <55
phosphorous restriction
phosphorous binders w/ meals
- Vit D precursor
- Vit D analog
- Calcimimetics |
|
|
Term
GFR < 30
normochromic, normocytic anemia
usually iron deficient, need IV iron replacement
Erythropoeitin deficiency: goal is to prevent transfusion |
|
Definition
| anemia of chronic kidney disease |
|
|
Term
| what are some endocrine changes that happen with ESRD? |
|
Definition
men: lowered testosterone
diminished libido, ED
women: lowered estrogen, relative infertility, increased spontaneous abortion
pregnancy: toxemia, worsened renal disease |
|
|
Term
| methods to slow progression of CKD |
|
Definition
treat underlying condition
- ace/arb if proteinuria
- avoid NSAIDs, bactrim, cimetidine
- BP control
- treat metabolic acidosis and high lipids
- smoking cessation
- limit protein intake <0.8 mg/kg/day
- nephrologist when GFR <60% |
|
|
Term
| when is dialysis requried for esrd? |
|
Definition
GFR <15 and/or:
uremic sx (fatigue, malaise, sob, anorexia)
volume overload
refractory hyperkalemia |
|
|
Term
| at what GFR is a person a candidate for kidney replacement |
|
Definition
|
|
Term
1. proliferative glomerulonephritis
- crescentic glomerulonephritis and rapid proliferative glomerulonephritis
- more acute, more aggressive
- moon-shaped crescent on glomerulus
2. membranous glomerulonephritis
- minimal change disease
- focal segmental glomerulosclerosis
3. membranoproliferative glomerulonephritis |
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Definition
1. nephritis syndrome
2. nephrotic syndrome
3. combined syndrome |
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Term
membranous glomerulonephritis
signs:
- proteinuria > 3g/day
- hypoalbuminemia
- edema - due to third spaceing
- hyperlipidemia
- lipiduria
primary: minimal change disease
Secondary: due to systemic illness |
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Definition
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Term
#1 cause of glomerular disease in kids
cause is unknown
- overall prognosis is excellent
- can be induced by NSAIDS
- renal biopsy: normal
sx: proteinuria
tx? |
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Definition
minimal change disease (nephrotic syndrome)
tx: steroids, ACEI/ARB |
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Term
#1 cuase of nephrotic disease in adults
- immune complex deposits in basement membrane
- usually primary (idiopathic)
- secondary - cancer
tx with ACEI in mild disease and steroids in severe
if pt has this -- make sure they get screened for cancer
if pt has cancer + proteinuria --> think this |
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Definition
| membranous nephrotic syndrome |
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Term
#2 cause of nephrotic syndrome in adults
- primary is idiopathic
- secondary: HIV, Obesity
- tx: steroids |
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Definition
| focal segmental glomeruloscerlosis (FSGS) |
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Term
| ___ is by far the most common cause of nephrotic syndrome |
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Definition
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Term
| nephritic syndrome: PHARAOH signs and symptoms |
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Definition
Proteinuria/edema
Hematuria
Azotemia (elevated BUN)
Red blood cell casts
Anti-strep titers
Oligouria
Hypertension (refractory)
RBC casts + proteinuria + refractory HTN --> think nephritic syndrome |
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Term
renal failure developing over a few days or a few weeks
- results from immunologic dysfunction such as anti-gbm antibodies, anca (anti-neutrophil cytoplasmic antibodies), IgA nephropathy
classic example: post-strep glomerulonephritis
- common in kids |
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Definition
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Term
typically occurs 10-14 days after beta hemolytic strep infection (pharyngitis or impetigo)
- most common in kids 2-6
sx: malaise, nausea, vomiting, HA, back pain
nephritic syndrome: hematuria, htn, some proteinuria, edema |
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Definition
poststreptococcal glomerulonephritis
tx: eradicate strep (abx), supportive care, recovery in 6-8 weeks
20% chance of reduced GFR in adults |
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Term
acute nephritic syndromes:
1. most common cause worldwide. common in asians. flu-like sx + hematuria
2. pulmonary hemorrhage, rapid progressive GN and + anti-GBM antibodies. hemoptysis + blood in urine. tx is plasma exchange
3. ANCA +, wegener's. lung problems + renal problems
4. associated wtih hep C
5. can havve nephrotic and nephritic properties |
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Definition
1. IgA nephropathy
2. anti-glomerular basement membrane diseas (goodpasture's syndrome)
3. vascultitis
4. cryoglobulinemia
5. membranoproliferatie GN |
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Term
| general treatment principles for nephritic and nephrotic syndromes |
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Definition
1. reduce proteinuria - ACE/ ARB/ NSAIDs
2. Restrict sodium 1-2 g/day, loop or thiazides to maintain urine output
3. low protein diet
4. vit d supplement
5. statins for hyperlipidemia |
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Term
| 3 tubular and tubulointerstitial disorders |
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Definition
cystic
acute tubulointerstitial nephritis
chronic tubulointerstitial nephritis |
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Term
1. account for 65-70% of all renal masses, are benign and require no tx unless cyst is complex. common with age.
2. increased # of cysts in CKD/ESRD pts. 2-7% develop in renal cell cancer |
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Definition
1. solitary cysts
2. acquired cystic disease |
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Term
- accounts for 4-5% of all end-stage renal disease in the US
- slowly progressive - as cysts grow, they take up more space and the kidneys can't work
- screen family members in their 2nd-3rd decade - cysts probably won't be big enough to pick up before then
- associated with cerebral aneurysms and hepatic cysts
- most commonly presents in 3rd and 4th decades with FLANK PAIN/BACK PAIN AND RENAL FAILURE OR HTN OR HEMATURIA
tx |
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Definition
autosomal dominant polycystic kidenys disease
hxof polycystic kidney + fam hx of cerebral aneurysm --> get MRI at age 30
tx: ACE inhibitors to preserve renal fxn
treat pain
quinolones for cyst infection
screen for cerebral aneurysm |
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Term
| acute renal failure due to drug reactions (abx, nsaids, ppis, diuretics) -- most common, systemic infections, or idiopathic |
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Definition
acute tubulointerstitial nephritis
tx: steroids |
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Term
| chronic decline in renal function due to obstruction, NSAIDs, heavy metals, or sarcoidosis |
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Definition
| chronic tubulointerstitial nephritis |
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Term
| What are some things that IVP are used to diagnose? |
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Definition
UTI
kidney stone
bladder stone
enlarged prostate
kidney cyst
tumor
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|
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Term
| indicated in screening of fetal deformities as a marker for some cancers including renal cell carcinoma and used to follow the cancers displaying the marker |
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Definition
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Term
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Definition
sympathetic ns
R-A-A system
baroreceptors |
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Term
ECF volume contraction is AKA ____
manifest as decreased plasma volume and hypotension/tachy
causes? |
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Definition
dehydration
caues: diarrhea, hyperthermia, vomiting, burns, alcoholism, malnutrition,
electrolyte imbalances: Hypo/hypernatremia! |
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Term
ECF volume expansion often coexists and causes ____
causes: water retention due to what? |
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Definition
hypertension
water retention:
- CHF
- high sodium
- cirrhosis
- nephrotic syndrome
- corticosteroids
- hyperaldosterone
- low protein
- hypertonic fluids |
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Term
causes of hypocalcemia
what two signs are associated with this? |
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Definition
alcoholism, breast fed infants, low sunlight, malabsorption, acute pancreatitis, PTH levels, diuretics
trousseau's sign: wrist and thumb drop when inflate BP cuff Chvostek's sign: tapping facial nerve causes twitch
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Term
What dx?
risk factors: smoking, obesity
Sx: hematuria, flank pain, weight loss, anemia
HEMATURIA MAY BE ONLY SX
Dx?
TX? |
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Definition
Renal Cancer
dx: CT w/ contrast
tx: refer to nephrology for radical nephrectomy |
|
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Term
| what is the best tx for renal cancer? |
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Definition
|
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Term
| What is the gold standard diagnostic study for polycystic kidney disease? |
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Definition
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Term
flank and back pain + pos family hx of aneurysm
dx with CT and US
UA: normal or hematuria
normal GFR
dx?
tx?
Long term complications? |
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Definition
polycystic kidney disease
50% develop ESRD by 60
tx: ACEI
treat cyst infection
low caffeine, good hydration, low salt
transplant
monitor for cerebral aneurysm |
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Term
| sudden increase in BUN/Cr + sudden decrease in urine production in CHF pt |
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Definition
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Term
| most common cause of increased creatinine? |
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Definition
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