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PANRE > nephrology and urology > Flashcards

nephrology and urology Flashcards

1
Q

most active secretion happens in the

A

distal convulted tubel

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2
Q

most reabsorption occurs at the

A

proximal tubule

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3
Q

early proximal convulted tuble

A

tubular reabsoprtion

acetazolamide and mannitol are diuretics that work on this

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4
Q

loop of hnle

A

thin descending loop of henre- passively absorbs H20, but does not let sodium and solutes through

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5
Q

THICK ASCENDING limb of loop of henley

A 
impereable to h20 but allows na, k , cl via na/k/2cl trasportor
reabsortpi on of magnesium and calciumloop diuretics work on this!!! ---STRONGEST class of diuretics!!
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6
Q

s.e of loop diuretics

A

hypocalcemia, hypomag, hypokalemia!!

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7
Q

thiazides

A

more likely to cause hyponatremia

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8
Q

early distal convuluted tuble

A

tubular SECRETION MAIN JOB!!- dilutes the urine!!
parathyroid hormone acts on the distal tuble to increase calcium reabsorption!!
THIazides also work on this- causing hyponatremia.

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9
Q

distal collecting tubule

A

determines the final oslmoalarity of urine (via aldosterone and ADH)

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10
Q

potassium sparing diuretics

A

associated with hyperkalemia and metabolic acidosis

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11
Q

hyperaldosteronism

A

associated with hypokalemia

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12
Q

ADH

A

peremable to H20 only in the presense of ADHD
present of ADH—> concentrated urine
ADH absence::: dilute urine

increased adh: production of a concentrated urine during times of hypoveolemia, hyperosmolarity and RAAS activation

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13
Q

nephrotic syndrome

A

proteinuria, hypoalmbuinemia, hyperlipidemia and EDEMA

glomerular damage causes tubular protein loss into the urine, urine loss of albumin ases hypoalbumin—which causes hyperlipideamia as liver makes more protein!! including lipoprotein

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14
Q

minimal change disease (nephrotic)

A

80% of nephrotic syndrome in children
podcyte damage seen on electron microscope- loss/fusion/diffuse effacement of the foot process
loss of negative charge
PREdENISON

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15
Q

focal segemental glomerucslerosis(nephrotic)

A

HTN- african american- heroin abuse

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16
Q

membranous nephropathy (nephrotic)

A

thickened glomerular basement membrane!!- idiotpathic!- caucsian male

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17
Q

secondary causes (nephrotic)

A

mc diabetes - for adults

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18
Q

nephoritc syndrome

A

edema, peripheral, periorital edeam, worse in morning, scorotal edema, DVT!!!
more than 3.5 g/day of urine is nephrotic syndrome
proteinuria, oval fat bodies, maltese cross shaped, hypoalbuminemia, hyperlipidemia

tx: direetics for edema, ACEI or ARBS for proteinuria

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19
Q

acute glomerulonephitis

A

htn, mehamturia, rbc casts, dependent enemia, azotemia
iga nephropathy- mc cause of agn in adults worldwide- igA mesangial deopsoits

post infectious: MC AFTER GABHS!!!!!cola clored/dark urine!!
increased antistreptolysis tigers, low serum complement

rapidly progressive glomerulephritis: goodpastuerus disease: anti gbm antibodies, kidney failure and hemoptysis- antibodies to glomerular basement membrae of kidney and lung alveoli
corticosteroids and cyclophosphamide

vasculitis: microscopic polyangitis- vasciulitis of small renal vessel: +p-anca

wegner’s: +c-anca: granulomatosis with polyangitis- necrotizing vasculitis!!!

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20
Q

acute glomerulonephritis

A

hematuria, peripheral, periorbital edema, cola colored/dark urine, oliguria, RBC cast,
DO RENAL BIOPSY!!
loss of protein and RBC loss!!

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21
Q

acute kidney injury

A

increased serum creatinine or BUN

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22
Q

prerenal

A

reduced renal perfusion- hypovoleia, MC type of AKI!!!
leads to intrinsic ATN if not orrected
volume repletion is tx

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23
Q

post renal

A

obstruction

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24
Q

intrinsic

A

direct kidney damage: nephrotoxic, cytotoxic, prolonged ischemia- cellular CAST formation!!
ischemic: prolonged prenrenal, hyoptension, hypovolemia
nephrotoxx: aminolycosdes, contrast dye, cyclosoproine- ATN MC type of intrinsic!!
epitehlia cell casts and muddy brown casts
remove offending agents, iv fluids

25
Q

acute tubulointestial nephritis (intrinsic damage to kidney)

A

inflammatory or allergic response- penicillins, NSAIDS, SULFA, cephalosporin, cipro, autoimmune,
fever, eosinophilia, WBC CASTS ARE pathognomonic!!! increased serum IGE for allerGEEE
remove offending agents

26
Q

urinary pattery

A

muddy brown or epithelial casts: acute tubular necoriss
rbc casts: acute glomerulphenritis
fatty casts: nephroti syndrome
hyaline cats: nonspecific (may be normla)

27
Q

prerenal

A

fena less than 1%, decreased urine NA- it keeps all the sodium!!
high specific gravity- increased urine osmolarity
bun and cr ore tha n20:1

28
Q

ATN

A

increased urine NA, FENA more than 2%- releases all the sodium out in the urine.! kidney is damaged and can’t really reabsorpt solutes

29
Q

adult polycystic kideny disease

A

autosomal dominant
kidney cysts and cysts in other organs
can lead to ESRD over time
abd flank pain, palpable flank mass, htn, hematuriaRENAL ULTRASOUND!!!
simple cysts: ace and observation
multiple: increase fluid intake- control htn

30
Q

chronic kidney disease

A 
gfr less than 15 is ESRD
dm is most common cause
htn 2nd mc cause of esrd
spot uablumin/ucreativene ration
24/hour urine coloection
broad waxy casts
small kidneys classic!!
bp goal less than 140/90
31
Q

siadh

A

posterior pitutary secrets ADH!!!- free water retention- adh is increased from pitutary or ectopic source

MC: STROKE, head trauma, cns tumors!!!
pulm: SMALL cell lung cancer
hypotnatremia!!
h20 restriction!!! cuz everytime u drink water- it gets retained otherwise!!
severe hyponatremia or intracranial bleed: iv hypertonic saline with furosemide

32
Q

DIABETES INSIPIDUS

A

ADH (vasopressin deficiency) central DI or insensitive to ADH due to kidney problems!!

central DI mc type
nephrogenic: lithium!!

polyuria, polydipsia, ncturia!!, hypernatremia!
fluid deprivation test!!!- continues to produce dilute urine which is abnormal!
adh stimulations tests: differentiates nephro from central DI
if its nephro: continued production of dilute urine which is abnormal!!

central dI: replace adh- desmopressin!!
nephrogenic di: hydrochlorithiazide, na/protein restriction!

33
Q

hyponatremia!!!

A

hypotonic hyponatremia is TRUE hyponatreia

if its normal serum osmlarity and hyopnatremia: lab error- increased protein and increased triglycerides

if its high serum osmolarity and hyponatremia: hyperglyemia and mannitol

in the true hypotnonic hyponatremia!!:
- hypovoleia- thiazides, extra renal loss like bleed, burns, n/vdiarrhea- correct with normal saline

isovolemia: SIADH, post op- WATER RESTRICTION!!
hypervolemic: chf, cirrhosis, nephrosis,–h20/salt restriction!!

34
Q

hyponatremia

A

can cause cns dysunction to cerebral edema- ams, vomiting, muscle cramps,siezures, coma

35
Q

hypernatremia

A

shrinkage of brain cells: cns dynsfucntion- seizures, coma, muscle waekness

hypovolemic: sweating, resp loss, gi loss, dehydration, severe hyperglycemia, osmotic diurectics
isoovelmica: diabetes inspidus
hypervolemic: mineralocorticoid excess

36
Q

hypomag

A

malabsopriton, ETOHics!! proton pump inhibitors!

increased DTR, tetany, arrhythmias palpiations
prolonged PR and QT interval!!- can lead to torsades!!
mild: magensium oxide (ORAL)
severe: iv mag sulfate!!

(hypocalcemia and hypokalemia associated with hypo mag will need to be treated first)

37
Q

hypermag

A

mg intake, renal insufficiency!!, acute or chronic renal failure

decreased DTR

respiratory depression!!!

mild: iv fluids and foresemide- leads to hypomag
severe: calcium gluconate!!- stabilizes cardiac membrane

38
Q

hypokaelmia

A

mc: diuretic tehrapy!!, vomiting , diarrhea, metabolic alkalosis

severe muscle weakness, decreased DTR

prominent U waves, t wave flattening first

give potassium, kcl oral , hypokalemia increases risk of digoxin tox

39
Q

hyperkalemia

A

t wave is tall!!
acute or chornic renal failure, ace/arbs/beta blockers, k sparing diuretics!
pseudohyperkalemia- venipuncture mc

weakness, flaccid paralysis,

iv calcium gluconate - stabilizes cardiac membrane
insuline
kayexlate!

40
Q

epidiymitis and orchitis

A

men less than 35: chlamydia
men more than 35 and childrren: Ecoli most common
viral: mumps

postiive phren’s sign: elevation of scorotum relieves pain
positive remasteric refeex: testicle elevates after stroking inner thigh!!

pyruia, bacteriuria

DOXY plus ceftraixone for less than 35
flouroquinoes for e.coli - for children: ephalexin or amoxcillin

41
Q

cryptorchidism

A

orchiopexy recommended at 6 months- performed before 1y ears old.
observation only if less than 6 months of age!!- most descend by 3 months!

42
Q

testicular cancer

A

15-40 year old- mc solid tumor!!
MC RIGHT SIDED!!!!- because cryptorchidism mostly coccurs on the right side
seminoma!!!!- most common!= sesntiive to radiation, simple, slower growing , stepwise spread
non seminomas- more aggressive- associated with increased alpha fetoprotein, increased beta hcg
scrotal ultrasound!!

43
Q

hydrocele

A

cystic testicular fluid collection- painless scrtoal swelling- most common
transillumination

44
Q

vacicocele

A

testicular mass of vacicose veins- pampiniform venous plexus and internal spermatic veins
MC on the LEFT side!!!
bag of warms- can cause inferitility
dilation worsens when patient is upright or valsalva

45
Q

cystitis

A

rare for males to have UTI!!!
women: intercourse-honeymoon cystitis, spermidcidal use!

e coli- most common cause for complicated and uncomplicated
pyelo; +cva tenderness , back/flank pain, nausea vomiting- pyuria.
IF WBC casts- pyelo
urine culture= DEFINITIVE DIAGNOSIS!!!- needs clean catch specimen if epithelia- contaminated

uncomp cystitis: nitrofurantoin, cipro, bactrim

complicated: flouro IV or po, aminoglycosides
pregnant: amoxicilin or nitrofurontoin
pyelo: cipro Po or IV, aminoglycosides!!!

46
Q

prostatis

A

e coli: more than 35 years old
less than 35 years old: chamlydia and gonorrhea

e.coli!!!!- in chronic prosttius
fever, chills, frequency, urgency, PErinela pain in acute prostatius
acute pro: tender, normal or hot , boggy prostate
chronic: non tender, bogg prostate

no prostatic massage in acute prostatitsi

acute prost : cipro or bactrim
less than 35: ceftriaxone plus doxy

chronic prostitis: bactrim X 6-12 weeks!!! resection (TURP) for refractory

47
Q

bph

A

prostate hyperplasia - bladder outlet obstruction, increased dihydrotestoestoner production
UNIFORMLY , ENLARGED< FIRM, RUBBEry prostate!!!
5alpha reductase inhibitors: finasteride- androgen inhibitor- inhibits coversion of testosterone to dihydrotestosterone- psitive effect on clinic course

alpha blockers: tamsulosin MOST urosselective- provides rapid symptom relief!!
surgery!- TURP

48
Q

prostate cancer

A

adenocarcinoma
HIGH INCIDENCE OF METS TO BONE- back pain/bone pain!!, uretrhal obstruction!- HARD, NODULAR, eNLARGED ASSYMETRICAL!!! prostate: increased PSA!!! ultrasound with needle biopsy!!!

49
Q

bladder cancer

A 
TRANSITIONAL CELL - most common!!!
smoking MC risk factor
cyclophasphamide and pioglitazone!!
cystoscopy with biopsy
painless gross of microscopic hematuria
50
Q

renal cell carincoma

A

smoking, dialysis, htn

flank pain, hematuria, palpable mass, left sided varicocle!!

51
Q

wilm’s tumor

A

nephroblsatoma mc in children- 1-5 th year!!
painless, palpable abd mass , heamturia, anemia
abd ultrasound

52
Q

nephrolithiassis

A

calcium oxalate MC!!
struvite- infection- proteus, kelbsiella- staghorn calciuli)

renal coliv, CVAT, hematuria, groin apain

non contrast CT ABD/pelvis- !!!!!! NON CONTRAST!!!!
only CALCIUM AND STRUVITE will show up on radiographs, not URIC acid stones!!

iv fluids, analgsic, antimetics, TAMUSOLOSIN!!- FOR STONES LESS THAN 5 mm in diamenter
FOR MORe than 7 mmg- extracorproean shock way lithrtripsy, stet

53
Q

erectile dysunfciton

A

phosphodiesterase 5 inhibitors: sildenafil- increased nitric oxide level, cyclic GMP- maintain errction longer- dont use with nitrates!!

54
Q

priapism

A

decreased venous outflow- MC! or increased arterial inflow
sickle cell disease- common in it!!
phenylephrine- 1st line!!!

55
Q

URETHRITIS

A

urethral discharge or pruritis: CHAMydIA most common!!, or gonorrehea!!
neonatal: gonorreha if 2-5 days, chlamydai if 5-7

56
Q

renovascular htn

A

htn!!!!!- ATHEROSCLEROSIS!!
abdominal BRUITS!!!
renal arteriorgraphy!!

57
Q

stress inconvitnenceq

A

urine leaks cuz of increased intraabdominal pressure!!- pregnancy, childbirt, surgery, estroge loss, postmenopasual
sneeze, cough, laughing- urine leaks
pevilc floor exercise: kegel exercise,

58
Q

urge incontinence

A 
URGE to pee!!!
detrusor muscle overactivity!!
OVERACTIVE BLADADER!!!
= bladder training first, or anticholitergics like oxybutynin- blocks cholinergic receptors
or TCA!!!- have antichol efects
59
Q

overflow incontinence

A

urinary REtentions DUE TO
UNDER ACTIVE BLADDEr
most commoly due to BLADDER ATONY!!!
intermittent or indwelilng catheteriziation!!!
even Bph can cause this!!
for bpha: tamsulosin
for bladder atony: cholinergics: bethancol!

PANRE (18 decks)

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