which enzyme is responsible for regulating blood pressure in the kidney?
renin
which kidney is lower?
right
which PMHx are common in the renal patient?
lupus
DM
hypertension
what are associated ROS for renal dz?
general: fever, wt loss, fatigue CV - dypnes, chest pain, edema GI - anorexia, NV cramps GU - polyuria, dysuria, hematuria Skin - rash, puritis
what does deep breathing suggest
metabolic acidosis
what are red flag symptoms of urinary frequency
fever
back pain
lower extremity weakness
what are red flag symptoms of dysuria?
fever flank pain recent instrumentation immunocompromised recurrence
what is involuntary bed wetting after age 5
nocturnal enuresis
what are the three types of urinary incontinence
inability to hold urine due to:
overflow
stress
urge
what are the red flags of polyuria?
abrupt onset night sweats cough weight loss psychiatric disorder
what is oliguria?
decreased urine output
anuria is?
urine output
microscopic hematuria should be investigated when
then presence of any RBCs >1
when painless urination is seen - what should be considered?
tumors of bladder, kidney, prostate - until proven otherwise
what are red flags in regards to hematuria?
gross hematuria
persistant microscopic in elderly
hypertension
edema
what is the most common cause of renal colic and what are red flag symptoms?
most often caused by passage of renal calculi
red flags:
fever
oliguria
anuria
what is commonly used for STI testing
NAAT PCR
which bacterial UTI is common in kiddos?
kelbsiella enterobacter
what host defenses reside in the uroepithelium and renal tubules?
tamm-horsfall glycoproteins
- IgA local antibodies also exist in the uroepithelium
in regards to urethritis, which organisms are responsible?
Gonococcal urethritis - 50% cases, yellow green d/c
NGU - non gonococcal urethritis - most are Chlamydia, whitish-mucoid d/c
- urgency, frequency, tingling with urination
what is a good ddx for recurrent UTI
bladder cancer
DM
prostate obstruction
what is unique to cystitis?
NO FEVER
- usually asx in kiddos and elderly
- run a UA
patient ptc with history of LUT infection, quickly have acquired chills, fever and tachycardia.. what condition is this and what is expected on lab work?
Acute Pyelonephritis
CBC - elevated WBC w left shift
UA - WBCs, pos LE, nitrites
** if protein is present on UA sign of nephron destruction
what are glitter cells and what do they represent?
PMNs with cytoplasmic granules in state of Brownian motion
seen in acute pyelonephritis
what is a common complication of acute pyelonephritis
renal abscess
what is key in regards to chronic pyelonephritis
can take over 20 years to develop
usually asymptomatic
Decreased SG is seen sometimes on UA
Image with KUB (kidney ureter bladder X-ray)
how is a definitive dx for glomerular disorder discovered?
renal biopsy
what is the classic presentation of nephritic syndromes?
PHAROH proteinuria hematuria azotemia RBC casts oliguria HTN
what is the most common cause of post-infectious glomerulonephritis?
group A beta hemolytic strep
- coca cola colored urine.
if untreated could lead to nephrotic syndrome, acute kidney injury, htn encephalopathy
what are the 3 rapidly progressive glomerulonephritis conditions and what concomitant symptoms distinguish them?
goodpasture’s syndrome - pulmonary hemorrhage
henoch-schonlein purpura - skin lesions
wegener’s granulomatosis (ANCA -assocaited)
what is the most common cause of glomerulonephritis worldwide?
BERGER’S DZ
- IgA nephropathy,
nephrotic syndromes present with?
severe proteinuria
- foamy urine
DDX with other illnesses that present with edema
CHF, liver failure, PN, malignant HTN
what is the most common cause of nephrotic syndrome and ESRD (end stage renal disease) in the US? what is commonly seen on lab work?
diabetic nephropathy
microalbuminuria 30-300 mg/d which progresses to proteinuria
what is a common sequelae of acute tubular necrosis (ATN)
acute renal failure
UA - proteinuria, hematuria, RTE and RTE casts
what’s important about acute tubointerstitial nephritis
acute onset of dec renal function
UA reveals NO bacteria, eosinophiluria often present
what are the 4 common causes of chronic tubulointerstitial nephritis
obstructive uropathy
reflux nephropathy
analgesic nephropathy (sloughed papillae in urine)
lead nephropathy
fanconi syndrome presents with ___ in adults or ____ in kiddos
osteomalacia in adults
hypophosphatemic rickets in kiddos
polyuria and polydipsia make you think DM
what is the classic triad of renal cell carcinoma?
gross hematuria
flank pain
palpable abd mass
what should be suspected in patients presenting with unexplained hematuria?
BLADDER CANCER