Term
rapid decline in renal function with an increase in serum creatinine (relative increase of 50% or an absolute increase of 0.5 to 1.0 mg/dL)
Characterized by azotemia - elevated BUN and Cr |
|
Definition
|
|
Term
|
Definition
prerenal - decrease in renal blood flow
intrinsic - damage to renal parenchyma
postrenal - urinary tract obstruction |
|
|
Term
| other causes of elevated BUN (3) |
|
Definition
catabolic drugs (steroids)
GI/soft tissue bleeding
dietary protein intake |
|
|
Term
| other causes of incraesed Cr (2) |
|
Definition
increased muscle breakdown
various drugs |
|
|
Term
|
Definition
| infection followed by cardiorespiratory complications |
|
|
Term
|
Definition
|
|
Term
| what do you need to monitor in a pt with ARF? (6) |
|
Definition
daily weight
I&Os
BP
serum electrolytes
watch Hb and Hct for anemia
watch for infection |
|
|
Term
| differentiating pre-renal, intrinsic, and post renal |
|
Definition
pre - signs of volume depletion and CHF
intrinsic - signs of allergyc reaction (rash)
post - suprapubic mass, BPH, bladder dysfunction |
|
|
Term
| lab findings in prerenal failure (2) |
|
Definition
oliguria - always found
increased BUN:Cr ratio > 20:1
increased urine osmolality
decreased urine Na+
increased urine/plasma Cr ratio (>40:1)
bland urine sediment |
|
|
Term
| causes of intrinsic renal failure |
|
Definition
ATN
glomerular disaese (GN) - Goodpasteur's, Wegener;s, poststrep, lupus)
vascular disease - renal artery occlusion, TTP, HUS
interstitial disease - allergic interstitial nephritis |
|
|
Term
| lab findings in intrinsic renal failure |
|
Definition
decreased BUN:Cr ration (<20:1)
increased urine Na+
decreased urine osmolality
decreased urine-plsma Cr ratio (<20:1) |
|
|
Term
| 3 basic tests for post renal failure |
|
Definition
PE - palpate the bladder
ultrasound - look for obstruction, hydronephrosis
catheter - look for urine |
|
|
Term
|
Definition
|
|
Term
|
Definition
| oliguria, diuretic, recovery |
|
|
Term
| tests to obtain in a pt with ARF |
|
Definition
UA
urine chemistry
serum electrolytes
bladder cath
renal ultrasound |
|
|
Term
|
Definition
|
|
Term
|
Definition
| renal parenchymal inflammation (pyelonephritis or interstitial nephritis) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| 3-4+ protein and blood indicate |
|
Definition
|
|
Term
|
Definition
ECF volume expansion and resulting pulmonary edema
hyperkalemia
metabolic acidosis
hypocalcemia
hyponatremia
hyperphosphatemia
uremia - build up of toxic end products
infection - pneumonia, URI, wound infection, sepsis |
|
|
Term
|
Definition
avoid meds that decrease renal blood flow
adjust meds to renal dosing
correct fluid imabalance
correct electrolyte disturbances
optimize cardiac output
order dialysis if symptomatic uremia, intractable acidemia, hyperkalemia, or volume overlead |
|
|
Term
|
Definition
|
|
Term
| mild vs moderate vs severe vs end stage CRF |
|
Definition
mild = GFR of 70-120
moderate = GFR of 30-70
severe = GFR of <30mL/min
ESRD = GFR < 10mL/min |
|
|
Term
| most common clinical measure of GFR |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| signs and symptoms associated with accumulation of nitrogenous wastes. BUN > 60mg/dL |
|
|
Term
|
Definition
|
|
Term
| GI sxs associated with CRF are most likely due to |
|
Definition
|
|
Term
| neurologic sxs associated with CRF (8) |
|
Definition
lethary
somnolence
confusion
peripheral neuropathy
uremic seizures
weakness
asterixis
hyperreflexia |
|
|
Term
| how does anemia of chronic disease look on blood smear? |
|
Definition
| normocytic normochromic anemia |
|
|
Term
| endocrine/metabolic disturbances associated with CRF |
|
Definition
hyperphosphatemia
hypocalcemia
renal osteodystrophy
calciphylaxis (vascular calfications tha tmay result in necrotic skin lesions) |
|
|
Term
|
Definition
diet - low protein, low salt
ACEI
BP control
Glycemia control
correction of electrolyte abnormalities
aenima
pulmonary edema
pruritis
dialysis |
|
|
Term
| 2 major methods of dialysis |
|
Definition
hemodialysis
peritoneal dialysis |
|
|
Term
| absolute indications for dialysis - AEIOU |
|
Definition
acidosis - significant and intractable
electrolytes - severe hyperkalemia
intoxications - methanol, ethylene glycol, lithium, aspirin
overload - hypervolemia
uremia - severe based on clinical presentation |
|
|
Term
|
Definition
nausea and vomiting
lethary
deterioration in mental status
encephalopathy
seizures
pericarditis |
|
|
Term
| definition of proteinuria |
|
Definition
|
|
Term
| classifications of proteinuria |
|
Definition
glomerular - may be seen in GN and lead to nephrotic syndrome
tubular - sickle cell, urinary tract obstruction, interstitial nephritis
overflow proteinuria - bence jones proteins of MM
UTI, fever, heavy exertion/stress, CHF, pregnancy, orthostatic proteinuria |
|
|
Term
| keys to nephrotic syndrome (6) |
|
Definition
urine protein excretion > 3.5g/24 hrs
hypoalbuminemia
edema - pedal to periorbital
hyperlipidemia, lipiduria
hypercoagulable state
increased incidence of infection |
|
|
Term
| causes of nephrotic syndrome |
|
Definition
primary glomerular disease
systemic disease - DM, collagen vascular disease, SLE, RA, HSP, PAN, etc
Amyloidosis, cryoglobulinemia
drugs/toxins - captopril, heroin, heavy metals, NSAIDs, penicillamine
infection - bacterial, viral, protazoal
MM
malignant HTN
transplant rejection |
|
|
Term
| causes of glomerular nephrotic syndrome |
|
Definition
membranous nephropathy - MC in adults
FSGS
membranoproliferative
minimal change disease - MC in kids |
|
|
Term
| early sign of diabetic nephropathy |
|
Definition
|
|
Term
| tx of symptomatic proteinuria |
|
Definition
treat underlying disease
ACEI
diuretics - if edema is present
limit dietary protein
treat hypercholesterolemia
vaccinate against influenza and pneumococus |
|
|
Term
|
Definition
| > 3 erythrocytes/HPF on UA |
|
|
Term
| gross, painless hematuria is a sign of what until proven otherwise |
|
Definition
|
|
Term
| MCC of glomerular hematuria |
|
Definition
| IgA nephropathy (Berger's disease) |
|
|
Term
| hematuria, pyuria, proteinuria, high frequency hearing loss with out deafness, progressive renal failure |
|
Definition
| hereditary nephritis - Alport's syndrome |
|
|
Term
| secondary glomerular disorders (12) |
|
Definition
diabetic nephropathy
hypertensive nephropathy
lupus
membranoproliferative glomerulonephritis
poststrep GN
Good Pasteurs
Dysproteinemias
sickle cell nephropathy
HIV nephropathy
glomerulonephritis in endocarditis
Wegener's granulomatosis
PAN |
|
|
Term
| glomerular disorders associated with Hep C, Hep B, syphilis, and lupus |
|
Definition
|
|
Term
| glomerular disorder associated with URI |
|
Definition
poststreptococcal
features = hematuria, edema, HTN, low complement levels, and proteinuria. antistreptolysin O may be elevated. |
|
|
Term
| classic triad of proliferative GN |
|
Definition
crescenteric
pulmonary hemorrhage
IgG anti-glomerular basement membrane antibody. |
|
|
Term
| clinical features of Goodpasteur's Syndrome |
|
Definition
| fever, myalgia, rapidly progressive renal failure, hemoptysis, cough, dyspnea |
|
|
Term
|
Definition
| improvement seen with prednisone, ACEI, and antiretroviral therapy |
|
|
Term
| causes of acute interstitial nephritis (AIN) |
|
Definition
acute allergic reaction to meds (MC)
infeciton
collagen vascular disease (sarcoidosis) |
|
|
Term
| classic findings of acute interstitial nephritis |
|
Definition
ARF
rash, fever, and eosinophilia
pyuria, hematuria |
|
|
Term
| causes of chronic interstitial nephritis |
|
Definition
prolonged urinary tract obstruction
reflux nephropathy
heavy use of analgesics
heavy metal exposure
arteriolar nephrosclerosis with associated HTN |
|
|
Term
| extrarenal cysts associated with PCKD are common where? (4) |
|
Definition
| spleen, liver, pancreas, brain |
|
|
Term
| when are ACEI contraindicated in renal disease? |
|
Definition
|
|
Term
| suspect renovascular HTN if (4) |
|
Definition
malignant HTN
sudden onset HTN
HTN that suddenly worsens
HTN that doesn't respond to standard medical therapy |
|
|
Term
| gold standard for dx of renal artery stenosis |
|
Definition
| renal arteriogram (but contrast is nephrotoxic - don't use if renal failure is present) |
|
|
Term
|
Definition
| calcium followed by uric acid |
|
|
Term
| what size kidney stones pass spontaneously? |
|
Definition
|
|
Term
| radiopaque stones visible on xray |
|
Definition
| calcium, cysteine, struvite (staghorn) |
|
|
Term
| colicky flank pain that radiates to the groin |
|
Definition
|
|
Term
| lower vs upper urinary tract obstruction |
|
Definition
lower (below uretrovesical junction) affects urination
upper typically causes renal colic |
|
|
Term
| causes of lower urinary tract obstruction (7) |
|
Definition
BPH, prostate cancer
urethral stricture, stone
neurogenic bladder
trauma
bladder cancer |
|
|
Term
| causes of upper uniary tract obstruction |
|
Definition
intrinsic - kidney stones, blood clots, sloughed papilla, crystal deposition, tumors, strictures, ureteropelvic or ureteropelvic or ureterovesical junction)
extrinsic - pregnancy, tumors, AAA, retroperitoneal fibrosis, endometriosis, prolapse, hematomas, Crohn's disease, diverticulitis |
|
|
Term
| initial test to tx urinary tract obstruction |
|
Definition
|
|
Term
| gold standard for diagnosis of ureteral obstruction |
|
Definition
|
|
Term
| indications for TRUS (prostate biopsy) |
|
Definition
PSA > 10
abnormal DRE
PSA velocity > 0.75/yr |
|
|
Term
| stages of prostate cancer A-D |
|
Definition
A = non palpable
B = palpable nodule confined to prostate
C = extends beyond capsule without mets
D = mets disease |
|
|
Term
| low back pain + enlarged prostate |
|
Definition
| keep in mind prostate cancer with vertebral mets |
|
|
Term
|
Definition
localized - radical prostatectomy
locally invasive - radiation plus androgen deprivation
mets disease - reduce amount of testosterone with any of the following: orchiectomy, antiandrogens, leuprolide |
|
|
Term
| common areas of mets for renal cell carcinoma |
|
Definition
| lung, liver, brain, and bone |
|
|
Term
| risk factors for renal cell carcinoma (5) |
|
Definition
cigarette smoking
phenacetic analgesics (high use)
adult PCKD
chronic dialysis
exposure to heavy metals |
|
|
Term
| classic triad of renal cell carcinoma |
|
Definition
occurs in the minority of pts
hematura, flank pain, and abdominal mass |
|
|
Term
| tx of renal cell carcinoma |
|
Definition
| radical nephrectomy for stages 1-4 |
|
|
Term
| MC tumor in the genitourinary tract |
|
Definition
|
|
Term
| MC type of bladder cancer |
|
Definition
| transitional cell carcinoma |
|
|
Term
|
Definition
depends on stage
stage 0 = IV chemo
Stage A = transurethral resection
Stage B (muscle invasion) = radical cystectomy, lymph node dissection, removal of all surrounds accessory organs, and urinary diversion.
Stage C (extends to perivesicular fat) - same as for stage B
Stage D (mets) - consider cystectomy and systemic chemo |
|
|
Term
| MC cancer in men age 20-35 |
|
Definition
|
|
Term
| MC tumor in men age 20-40 |
|
Definition
|
|
Term
| MC type of germ cell tumor |
|
Definition
|
|
Term
| biggest risk factor for testicular cancer |
|
Definition
|
|
Term
true or false
testicular tumors are almost always malignant while extratesticular tumors within the scrotum are almost always benign |
|
Definition
|
|
Term
| staging of testicular cancer |
|
Definition
Boden-Gibb staging
A = confined to testis/cord
B = retroperitoneal lymph node spread
C = distant mets |
|
|
Term
| testicular cancer with elevated B-hCG |
|
Definition
|
|
Term
| testicular cancer with elevated AFP |
|
Definition
|
|
Term
| peak incidence of penile cancer |
|
Definition
| men in their 70's - frequently associated with HSV and HPV 18 infection |
|
|
Term
| twisting of the spermatic cord leading to arterial occlusion and venous outflow onstruction |
|
Definition
| testicular torsion - surgical emergency, must be decompressed within 6 hours |
|
|
Term
| MC organism causing epididymitis in children, sexual active, and elderly men |
|
Definition
children - e coli
sexually active - STD
elderly - e coli |
|
|
Term
| differentiation of testicular torsion and epididymitis |
|
Definition
| torsion has a more acute onset and is not associated with fever |
|
|
