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Renal Block

Clinical Medcine

edema, ascites, HTN, ortho hypoTN, skin striae, retinal sheen = nephrotic syndrome
renal stones lodge at: UPJ (kidney stones), ureterovesicular jtn/UVJ (bladder stones), or ureter at level of iliac vessels
types of stones Ca ox (75-85%); uric acid (8%); cystine; struvite (10%)(in pt w/freq urease-prod infxn)
renal stone in upper ureter sx: radiate to ant abdomen
renal stone in lower ureter sx: rad to ipsilateral groin, testes/ labia
renal stone in UVJ sx: urgency, frequency, pelvic pain
Total body water (TBW): compartments 60% ICF, 40% ECF (32% ISV, 8% IVV)
hyponatremia = Na <135 (sxs at Na <125)
hyponatremia w/hypervolemia causes CHF, nephrotic syndrome, AKI, hepatic cirrhosis
hyponatremia w/euvolemia causes hypothyroid, glucocorticoid xs, SIADH
hyponatremia w/hypovolemia causes Na loss (renal or extrarenal)
hyperkalemia (K >5) causes AKI, metab acidosis, cell death, hyporeninemic hypoaldosteronism
hypokalemia (K <3.5) causes diuretics, renal tubular acidosis, GI losses
hypercalcemia causes hosp pts w/malig (lung, head/neck, MM, NHL, cervical, RCC); vit D intox; hyperPTH; sarcoid
Dry skin, brittle nails, mx cramps/tetany, paresthesias, perioral numbness, SOB, crackles, S3, poss syncope & angina = hypocalcemia (Ca <8.5); usu 2/2 CKD or hypoPTH
hyperphosphatemia most common cause CKD
Hyperphosphatemia (1.0-2.5); severe (<1.0) can lead to: rhabdo, paresthesia, encephalopathy
hypermagnesemia (2.5 mEq/L) s/s 1st: reduced DTRs; mx weak, hypoTN, resp depression, cardiac arrest; N/V, flushing; high bleeding time/coag
prostatitis bugs GN (E coli) or enterococcus; poss NG/CT
BPH etiology Poss: androgen, estrogen, stromal GF dysregulation, decreased cell death, inc stem cells, genetics
BPH obstructive sxs: dec force of urinary stream, hesitancy, postvoid dribbling, incomplete voiding
BPH irritative sxs: freq, urgency, nocturia
prostate ca prevalence by site: peripheral zone > transition zone (periurethral area) > central zone (urethra + ejac ducts)
testicular ca s/s painless solid testic swelling; poss heaviness; para-aortic LN involvement resembles ureteral obstruction
testicular ca prevalence by type seminoma (35%); nonseminoma (65%): mixed > embryonal > teratoma > choriocarcinoma
entrapment of foreskin behind glans penis = paraphimosis; poss 2/2 frequent caths
Predictors of ED: HTN, DM, HLD, CVD
Hydrocele is usu 2/2: fluid filled congenital remnants of tunica vaginalis (2/2 patent processus vaginalis)
spermatocele = painless cystic mass containing sperm; usu <1 cm; superior & posterior to testes
Varicocele = venous varicocity within spermatic vein (pampiniform plexus); L vein > R vein (bc longer)
Varicocele s/s chronic nontender mass, does not transilluminate; bag of worms, enlarges w/Valsalva, diminishes w/elevation
Male infertility: most common etiologies varicocele (37%); idiopathic (25%)
Male factors contribute what percent to infertility cases? 40%
BPH vs prostate ca: findings BPH: firm smooth enlarged prostate, normal PSA; cancer: firm, irregular, nodular non-tender prostate, elevated PSA
Normal range: pH: 7.40 (7.35-7.45)
Normal range: pO2: 80-100 mmHg
Normal range: pCO2: 35-45 mmHg
Normal range: HCO3: 22-26 mmol/L
Anion gap = cations (Na+) - anions (Cl- + HCO3-); Normal AG = 7-13 mmol/L
Resp compensation for metabolic acidosis pCO2 should fall 1.2 for every 1.0 drop in HCO3
Irritative voiding symptoms, Fever, chills, CVA tenderness Pyelonephritis
Crush injury, alcoholic on ground, elevated CPK, AKI Rhabdomyolysis
Painless hematuria, flank pain or mass Renal cell Carcinoma
Oliguria, hematuria, proteinuria following streptococcal infection; AM facial edema & PM LE edema: Acute glomeruloneprhitis
Hematuria, purpuric rash following streptococcal infection Glomerulonephritis, HSP
Inability to retract foreskin; erythema, TTP, poss purulence Phimosis
<40 yo male with high fever/chills, perineal pain, dysuria, freq/urgency, prostate swollen/TTP Acute prostatitis
>50 yo obstructive voiding sx, nocturia. Firm smooth enlarged prostate; Normal PSA BPH. (Cancer would have firm, irregular, nodular non-tender prostate, elevated PSA)
Incontinence with straining Stress, 2/2 inc intra-abd pressure
Hearing loss or tinnitus w/ metabolic acidosis Aspirin OD
Prostate ca RFs AA, age, FH, testost; high Gleason: high mets risk (usu to bone); not always high PSA
testicular torsion most emergent scrotal pain prob, absent cremasteric sx, comp: necrosis; dx US; surgery
blue dot sign Testicular appendiceal torsion
Nephrotic syndrome complications: Pneumococcal pna / cellulitis; Spontaneous bacterial peritonitis; PE; NOT cardiac arrhythmias
Nephrotic syndrome causes kids: MCD; adults membranous nephropathy (AA: FSGN)
infrarenal cause of AKI in a hospitalized patient ATN
BPH Pathophysiology Proliferation of fibrostromal tissue => urethral compression; dev in periurethral or transitional zone; BPH req older age and functioning Leydig cells
BPH Sx/Sx AUA sx score (0-35, severe >20), IPSS; LUTS (irritative & obstructive sxs). DRE: firm smoothly enlarged, non-nodular
BPH DDx overactive bladder, interstitial cystitis, prostatitis, prostate or bladder ca, UTI, neurogenic bladder, urethral stricture
AKI Pathophysiology multiple: pre, infra (vascular, glom, interstitial, tubular [ischemic, nephrotoxic, sepsis), postrenal
AKI Etio contrast, aminoglycoside, NSAIDs, COX-2, cisplatin
AKI Sx/Sx N/V/D, anorexia; poss edema, rash, purpura; ATN: wt loss
AKI DDx CKD (anemia more likely); ATN: high U-Na, FeNa; lowU-Cr, UrOsmo; Prerenal Azo: low U-Na, FeNa; high U-Cr, UrOsmo
CKD etiology DM (40%), HTN (33%)
Glomerulonephritis Etio PSGS, Hep, Wegener, Goodpasture, Churg Strauss
Nephritic syndrome AKI, HTN, urinary sediment (RBC, RBC casts)
Nephritic syndrome DDx PSG, SLE, SBE, IgA nephropathy, HSP, Wegener
Nephrotic syndrome Etiology DM2, multi myeloma, amyloid, SLE, MCD, PSGN, malig; Hep C (membranoproliferative); HIV (FSGS)
Respiratory acidosis Etio impairment in rate of alveolar ventilation; acute medullary resp ctr depression (narcotic OD), resp mx paralysis, airway obstruction; chronic: emphysema, pickwickian
Resp acidosis Sx/Sx metab encephalopathy: somnolence, confusion, narcosis, asterixis; fundi: dilated, tortuous vessels, possible papilledema
Resp acidosis DDx/causes COPD, airway obstruction, CNS depression (opioids, brainstem inj), neuromx (GBS, MG, botulism), myxedema
Resp alkalosis (hypocapnia) Patho/etio hyperventilation reduces PCO2, inc pH; No. 1 is hyperventilation syndrome (including anxiety); also GNR septicemia/fever, cirrhosis, PE, CHF, ILD, pna, pulmo edema, HAPE, CVA, anemia, PG (2/2 progesterone stim of resp ctr), acute salicylism
Resp alkalosis Sx/Sx lightheadedness, anxiety, perioral numbness, acroparesthesias (pain hands & feet)
Resp alkalosis DDx PE, pulmo edema, PTX, ARDS, pulmo art HTN, asthma, interstitial pulmo fibrosis
NAGMA possible causes = FUSEDCARS (Fistula, Uretero-enterostomy, Saline admin, Endocrine (hypErPTH), *Diarrhea*, Carbonic anhydrase inhibitors, Ammonium Chloride, *Renal tubular acidosis*, Spironolactone
AGMA: GOLDMARK Glycol, Oxoproline, Lactate, D-lactate, Methanol, Aspirin, Renal failure, Ketoacidosis
Metab acidosis Sx/Sx CP, palpitations, HA, AMS (anxiety), decreased visual acuity, n/v/abd pain, wt loss, mx weakness, bone pain; Kussmaul (profound DKA), lethargy, stupor, coma, seizures; V-tach, hypotension
Metabolic alkalosis: chloride-responsive (low urine Cl): due to: diuretic tx (contraction alkalosis) or loss of gastric secretions (2/2 vomiting or NG tube)
Metabolic alkalosis: chloride-resistant (high urine Cl): etio Bartter or Gitelman syndrome; hyperaldosteronism; bicarb intake in CKD
CKD most common causes DM, HTN, glomerulonephritis, PKD
CKD s/s cachexia, pallor, HTN, ecchymosis, sensory deficits, asterixis, kussmaul
causes of glomerulonephritis HSP, post-infxs GN, IgA nephropathy, membranoproliferative GN
glomerulonephritis: focal vs diffuse focal involves <50% of all glomeruli
Created by: duanea00