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Renal Block
Clinical Medcine
| Question | Answer |
|---|---|
| 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
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