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PANCE NEPHROLOGY
Kidney stones 5-10mm - ✔Early intervention, Lithrotripsy, fluids , analgesics Gold standard treatment for kidney stones > 10mm - ✔Percutaneous nephrostomy, ESWL, analgesics Pain radiating to ipsilateral groin , testicle or labile - ✔A kidney stone in the lower ureter How does plain film show with most common renal stones? - ✔Radiopaque Post renal causes of ARF - ✔Obstructive uropathy, BPH, Bladder outlet syndrome, urolithiasis What is the most common renal tumor seen in childhood? - ✔Wilms tumor What is the test of choice for Kidney stones? - ✔Helical/spiral CT scan Signs and symptoms of Glomerulonephritis - ✔Hematuria, Oliguria, anuria, Tea colored urine, edema( face and eyes-pm) (feet and ankles-PM) Who is glomerulonephritis M.C. IN? - ✔Children- post infection- strep How is glomerulonephritis diagnosed? - ✔Anti-treptolysin- O titer, serum component C3 levels are decreased Treatment for glomerulonephritis - ✔Restrict salt and fluid intake, may need dialysis if azotemia, steroids Azotemia - ✔accumulation of wastes( urea and creatinine) Pre- renal causes of ARF - ✔Hypovolemia, Hypotension, CHF, Nephrotic syndrome, Renal artery stenosis, Aortic Anerysym, Embolic disease Asymptomatic abdominal mass in child with hematuria -
✔Nephroblastoma- Wilms tumor What is the internists tumor? - ✔Renal cell carcinoma usually found incidentally on Imaging- Flank pain, hematuria abdominal pain or mass GFR in CKD - ✔<60ML Causes of CKD - ✔DM II, Glomerulonephritis, Polycystic kidney disease, HTN, Intrinsic causes of ARF - ✔Acute tubular necrosis, nephrotoxins, Interstitial dz( acute interstial nephritis, SLE, Glomerulonephritis Gout - ✔Uricd acid level> 8 is suspicious not diagnostic Pseudogout - ✔Calcium pyrophosphate- knee wrist elbow Treatment Gout - ✔NSAIDS, diet modification- purine free, Colchicine, injections, Allopurinol Gleason Scale - ✔Prostate cancer staging WBC casts in urine - ✔infectious process- pyelonephritis RBC casts - ✔Glomerulonephritis Hyaline casts - ✔concentrated urine- Physical exertion, stress, febrile illness Urethritis, conjunctivitis, and oligoarthritis and mucousal ulcers - ✔Reactive arthritis AFP can detect what early cancer? - ✔Testicular cancer Where do 75% of prostate cancers arise from? - ✔peripheral zone
Testicular torsion - ✔Sudden onset of severe unilateral testicular pain and swelling where the teste is twisted on its spermatic cord will quickly lead to ischemia and is a surgical emergency- seen by doppler Peripheral edema, proteinuria, hypoalbuminuria, hyperlipidemia,Lab- maltese crosses and oval fat bodies - ✔Nephrotic syndrome Polycystic kidney disease - ✔Multiple renal cysts that are made of proteins that are made in the renal tubules and collecting system Orchitis is frequently caused by? - ✔MUMPS Anti-glomerular basement membrane antibodies - ✔GOOD PASTURES SYNDROME What is the most common form of polycystic kidney disease? - ✔Autosomal dominant polycystic kidney disease -it is almost always bilateral s/s of ADPKD - ✔back pain, flank pain, nocturia, proteinuria, bacteriuria hematuria, palpable kidneys Calcium Stones - ✔Most common- RADIOPAQUE Uric acid stones - ✔Radiolucent Cystine stones - ✔Radiolucent Struvite stones - ✔Radiopaque combination of magnesium, calcium, and ammonium, formation is increased by urinary tract infections Staghorn stones - ✔A type of kidney stone that usually needs surgical intervention ANCA- Anti-neutroplhilic cytoplasmic antibodies that affects multiple organ systems that cause inflammation of blood vessels-sores often develop in nose and mouth, gums - ✔Wegeners granulomatosis
Enlarged boggy tender prostate - ✔prostatitis Low serum creatinine - ✔low muscle mass High serum creatinine - ✔decreased GFR DRUG INDUCED INTERSTITIAL NEPHRITIS - ✔Eosinophiluria- Rifampin, methicillin Minimal change disease - ✔Nephrotic syndrome in children Kimmelstiel- Wilson Nodules - ✔Diabetic nephropathy Polycystic kidney disease complications - ✔Berry aneurysms, liver cysts, diverticulosis Henoch schonlein purpura - ✔palpable purpura, arthralgias and abdominal symptoms Which organism is indicated in Hemolytic uremic syndrome? - ✔E.Coli strain 0157:H Patine having perineal pain that feels like a " tennis ball stuck between my legs" indicates what? - ✔Acute bacterial prostitis Type renal calculi associated with infection - ✔Struvite ^ LDH, b-HCG, AFP - ✔Prostate cancer If sodium > 200 what procedure should be done? - ✔Dialysis respiratory ALKALOSIS - ✔Ph 7.56 PCO2 30 HCO3 20 Respiratory acidosis - ✔Ph 7.12, PCO2 55mm/hg HCO3 27Meq.L
Maltese Cross and Oval fat bodies - ✔Nephrotic syndrome
3.5g/day proteinuria, <3 g/day hypoalbuminemia, Hyperlipidemia, Lipiuria, and generalized facial edema- puffy eyelids------ NO HEMATURIA - ✔Nephrotic syndrome GFR < 60 - ✔CKD Renal calculi - ✔Struvite- radiopaque **Calcium- radiopaque Uric acid- radiolucent Cystine- radiolucent Nephritic syndrome - ✔< 3.5 g/d proteinuria, oliguria, azotemia, HTN, HEMATURIA Paraphimosis - ✔Entrapment of foreskin behind the glans, can be caused by vigorous sex Phimosis - ✔Loss of ability to retract foreskin over the glans Hyodrocele - ✔soft NONTENDER mass of the hemiscrotum that transilluminates Nontender firm cystic mass containing sperm that free floats above the testicle- transilluminates - ✔Spermatocele- no Tx unless very large 17 yo male presents with pain in left testicle following playing soccer, he has a h/o cryptorchidism - ✔Testicular torsion Dx- US Tx- surgical emergency within hours to save testicle if true torsion Varicocele - ✔Unilateral NON-tender scrotal mass - bag of worms When examining the prostate what should be avoided and why? - ✔Vigorous exam must be avoided because it can cause septicemia Most common cause of Epididymitis in <35 year olds - ✔Chalmydia
Most common cause of Epididymitis in >35 year olds - ✔E.coli LUTS is - ✔lower urinary tract symptoms- BPH Obstructive BPH - ✔Frequency, Nocturia, Urgency with decreased force of urinary stream, hesitancy, straining, post-void dribbling, sensation of incomplete emptying of the bladder Adenocarcinoma - ✔MOST COMMON cancer of prostate Urge incontinence - ✔strong desire to void followed by by loss of urine Stress incontinence - ✔leakage with urine with increased abdominal pressure Overactive bladder - ✔increased frequency, urgency, nocturia treatment for overactive bladder - ✔kegel exercises, Tolterodine , Oxybutynin Transitional cell carcinoma is a - ✔uroepithelial tumor that causes bladder cancer
