-
CA inhibitors used for
- Glaucoma
- Epilepsy
- Alt. Sickness
- Metabolic Alkalosis
-
Site of axn for CA i's
Proximal convoluted Tubule
-
SE of CA i's
- Mild metabolic acidosis
- K
- Nephrolithiasis
-
Use for osmotic agents (mannitol)
-
SE osmotic agents
- Pulmonary edema
- Relative NA
-
Site of axn of osmotic agents
-
Loop diuretic's use:
- CHF
- Pulmonary edema
- Hypercalcemia
- Cirrhosis
- Rapid onset-good for emergency situations
-
SE Loop Diuretics
- Ototoxicity
- Uricemia (gout)
- K
- Ca
-
Thiazides use:
- HTN
- CHF
- Hypercalciuria w norm serum Ca
- Nephrogenic DI
-
-
K sparer's use:
- 2 hyperaldosteronism
- CHF
- K preserving diuresis
- PCOS (aldactone)
- Acne (aldactone)
-
SE of K sparer's:
- Gynecomastia (aldactone)
- Menstrual irregularity
- K
-
Name 4 K sparer's
- Spironolactone
- Eplernone
- Triamenterne
- Amiloride
-
Name a diuretic that can be used in ppl with sulfa allergy
Ethacrynic acid
-
Treating pyleonephritis
- Fluoroqunilones
- Aminoglycosides
- Cephalosporins
- (1-2 days IV then outpt oral)
- If severe or complicated 14-21 IV antibiotics
-
Treating pyleonephritis in pregnant women.
Amp/gent or ceftriaxone
-
How do you see a Uric H stone
IVP
-
Expectant management of kidney stone:
- Strain urine with strainer
- Drink 3L h2o
- Tamsulosin-relaxes mm
- NSAID
- Repeat CT
-
Require sx for kidney stone if:
- Unable to pass after 4-6wks
- Complete urinary obstruction
- Persistent infxn
- Impaired renal fxn
-
Stones what size likely to pass?
-
5 types of kidney stones
- Calcium oxalate
- Struvite
- Calcium phosphate
- Uric acid
- Cystine
-
Only stone that can not be seen on CT/Xray.
Uric acid
(radiolucent)
-
Staghorn calculi
- Struvite
- (mg-nh4-po4)
- Cystine-rarely
-
Cause of calcium oxalate stone
- Idiopathic hypercalciuria
- Also SB dz
-
Cause of struvite stone
UTI-proteus, klebsiella
-
Cause of calcium phosphate stone
Hyperparathyroidism
-
Treat uric acid stone by..
Alkalinizing urine
-
Large palpable kidneys, HTN, hematuria, flank pain. Dx?
Polycystic kidney dz (PKD)
-
Which PKD more common?
Autosomal dominant-adult onset
-
Treat PKD?
- Vasopressin R antagonist
- Amiloride
- Drain large cysts
- Dialysis
- Transplant
-
Complications in PKD
- Incranial aneurysms
- SAH
- MVP
- ESRD
- Hepatic cysts
-
#1 risk factor for RCC
Smoking
-
Scrotal variocele, flank pain, HTN, hematuria. Dx?
RCC
-
Why do you usually move directly to surgical resection of RCC & bypass the biopsy?
Biopsy can SEED cancer!
-
4 cancers causing EPO
- RCC
- HCC
- Pheochromocytoma
- Hemangioblastoma
-
Paraneoplastic syndromes with RCC
- Anemia
- Erythrocytosis
- Hepatic dysfxn
- Ca
- Cachexia
- Thrombocytosis
- Polymyalgia Rheumatica
-
Med that cause interstitial nephropathy ("allergic")
- Aminoglycosides
- B lactam antibiotics
- Sulfonamides
- NSAIDs
- Allopurinol
- PPI's
- Diuretics
-
Toxic causes of interstitial nephropathy
- Cadmium
- Lead
- Cu
- Mercury
- Poison mushrooms
-
Rash, fever, Cr, eosinophilia, granular or epithelial casts. Dx? Tx?
Interstitial "allergic/drug induced" nephropathy
- Stop offending agent!
- Steriods!
-
Complication of Interstitial "allergic/drug induced" nephropathy
- ATN
- ARF or CRF
- Renal papillary necrosis
- ESRD
-
Causes of nephritic glomerulonephritis:
(PIG WAIL)
- P: Post-infxn glomerulonephritis
- I: IgA nephropathy
- G: Goodpasture's
- W: Wegener's
- A: Alport's
- I: Idio. crescentic glomerulonephritis
- L: Lupus nephritis
-
Recent infxn, oliguria, brown urine, HTN, kid. Dx? Tx?
Post-streptococcal (infectious) glomerulopnephritis
Self limited & supportive tx
-
Post-streptococcal (infectious) glomerulopnephritis EM? Other labs?
Bumpy depositis of IgG and C3 on renal BM.
- UA- hematuri, proteinuria
- ASO titer
-
Hematuria, flank pain, low grade fever, mesangial cell proliferation on EM. Dx? Tx?
IgA nephropathy (Berger's)
- Self limited
- ACE i
- Statin
- Steriod
-
Increased serum IgA & mesangial cell proliferation
IgA nephropathy
-
IgG antiglomerular BM antibodies. Dyspnea, hemoptysis, hematuria, myalgia. Dx?
Goodpasture's
-
Goodpasture's fluorescence
Linear pattern of IgG antibody deposition
-
Treatment Goodpasture's
- Plasmapheresis
- Steriods
- Immunosuppressants
-
Hematuria, RF, high frequency hearing loss, cataracts. Dx?
Alports
Defect in collagen IV in BM
-
Alport's EM
Glomerular basement membrane inconsistency
Split GBM
-
Rapidly progressive RF
Idiopathic crescentic glomerulonephritis
+ ANCA
-
Idiopathic crescentic glomerulonephritis (2 causes)
- Wegener: cANCA
- Pauci immune: pANCA
Crescents on EM
-
Renal dz + ANA, anti-DNA antibodies
Lupus nephritis
-
Respiratory symptoms, hematuria, granulomatous inflammation. cANCA dx? Tx?
Wegener's
- Cyclophosphamide
- Corticosteriods
-
Young kid with HTN, increased freq of infxn, flattening of podocytes on EM
Minimal change dz
-
MC kidney syndrome in HIV
Focal segmental glomerular sclerosis
-
Hyperlipidemia, albumin, hematuria, drug use, proteinuria dx
Focal segmental glomerular sclerosis
-
MC kidney syndrome in black person
Focal segmental glomerular sclerosis
-
Spike & dome BM thickening
Membranous glomerulonephritis
-
Train track, double layer EM
Membranoproliferative glomerulopnephritis
-
Hep B or C association
Membranoproliferative glomerulonephritis
-
Metabolic alkalosis causes
- Vomiting (ctrxn alkalosis)
- Diuretucs
- Cushings
- Hyperaldoseronism
- Adrenal hyperplasia
-
Respiratory alkalosis
- Hypervent
- High altitude
- Asthma
- ASA toxicity
- PE
-
Respiratory acidosis
- COPD
- Respiratory depression
- Neuromuscular dz
-
AG metabolic acidosis
- Methanol
- Uremia
- DKA
- Paraldehyde
- INH
- LA
- Ethanol
- Salicylates
-
Normal AG metabolic acidosis
-
-
6 D's of hypernatriemia
- Diuretics
- Dehydration
- DI
- Docs-iatrogenic
- Diarrhea
- Disease of kidney-hyperaldosteronism
-
Too rapid correction of hypernatriema can cause
Cerebral Edema
-
Treatment of hypernatriema
Gradual hydration of NS if dehydrated until stable then 1/2 NS
-
Na (serum), urine osmolality, large urine volume. Cause?
Diabetes Insipidous
-
-
Treat NDI
- Salt restrict
- h2o
- Thiazide
- Indomethacin
-
If lithium induced NDI tx?
-
Water deprivation test and response in CDI vs NDI
CDI: respond, urine osmolality
NDI: no change
-
Na (serum), urine osmolality, ( uNa >20)
SIADH
-
Treatment of SIADH
- Fluid restrict
- Loop diuretic
- Hypertonic saline
- Demeclocycline
-
Correction of hyponatremia too quickly leads to
CPM
Correct by 12 in 24hrs!
-
Causes of hypercalcemia
- C: Calcium supplementation
- H: Hyperparathyroidism
- I: Immobility/iatrogenic
- M: Milk alkali
- P: Paget
- A: Addisons/Acromegaly
- N: Neoplasm
- Z: ZE
- E: Excess vit A
- E: Excess vit D
- S: Sarcoidosis
-
Differentiate b/t familial hypocalciuric hypercalcemia and other causes of hypercalcemia by
- +FH
- Low urine Ca
- Absence of osteopenia, nephrolithiasis & AMS
-
UTI treatment
- Amoxicillin
- TMP SMX
- Fluoroquinolones
-
UTI treatment in pregnancy
- Amoxicillin
- Cephalexin
- Nitrofurantoin
-
MC bladder Ca
Transitiona cell
-
Treatment urethritis
Ceftriaxone with doxy or azithromycin
-
Treatment in prostatitis under 35
Ceftriaxone with doxy or azithromycin
-
Treatment in prostatitis over 35 or anal intercourse
TMP SMX or fluoroquinolone
-
Treatment of BPH
- Alpha 1 blocker: terazosin
- 5alphareductase i: finasteride
- TURP
- Transurethral needle ablation
-
Treatment of prostate cancer
- Prostatectomy
- Radiation therapy
- PSA follow up
- Antiandrogen (fludimide, leuprolide)
- Chemo
-
Epididymitis treatment under 35
Ceftriaxone & doxycycline/fluroquinolone
-
Treatment of testicular torsion
- Emergent surgical reduction
- Orchiopexy
-
-
Beat treatment for enuresis
Alarms!
-
Causes of persistent hematuria
- Adult PKD
- BPH
- Neoplasm-bladder, kidney, prostate
- Glomerular dz
-
Do not biopsy what 2 cancers due to potential of seeding
-
Testicular cancer with Beta-hCG, AFP
Germ cell tumors
- -Seminomatous
- -Nonseminomatous
-
Testicular cancer with estrogen
- Stromal cell tumor
- -Leydig
- -Serotoli
- -granulosa
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