GU

• Acute loss of renal function, usually 24-48 hours
• generally resolves in 3 months of onset
• -can progress to acute renal failure if oliguria
• (<400cc/day) and increased serum creat (0.5
• mg/dL/day)
• RIFLE criteria OR pre, intra, post renal method

• -BUN increased out of proportion to
• Creat
• -reversible w/ proper therapy
• -obstruction, ATN,contrast media

<100cc/24hrs

• Abnormally high levels of nitrogencontaining
• compounds (such as urea,
• creatinine, various body waste
• compounds, and other nitrogen-rich compounds) in the blood
• BUN >100mg/dL

• Progressive condition caused by enlargement of the prostate gland, usually inmen over 50yrs
• -50% of men >50yrs
• -80% of men >80yrs
• May be response of prostate to androgens over time
• -Dietary fat may play a role

• UA:
• pyuria suggests infection
• hematuria may indicate malignancy
• Ucx:
• r/o UTI if irritative symptoms present
• BUN/Creat to assess renal insufficiency
• PSA for respective decade
• 50 yeers start PSA unless hx or Af. Amer = 30 years
• transrectal ultrasound for nodule or elevated PSA

• Mild? - watchful waiting, refer to urologist
• Alpha blockers (relax muscle fibers in prostate and capsule and internal urethral sphincter)
• -Terazosin 1mg at bedtime, up to 10mg
• -Prazosin 1-5mg PO BID
• -Doxazosin 1-8mg daily
• -Combo (tamsulosin 0.4 or 0.8mg daily, urotaxtral, silodosin)
• Hormonal manipulation
• -Finasteride 5mg/day x 6mo (blocks conversion of testosterone to dihydrotestosterone, shrinks epithelial part of prostate)
• -Dutasteride 0.5mg daily
• -Estrogens, androgens, GnRH if finasteride not tolerated
• Phytotherpay:
• -saw palmetto berry (decreases PSA, no evidence to suggest decreases ca risk)
• -echinacea
• -pumpkin/squash
• -stinging nettle
• -rye
• -leaves of trembling poplar
• Surgery:
• -TURP
• -TUIP (no tissue resected, can be done outpatient)

• Act on alpha receptors to enhance prostate muscle tone (increases obstruction)
• -decongestants and diuretics
• Decrease bladder muscle contraction (increases
• retention)
• -anticholinergics (antihistamines), bowel
• antispasmodics, TCAs, opiates, antipsychotics (SSRIs)

Irritative: freq, dysuria, urgency, nocturia, incontinence

Obstructive: hesitancy, straining starting and stopping, dribbling, retention decreased force/caliber of stream, sensation of incomplete bladder emptying, double voiding

*size doesnt correlate with severity of symptoms or degree of obstruction

• DRE: smooth and rubbery feel normal, if enlarged, nodular, hard possible mallignancy
• Start DRE at 40 YO

• -diuretics for volume overload
• -monitor and tx metabolic acidosis PRN
• -monitor ytes (hypercalcemia in chronic
• renal failure)
• -treat anemia PRN
• -treat azotemia (BUN>100mg/dL) w/ RRT/dialysis

• Progressive impairment over months to years
• (chronic renal failure)
• -steady increase in BUN and creat (10:1 ratio)
• -intrinsic kidney damage irreversible, but
• progression can be slowed
• -GFR <60mL/min over 3 mo +/- kidney
• damage