Renal, GU diseases

• kidney stones
• infection
• bladder or kidney cancer
• glomerular disease, IgA nephropathy
• trauma
• strenuous exercise
• systemic disease
• bleeding disorders
• sickle cell disease
• meds: cyclophosphamide, anticoags, salicylates, sulfonamides

• Minimal change disease
• FSGS
• Membranous glomerulonephritis
• IgA nephropathy
• Alport's syndrome

• hematuria and HTN often present
• progressive course, resistant to steroid tx

• usually nephrotic syndrome presentation
• primary disease: idiopathic
• secondary disease: infection (hepatitis, syphilis, malaria), drugs, neoplasms, lupus

• most common cause of glomerular hematuria
• asymptomatic recurrent hematuria and mild proteinuria
• mesangial IgA and C3 deposition

• X-linked or AD
• hematuria, pyuria, proteinuria, high-freq hearing loss, progressive renal failure

• Hepatitis C infx (also Hep B, syphilis, lupus)
• Associated with cryoglobulinemia
• Poor prognosis, renal failure in 50%

• most common cause of nephritic syndrome
• develops 10-14 days after group A strep infx
• Antistreptolysin-O elevated
• hematuria, edema, HTN, low complement levels, proteinuria
• therapy is supportive: antihypertensive, loop diuretics, antibiotics controversial

• triad: proliferative GN, pulmonary hemorrhage, IgG anti-GBM antibody
• fever, myalgia, rapidly progressive renal failure, hemoptysis, cough, dyspnea
• Lung disease precedes kidney disease by days-weeks

Upper respiratory symptoms, purulent/bloody nasal discharge, oral uclers, pulmonary symptoms, renal involvement, eye disease, MSK, tracheal stenosis

abnormal chest radiograph, elevated ESR, anemia, hematuria, +c-ANCA

• Usually allergic reaction to medication: PCN, NSAID, diruetics, anticoags, phenytoin, sulfonamides
• also infx (streptococcus spp, Legionella), collagen vascular disease
• classic findings: Rash, fever, eosinophilia

• Inability to secrete H+ at distal tubule, leads to hypokalemic hyperchloremic NAGMA
• increased excretion of ions: decreased ECF volume, hypokalemia, renal stones/nephrocalcinosis, rickets/osteomalacia
• causes: congeital, multiple myeloma, nephrocalcinosis, nephrotox (ampho B tox), SLE, Sjogren's, analgesic nephropathy, cirrhosis
• treatment: sodium bicarb to correct acidosis and prevent kidney stones

• Inability to reabsorb HCO3- at proximal tubule, increased excretion of bicarb leads to hypokalemic hyperchloremic NAGMA
• causes: Fanconi syndrome (children), cystinosis, Wilson's disease, lead toxicity, multiple myeloma, nephrotic syndrome, amyloidosis
• treatment: do not give bicarb. Na restriction to increase Na reabsorption and thus bicarb in proximal tubule

• results from any condition that is associated with hypoaldosteronism (common in interstitial renal disease or diabetic nephropathy)
• hyperkalemia, acidic urine, NAGMA
• treatment: furosemide, MC +/- GC replacement

• hereditary or acquired proximal tubule dysfn
• glucosuria, phosphaturia (leads to rickets/impaired growth; osteomalacia, osteoporosis, pathological fractures), proteinuria, polyuria, dehydration, type 2 RTA, hypercalciuria, hypokalemia
• tx: phosphate, K, alkali, salt supplementation, hydration

• AD inheritance
• hematuria, abd pain, HTN, palpable kidneys
• associated with intracerebral berry aneurysm, infection of cysts, renal failure, renal stones, MVP, cysts in other organs, diverticula, hernias
• Dx: ultrasound

• most common cause of 2ndary HTN
• causes: atherosclerosis, fibromuscular dysplasia
• suspect in: malignany HTN, sudden onset HTN, worsening or refractory to medical tx
• dx: renal arteriogram (gold standard), MRA

• calcium- calcium oxalate or calcium phosphate
• uric acid
• struvite
• cystine

• bipyramidal, biconcave ovals
• radiodense
• secondary to hypercalciuria and hyperoxaluria

• flat square plates, radiolucent
• associated with hyperuricemia, secondary to gout or chemotherapy (high cell destrux)

• rectangular prisms, radiodense
• occur in patients with recurrent UTIs due to urease-producing orgs (urea --> ammonia)
• facilitated by alkaline urine

• hexagon-shaped, poorly visualized
• genetic predisposition: cystinuria

• analgesia
• vigorous fluid hydration
• antibiotics
• if stone does not pass in 3d or pain not controlled, extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy

• high fluid intake, limit animal protein intake in hyperuricosuria, limit calcium intake
• thiazide diuretics reduce urinary calcium
• allopurinol effective in preventing high uric acid levels

• classic triad: hematuria, flank pain, mass (less than 10%)
• paraneoplastic syndrome: can ectopically secrete EPO, PTH-like hormone, renin, cortisol, gonadotropins

likely to recur after removal

• cigarette smoking
• industrial carcinogen
• radiation, biologic agents
• long-term treatment with cyclophosphamide

• Germ cell tumors (95%): Seminoma (35%)- most common. Nonseminomatous (65%)- embryonal carcinoma, choriocarcinoma, teratoma, yolk sac carcinoma
• Non-germ cell tumors (5%), usually benign: Leydig cell tumors, Sertoli cell tumors

• b-hCG: always elevated in choriocarcinoma, some nonseminomatous germ cell tumors
• AFP: increased in embryonal tumors, never in choriocarcinoma or seminoma