pulmonary > GU > Flashcards

GU Flashcards

(49 cards)

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1
Q

hematuria definition

A

> 3 RBC/HPF

  • gross: more nonglomerular
  • microscopic: more likely glomerular
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2
Q

causes of hematuria…

A

TITS:

  1. trauma (foley, blunt, exercise, FB)
  2. Infection / inflam - UTI #1 cause in adults!! glomerulonephritis, AIN, Goodpasture, IgA nephropathy, heoch-shoelien, wegener
  3. Tumor: GROSS PAINLESS HEMATUREIA IS BLADDER / KIDNEY CANCER UNTIL PROVEN OTHERWISE!!
  4. Stones - hypercalciuria
    other: alport syndrome, RTA, heme d/o, meds (cyclosporine, aminoglycosides, analgesics) BPH
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3
Q

initial tests for workup…

A

Urine dipstick and U/A w/ microscopy and examine urine sediment and culture to r/o UTI. cytology w/ malignancy RF

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4
Q

RF for bladder malignancy

A

> 50 y/o, male, smoking, occupational exposure to chem/dyes, painless gross hematuria

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5
Q

diagnostic tests for GU system…

A

image (US/IVP/CT w/ and w/o contrast) upper (kidneys and ureters) and scope lower w/ cystoscopy unless infection present!

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6
Q

hematuria w/ no RBC found on mrico…

A

do dipstick..if positive for heme: mygolobin (clear plasma) or hemoglobin (red) or d/t food (beets) or meds

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7
Q

dark cola urine w/ elevated BP, edema w/ proteinuria w/ RBC casts and dysmorphic RBC on micro…

A

GLOMERULAR! usually glomerulonephritis
think about post-streptococcal GN w sore throat and skin infection 1-2 weeks prior or bergers dz (IgA nephroaphty) w/ 1-2 days of runny nose, sore throat and cough

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8
Q

w/ pyruia present + burning / dysuria on micro…

A

send for culture and tx for UTI

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9
Q

hematuria + hemoptysis

A

goodpastures! check for anca and antibodies to collagen

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10
Q

male w/ hematuria + deafness…

A

alport syndrome!

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11
Q

kid w/ recent viral infection, abdominal pain, arthralgais and purpura…

A

henoch-shoelein purpra

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12
Q

hematuria + little proteinuria micro and clots…

A

extraglomerular! check imaging for renal dz (CT) or bladder (cystoscopy)

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13
Q

UTI bugs

A

1 ecoli

90% d/t e coli, staph saprophyticus, enterococcus
-noninfectious: look for radiation, cyclophosphadmide

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14
Q

UTI - at risk populations

A
  1. diabetics (at risk of UPPER), renal failure
  2. immunocompromised
  3. spinal cord injury
  4. obstruction - neurogenic bladder, reflux,
  5. uncirc males
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15
Q

asymptomatic bacteriuria

A

2 successive positive cultures !(>10x5e)
ONLY TREAT IF PREGO OR BEFORE UROLOGIC PROCEDURE!
**only need 1 in males!

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16
Q

sx

A

void symptoms: dysuria, urgency, frequency
hematuria
suprapubic tenderness
**no systemic / fever

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17
Q

diagnosis:

A
  1. dipstick - nitrites specific for gram neg; leuk esterase key for uti
  2. u/a: criteria
    1. bacteriuria >1 org/field
    2. pyruria more or equal to 10 leuk / miroliter!
  3. urine culture - used more in hospital or w/ recurrent, obstruction, diaphragm use, prolonged >7 days of symptoms, diabetic, 65 and older
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18
Q

complicated UTI

A

considered if:

  1. male
  2. diabetic
  3. immunocopromised
  4. prego,
  5. h/o pyelonephritis w/in last year
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19
Q

tx for uncomplicated UTI

A
  1. keflex 250-500 mg q 6 x 3 days
  2. macrobid 100 mg q 12 hr x 3 days
  3. bactrim (160/800) BID x 3 days
    - can give pyridium for dysuria (turns pee orange)
    - fosfomycin 3 g dose (not really used)
    * *if recurrent w/in 2 weeks of treatment, treat another 2 weeks and get a culture!
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20
Q

prego UTI

Study These Flashcards
A
  1. ampicillin
  2. amoxicillin
  3. augmentin
  4. cephalosporins
    treat x 7 days
    NO FQ
21
Q

male UTI

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A 
fconsidered COMPLICATED
1. urologic workup
2. bactrim and FQ
NO MACROBID AND NO BETA LACTAMS!
treat for 7 days if no sx of prostatitis / pyelo!
22
Q

when to consider prophylactic tx…

Study These Flashcards
A

if 3 or more episodes in 1 year!

  • *do urologic eval!!
    1. bactrim (40/200)
    2. macrobid
    3. keflex
  • single dose at bedtime or after intercourse!
23
Q

pyelonephritis!

Study These Flashcards
A

infection of upper urinary tract d/t reflux from bladder
E coli most common bug
uncomplicated if it remains at renal pyelocalyceal-medullary region (complicated can affect any part of kidney)

24
Q

pyelo complications…

Study These Flashcards
A
  1. urosepsis
  2. emphysematous - gas producing bacteria more in diabetics
  3. chronic leading to scarring - often in patients w/ renal disease
25
pyelo sx
cystitis + systemic - fever, chills, tachycardia, flank pain, CVA tenderness
26
pyelo diagnosis
1. u/a -LEUKOCYTE CASTS, pyuria, bacteriuria 2. urine cultures - done in ALL 3. blood culture - do if ill-appearing or IN HOSPITALIZED 4. cbc, renal function (if impaired reversible) - do imaging if refractory to treatment
27
pyelo tx -outpatient
NO MACROBID! oral: bactrim or FQ (cipro, levo) x 10-14 days - repeat urine culture in 2-4 days after cessation of tx - if no reponse, get imaging (CT or ultrasound)
28
pyelo tx - inpatient
* admit if really sick / old / prego / cannot tolerate orals / sig comorbidities / urosepsis 1. IV ampicillin and gentamicin or cipro * *continue IV until afebrile x 24 hrs, then oral to for 14-21 day course - once changed to oral: 2. cipro 750 BID x 21 d 3. bactrim x 21 days * *w/ urosepsis, treat w/ IV 2-3 weeks
29
recurrent pyelo
- if same organism, treat x 6 weeks | - if new organism, tx x 2 weeks
30
ATN
85% of intrinsic AKI - two major types 1. ischemic: prolonged decreased RBF and GFR kills tubular cells! i.e. hypotension, dehydration, shock, sepsis 2. nephrotoxic: meds - - aminoglycosides -often 5-10 days after onset (last in system x 1 mo) - cyclosporine (dose dependent - should improve w/ dec dose or stopping med) - NSAIDS - vanco, acyclovir, amphotericin B (toxic at 2-3 g dose and up) * ***RADIOCONTRAST! #3 cause of AKI! give 0.9% NS 1L over 10-12 hr before and after procedure for protection! can give n-acetylcysteine 600 mg every 12 hours twice before and after or sodium bicarb - avoid nephrotoxic meds day before and after dye! - endogenous: myoglobin w/ rhabdo (check CK - most over 16,000 tx w/ volume repletion!) and hemoglobin (hemolysis / transfusion reaction - tx underlying and hydrate!) - hyperuricemia secondary to chemo! - bence jones proteins w/ MM
31
ATN labs
- hyperkalemia and hyperphos - BUN:crt 2-3% or >20 meq/l - GRANULAR MUDDY CASTS!!! RENAL TUBULAR EPITHELIAL CELLS!
32
ATN treatment
- fluids!! volume repletion and stop all nephrotoxic agents! - may use loops furosemide w/ chlorthiazide or metolazone to increase urine outpu - can use furosemide drip to avoid toxic doses of loops (hearing loss and cerebellar dysfunction) * w/ rhabdo - dont treat hypocalcemia unless symptomatic! * avoid mag-containing antacids / laxatives - kidney hangs onto potassium, phos, H+, magnesium w/ damage!
33
3 phases of ATN
1. injury | 2. oliguric phse: 10-14 days w/ urine output 500 ml/d - GFR increases, BUN:crt begin to fall!
34
AIN patho / causes
interstitial inflammation, most commonly due to ALLERGIC (THINK EOS!) TO NEW MEDICATION!!! (PCN, SULFA, CEPH, diuretics, PPI!!! VERA SAID #1 CAUSE, ALLOPURINOL, RIFAMPIN) - infection - esp kids - STREP! legionella - AI and collagen dz...sarcoid..SLE, sjogrens
35
AIN classic findings...
FEVER, RASH, PYURIA, EOS IN URINE!!! | **look for hx of NEW MEDICATION or RECENT ILLNESS! with signs of AKI
36
AIN diagnosis
clinical w/ new exposure and has: fever, AKI, rash, eosinophilia! -get u/a (may have protein /hematuria)
37
AIN tx
remove agent - often reverses | w/o improvement, may need steroid (prednisone 60 mg/d x 1-2 weeks or iv methylprednisone x 1-4 d)
38
acute glomerulonephritis...
uncommon cause of AKI - inflammatory glomerular lesions w/ proteinuria (<3 g/d) hematuria and RED CELL CASTS W/ DYSMORPHIC RBC!!!
39
glomerulonephritis causes...
1. immune * *most common: poststreptococcal GN - IgA nephropathy (Berger disease) 2. anti-gbm / good pasture 3. vasculitis, collagen dz, SLE, polyarteritis nedosa, henoch shonelein
40
GN pres...
* *boy w/ history of strep infection (sore throat 1-2 weeks prior or skin infection 2-4 weeks prior) w/ new onset periorbital and scrotal edema w/ dark urine - dependent edema and HTN
41
GN labs..
- increasing BUN:crt | - U/A dipstick: hematuria, mod proteinuria <3g/d, red cells, red cell casts and white cells
42
whats most specific for GN on dipstick?
RED CELL CASTS!!!
43
extra tests to get once Dx GN...
completment levels, ASO titer, anti-GBM, ana, anaca, hepatitis, blood cultures, cryoglobulins -renal u/s
44
nephrotic syndrome...
keys: lose protein d/t increased permeability! 1. urine protein >3.5 g/ 24 hr 2. hypoabluminemia 3. hyperlipidemia - get increased LDL and VLDL w/ increase in albumin synthesis 4. edema - hypercoaguable d/t loss of anticoags in urine - increased infection d/t increased loss of immunoglobulins in urine
45
testing w/ nephrotic...
1. dipstick - w/ positive get u/a 2. u/a - RBC cast indicate GN - WBC cast = pyelo or interstitial nephritis - fatty cast = NEPHROTIC! * w/ positive u/a get 24 hour urine collection! 3. test for microablumin - if positive dipstick, get radioimmunoassay
46
most common causes of nephrotic...
adults: membranous glomerulonephritis kids: minimal change disease
47
nephritic sydrome keys...
inflammation of glomeruli w/: 1. hematuria 2. AKI - azotemia, oliguira 3. HTN 4. edema - may have mild proteinuria
48
nephritic causes...
#1 post-streptococcal!
49
glomerular vs tubular disease..
Glomerular is more chronic, causes nephrotic syndrome, requires biopsy and tx w/ steroids Tubular more acute, d/t toxins, no biopsy no steroids!
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