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UROLOGY & RENAL

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laracrystalo's version from 2016-07-24 20:04

FAST ASSOCIATIONS for nephritic/nephrotic syndromes

Question Answer
crescentRPGN
wire loops on LMDPGN
full house stainingDPGN
Henoch-schonlein purpuraIgA
AsianIgA
retinopathy/lens dislocationAlport
basket-weave appearance on EMAlport
can't see, can't pee, can't hear a buzzing beeAlport
tram trackMPGN
Hep CMPGN
nephritic-nephroticMPGN, DPGN
dense depositsintramembranous MPGN
starry skyPSGN
lumpy bumpyPSGN
subepithelial humpsPSGN
linear IFRPGN goodpastures
subepithelial depositsPSGN, membranous nephropathy
subendothelial depositsMPGN, DPGN
mesangial hypercellularityIgA, MPGN
Hep Bmembranous
spike and domemembranous
hodgkins lymphomaminimal change
normal glomerulus in LMminimal change
hispanics and AAFSGS
white peoplemembranous
kidsminimal change, PSGN
sickle cellFSGS
obesityFSGS
HIVFSGS
multiple myelomaamyloidosis
kimmelstiel wilson lesionsdiabetic glomerulonephropathy (just expansion of mesangium--not hypercellularity)
cryoglobulinemiaMPGN
defined by M protein virulence factorPSGN
X-linkedAlport syndrome
low serum C3 levelsPSGN, MPGN
how is the plasma oncotic pressure in nephrotic syndromes?low plasma oncotic pressure --> net plasma filtration into interstitium --> decreased intravascular volume --> RAAS activation --> edema
alpha 3 chain of type IV collagengood pastures (RPGN)
C-ANCAwegeners granulomatosis with polyangitis
P-ANCAmicroscopic polyangitis
upper respiratory tract infectionwegeners g with p (C anca) --> RPGN
pauci-immunegranulomatosis with polyangitis RPGN (wegeners)
solid tumorsmembranous nephropathy
thrombotic complicationsnephrotic syndrome loss of antithrombin III (hyper coagulable state)
maltese cross in the urinethis is the description of oval fat bodies seen under polarized light from the urine of nephrotic syndrome patients--> bc liver starts making more lipoproteins due to the protein loss
fibrils on EMamyloid
renal vein thrombosismembranous nephropathy
non hodgkin lymphomamembranoproliferative
leukemiamembranoproliferative
heroinFSGS
mesangial proliferationIgA
dysmorphic RBC and casts is indicative of ...glomerular damage
glomerulosclerosisDM nephropathy
low C3post strep, membranoproliferative, lupus nephritis
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MORE RENAL AND RTA

Question Answer
anion gap formulaNa - (Cl + HCO3)
stepwise protocol?calculate AG, if normal, think RTA, and look at K+. If K+ is high , it's type 4, if K+ is low, its type 1 or 2
low K+RTA 1 (distal) or RTA 2 (proximal)
amphoterecin BRTA 1 (distal)
kidney stonesRTA1 (distal)
pH > 5.5RTA1 (distal)
sjogrensRTA1 (distal)
increased bone turnoverRTA1 (distal)
pH < 5.5Type 2 (proximal) or type 4 (hyperkalemic)
ricketsRTA 2 (proximal)
acetazolamideRTA 2 (proximal)
multiple myelomaRTA 2 (proximal)
tenofovirRTA 2 (proximal)
high K+RTA 4
ACEiRTA4
decreased aldosteroneRTA 4
ARBsRTA 4
NSAIDSRTA 4
heparinRTA 4
adrenal insufficiencyRTA 4
bactrimRTA 4
spironolactoneRTA 4
autoimmune disordersRTA 1 (distal)
tx for RTA 1replace bicarb
tx for RTA 2give thiazides
tx for RTA 4fludrocortisone
causes of non AG met acid?RTA and diarrhea
difference between non AG met acidosis causes?diarrhea has - urine AG, RTA has + urine AG
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ACID/BASE and AKI

Question Answer
reasons for anion gap metabolic acidosisMethanol/metformin, Uremia, Dka, Propylene glycol, Iron, Lactic acidosis, Ethylene glycol, Salicilate
reasons for nongapped acidosisFistula, Ureterograstric conduits (colostomy), Saline administration, Endocrine (low aldo), Diarrhea (low HCO3), Carbonic Anhydrase inhibitors, Acid infusion, Renal tubular acidosis, Spironolactone
reasons for metabolic alkalosiscontraction alkalosis (Cl sensitive--Cl < 15--diruetic loss, GI loss via vomiting, Barters syndrome) and Cl insensitive--(Cl > 20--exogenous bicarb, hyperaldosteronism, renal artery stenosis, cushing little, licorice)
low urine Na+ of < than 20prerenal
normal urine sedimentprerenal
feNa+ < than 1%prerenal
B:C > 20prerenal
urine osm > 500prerenal
B:C < 15intrarenal
urine Na+ > 20intrarenal
FeNa+ >1%intrarenal
urine osm is similar to plasmaintrarenal (about 290)
urine Na+ > 40postrenal
FeNa+ > 1%postrenal
urine osm < 350postrenal
examples of water diuresiscentral DI, nephrogenic DI, psychogenic polydipsia
examples of solute diuresishyperglycemia, post obstructive diuresis
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WATER and SODIUM

Question Answer
serum Na+ before water deprivation in CDInormal
urine osm before water deprivation in CDIlow
serum Na+ after water deprivation in CDIhigh
urine osm after water deprivation in CDIlow
serum Na+ after desmopressin in CDInormal
urine osm after desmopressin in in CDIhigh
serum Na+ before water deprivation in NDInormal
urine osm before water deprivation in NDIlow
serum Na+ after water deprivation in NDIhigh
urine osm after water deprivation in NDIlow
serum Na+ after desmopressin in NDIhigh
urine osm after desmopressin in in NDIlow
serum Na+ before water deprivation in psychogenic polydipsialow
urine osm before water deprivation in psychogenic polydipsialow
serum Na+ after water deprivation in psychogenic polydipsianorm
urine osm after water deprivation in psychogenic polydipsiahigh
indications for acute hemodialysissevere metabolic Acidosis, severe Electrolyte disorders (hyperkalemia), drug Intoxication, refractory fluid Overload, Uremia
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Random high yield RENAL ASSOCIATIONS

Question Answer
Fanconi syndromeresorptive defect in PCT --> increased excretion of AA, glucose, HCO3, PO4, metabolic acidosis
Bartter syndromereabsorptive defect in thick ascending loop of henle causing hypokalemia, metabolic alkalosis, hypercalciuria (similar to furosemide use bc affects Na/K/2cl)
Gitelman syndromeresorptive defect of NaCl in DCT --> hypokalemia, hypomagnesemia metabolic alkalosis, hypocalciuria
Liddle syndromeincreased Na resorption in collecting tubules (enac channel) --> HTN, hypokalemia, met alk, decreased aldo
how to treat Liddle?amiloride
licoricesyndrome of apparent mineralocorticoid excess --> HTN, hypokal, met alk, low aldo
torsades de pointeslow Mg++
prolonged QTlow Ca++
U waveshypokalemia
flattened T waveshypokalemia
wide QRShyperkalemia
peaked T waveshyperkalemia
calcium oxalate stone treatmentcitrate, thiazides, hydration
Beckwith-wiedemann syndromewilms tumor, macroglossia, organomegaly, hemihypertrophy
WAGR complexwilms tumor, aniridia, GU malformation, mental Retardation
Schistosomiasissquamous cell carcinoma of bladder
thyroidization of kidneychronic pyelonephritis
common cause of chronic pyelonephritisvesicoureteral reflux ( reflux from bladder up the ureters to the kidneys)
muddy brown castsacute tubular necrosis
ethylene glycolcalcium oxalate stones, nephrotoxic acute tubular necrosis
sickle cell diseaseFSGN, renal papillary necrosis
causes of renal papillary necrosisSickle cell, Acute pyelonephritis, Analgesics (NSAIDS), Diabetes mellitus
portal HTN in babyARPKD
berry aneurysmsADPKD
white cell castspathognomonic for pyelonephritis
eosinophilic castschronic pyelonephritis (thyroidization of kidney)
pyuria with eosinophils and rashinterstitial nephritis
eosinophiluriadrug induced interstitial nephritis
aminoglycosidesacute tubular necrosis
abdominal and flank bruitsRenal artery stenosis
causes of renal artery stenosisatherosclerotic plaques in arterial intima of elderly, fibromuscular dysplasia of women of child bearing age
test for cysteine stonesfirst check for elevated urinary cysteine levels (aminoaciduria) but also can use sodium cyanide nitroprusside test to qualitatively screen for urinary cystine. Positive test results in a red-purple discoloration.
sodium cyanide nitroprusside testqualitative screen for urinary cystine. + is red purple discoloration
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RENAL PHARM ASSOCIATIONS

Question Answer
causes HCO3 excretionacetazolamide
loop diuretic for someone with a sulfa allergyethacrynic acid
ototoxicityloop diuretics
decreased Ca+loops
increased Ca+thiazides
can be used to treat osteoporosisthiazides
hyperkalemiaK+ sparing diuretics (spironolactone and epleronone)
ACE inhibitor effect on GFRnormally decreases AII and decreases GFR by preventing constriction of EA (rise in renin and in bradykinin) BUT, cause dangerous decrease in GFR (increased creatinine) in bilateral renal artery stenosis
treats pulmonary edemaloops
beta blocker effectsdecreased renin, decreased Angiotensin I, decreased Angiotensin II, decreased Aldosterone, no change in bradykinin
ARB effectsblock AT1 receptor and inhibit effects of Angiotenin II while also disturbing the negative feedback --> increased renin, increased Angiotensin I, increased Angiotensin II, decreased aldo, no change in bradykinin --> overall decrease in GFR
thiazide side effectshyper GLUC --> hypokalemia, metabolic alkalosis, hypnatremia, hyperglycemia, hyperlipidemia, hyperuriciemia, hypercalcemia, sulfa allergy
loop side effectsOH DANG --> ototoxicity, hypokalemia, dehydration, allergy (sulfa), nephritis (interstitial), gout
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FAST ASSOCIATIONS for nephrolithiasis

Question Answer
ethylene glycolcalcium oxalate stones
radiolucenturic acid stones
vitamin C abusecalcium oxalate stones
dumbbell shapecalcium oxalate stone
envelope shapecalcium oxalate stone
coffin lidammonium magnesium phosphate stone
staghorn calculi in adultsamp stone
staghorn calculi in kidscysteine stone
hexagonal/benzene ring shapecysteine stone
leukemia/myeloproliferative disordersuric acid stones
rhomboiduric acid stone
rosetteuric acid stone
crohns diseasecalcium oxalate stones
principal site of uric acid stone formationcollecting duct due to acidic urine pH
tumor lysis syndrome can causeuric acid stone formation
calcium levels for most folks with calcium stonesnormocalcemia, (idiopathic) hypercalciuria
tx uric acid stonesalkalinization of urine with water intake and potassium citrate
potassium citrate treatsuric acid stones
tx with thiazide diureticscalcium stones
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RANDOM UROLOGY

Question Answer
tender testes indicates epididymitis
blood at beginning of urination urethral injury
blood at end of urinationprostate or bladder injury
blood during entire urination ureter or kidney injury
clots in urinebladder injury
casts or damaged RBC glomerular damage
tx interstitial cystitisamytriptiline, analgesics, behavioral/trigger avoidance
what is interstitial cystitispainful bladder syndrome (pain with filling, relieved by voiding), dyspareunia, urinary frequency, urinary urgency, worse with alcohol and exercise. the FIBROMYALGIA of urology
potter sequence is most commonly due to posterior urethral valves
diuretic abuse can be identified by these labs ...excretion of water and electrolytes. Dehydration, weight loss, orthostatic hypotension. Low serum Na+ and low serum K+, high urine Na+ and high urine K+
dehydration labshigh urine osmolality and low urine sodium
sensitive indicator of hypovolemiaBUN/Cr
pelvic fracture causesposterior urethral injury
signs of posterior urethral injuryblood at meatus, high riding prostate, scrotal hematoma, inability to void despite urge, palpably descended bladder
what should you think if varicocele doesn't reduce in recumbent statethink underlying mass, maybe RCC, get CT of abdomen
how to diagnose severe VCURvoiding cystourethrogram
how to deal with penile fracture? do retrograde urethrogram and surgical exploration
baby born with large bladder and no urine production?posterior urethral bavles
tx of posterior urethral valves?place urethral catheter to drain bladder and then do VCUG
cryptorchidism protocol?if inguinal canal, watch and wait till 1 yr, if in abdominal cavity, do orchiopexy
why do orchiopexy for cryptorchidism?will never have normal fertility. This is done to allow palpation of the testes bc at increased risk for testicular cancer
does varicocele transilluminate?NO
way to tell difference between testicular torsion and epididymitis?epididymitis has a + preen sign (decreased pain with scrotal elevation). Torsion is always painful
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