PE: not in women with classic signs, always in men because it is less common
When can you give an appropriate empirical abx in suspected UTI? (3) when to refer?
-classic symptoms in young women
-vaginal urethral discahrge
refer if it not clearly an infection
When should you do an intravenous urogram?
NEVER! Just refer them on for CT
How do you manage renal trauma?
Usually just watch and wait. The renal capsule will hold the kidney together and the tamponade pressure will limit bleeding. If you surgically incise the parenchyma you will lose this pressure. You save more renal tissue this way
If there is suspected urethral trauma what should you NEVER do? Why? What should you do instead?
DONT INSERT A FOLEY CATHETER!! you can turn a partial urethral injury into a full injury and then they need surgery! use a suprapubic catheter
How do you investigate suspected urethral injury?
retrograde urethrogram (xray contrast up the urethra)
Describe 5 things you typically see in primary nocturnal enuresis histories
bedwetting since toilet training
no daytime Sx
no bowel Sx
developmental stages are normal
80% of children achieve night time control of urination by what age?
What is the definition of a UTI?
When should you do a voiding cystourethrogram? what is it looking for?
-recurrent febrile UTI
-U/S or nuclear renal scan (which you would do first) is abnormal.
looking for vesicouretral reflux
If you have UTI and a high fever what does this suggest?
What is the most common cause of hematuria in children?
glomerulonephritis (think especially if they are post GAS-infection) and there are RBC casts and proteinuria
If testicles dont come down by this age, they are NOT going to come down on their own
In crytptorchidism. Why should you do orchidopexy by year one?
because of worry about infertility (starts decreasing at this point). Cancer risk does not change with surgery
If you see a child with hypospadius (large urethral opening on the underside of the penis) what should you never do? why?
circumcise him, because you will need the skin later on for reconstruction.
Prostate cancer is a dietary disease. three dietary things for reducing prostate cancer?
green tea, soy products, cooked tomato products
According to dee dee what drink should you suggest for preventing UTI?
What are reasonable hippie choices for treating nonbacterial prostatitis (2)
If a patient has elevated kidney function tests what should you not forget to ask about?
supplements and botanical therapies
Describe the clinical classification of urinary incontinency (5)
-urgency: strong desire to pee, but can't wait long enough for the toilet
-stress urinary: caused by increased intraabdominal pressure (e.g. cough)
-mixed urinary: combo of stress and urge
-overflow: retention, void small amounts with large residual volume
-total: complete loss of control
Describe the common lesions than can cause neurogenic bladder
spinal cord (2)
Brain: stroke, concussion, tumor, parkinson's
SC: MS, acute lesions
peripheral: sensory (diabetes), motor (polio, herpes, etc)
Describe what the following measure:
-cystometrogram: intrabladder pressure changes in response to gradual filling.
-persistent flatline: atonic bladder
-early spike: overactive bladder
-uroflowmetry: pattern of urination
Absolute indications for catheter drainage/urinary diversion (3)
-UUT deterioration or persistently poor emptying despite optimal treatment
-Unmanageable vesicouretral reflux with infection causing UUTI
-temp diversion for an abscess or fistula makes LUT unusable as a reservoir or conduit
DDx of Pre renal causes of AKI (5)
-renal artery stenosis
Vascular causes of AKI (2)
Key urine findings in these AKI types
-pre-renal: empty (hyaline) casts
-glom: RBC casts
-tubular: granular "muddy brown" casts
-interstitial: WBC casts
-vascular: "bland" urine
compare and contrast pre-renal AKI and ATN
They are both different end of the same spectrum:
pre-renal: hyaline casts, reversible, Urine Na is low
ATN: granular casts, irreversible, urine Na is not low
What are the non-glomerular renal causes of hematuria (4+)
definition of proteinuria and albuminuria
>150 mg/day protein
>30 mg/day albuminuria
Describe the 5 causes of proteinuria
Transient (benign: exercise, illness, etc)
glomerular (nephrotic, nephritic)
tubular (tubes secreting)
overflow (too much monoclonal protein, e.g. MM)
Orthostatic (benign, young people, split urine test)
What are the top 5 causes of nephrotic syndrome?
1) minimal change disease
2) focal segmental glomerular sclerosis
What is the clinical triad of nephritic syndrome?
-AKI - subacute increase in Cr
list some examples of the three types (based on path stain) of nephritic syndrome
linear: anti-GBM (goodpasture's)
granular (low C3, C4): IgA nephropathy, lupus nephritis, membranoproliferative GN, post infectious GN
What is a Normal Anion Gap Metabolic Acidosis (NAGMA)? How do you differentiate the causes
Basically if the ion gap is normal OR if the change in bicarb is greater than the change in anion gap (which basically means that there is something else causing the bicarb to dip) then there is NAGMA as well. Either RTA or Diarrhea
Urine ion gap = Na+K-Cl
-If it is neGUTive, bicarb is being made (and putting lots of Cl in the urine) and this is due to diarrhea
-If it is positive, there is low Cl meaning that bicarb is not being made because of some problem in the tubules (RTA)
Describe the 3 types of RTA
Type I (distal) - decreased acid secretion into DT
Type II (proximal) - decreased bicarb reabsorption in proximal tubule
Type IV (aldosterone) - not enough aldo production, decreases acid secretion in distal tubule and cause hyperkalemia