Renal, GU diseases

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Renal, GU diseases
2011-08-09 01:56:05
internal medicine renal GU

From Step up to medicine
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  1. Hematuria, causes
    • 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
  2. Primary glomerular disorders
    • Minimal change disease
    • FSGS
    • Membranous glomerulonephritis
    • IgA nephropathy
    • Alport's syndrome
  3. FSGS: presenting symptoms, course
    • hematuria and HTN often present
    • progressive course, resistant to steroid tx
  4. Membranous glomerulonephritis: presentation, primary and secondary causes
    • usually nephrotic syndrome presentation
    • primary disease: idiopathic
    • secondary disease: infection (hepatitis, syphilis, malaria), drugs, neoplasms, lupus
  5. IgA Nephropathy (Berger's disease): presenting symp, pathology
    • most common cause of glomerular hematuria
    • asymptomatic recurrent hematuria and mild proteinuria
    • mesangial IgA and C3 deposition
  6. Alport's Syndrome: inheritance, presenting symptoms
    • X-linked or AD
    • hematuria, pyuria, proteinuria, high-freq hearing loss, progressive renal failure
  7. Membranoproliferative GN: causes, prognosis
    • Hepatitis C infx (also Hep B, syphilis, lupus)
    • Associated with cryoglobulinemia
    • Poor prognosis, renal failure in 50%
  8. Poststreptococcal GN: presenting symptoms, diagnosis, treatment
    • 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
  9. Goodpasture's syndrome: symptoms, diagnostic triad
    • 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
  10. Wegener's Granulomatosis: symptoms
    Upper respiratory symptoms, purulent/bloody nasal discharge, oral uclers, pulmonary symptoms, renal involvement, eye disease, MSK, tracheal stenosis
  11. Wegener's Granulomatosis: diagnosis
    abnormal chest radiograph, elevated ESR, anemia, hematuria, +c-ANCA
  12. Acute Interstitial Nephritis: causes, findings
    • Usually allergic reaction to medication: PCN, NSAID, diruetics, anticoags, phenytoin, sulfonamides
    • also infx (streptococcus spp, Legionella), collagen vascular disease
    • classic findings: Rash, fever, eosinophilia
  13. RTA, type 1: pathophys, causes, treatment
    • 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
  14. RTA, type 2: pathophys, causes, treatment
    • 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
  15. RTA type 4: causes, treatment
    • 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
  16. Fanconi Syndrome: cause, pathophys, treatment
    • 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
  17. Polycystic Kidney Disease, adult onset: inheritance, symptoms, diagnosis
    • 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
  18. Renal Artery Stenosis: causes, diagnosis
    • 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
  19. Nephrolithiasis: types of stones
    • calcium- calcium oxalate or calcium phosphate
    • uric acid
    • struvite
    • cystine
  20. Calcium Stone: characteristics, causes
    • bipyramidal, biconcave ovals
    • radiodense
    • secondary to hypercalciuria and hyperoxaluria
  21. Uric acid stone: characteristics, causes
    • flat square plates, radiolucent
    • associated with hyperuricemia, secondary to gout or chemotherapy (high cell destrux)
  22. Struvite stones: characteristics, causes
    • rectangular prisms, radiodense
    • occur in patients with recurrent UTIs due to urease-producing orgs (urea --> ammonia)
    • facilitated by alkaline urine
  23. Cystine stones: characteristics, causes
    • hexagon-shaped, poorly visualized
    • genetic predisposition: cystinuria
  24. Nephrolithiasis: treatment
    • analgesia
    • vigorous fluid hydration
    • antibiotics
    • if stone does not pass in 3d or pain not controlled, extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy
  25. Nephrolithiasis: prevention (diet, pharm)
    • 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
  26. Renal cell carcinoma
    • classic triad: hematuria, flank pain, mass (less than 10%)
    • paraneoplastic syndrome: can ectopically secrete EPO, PTH-like hormone, renin, cortisol, gonadotropins
  27. Bladder cancer, risk factors
    likely to recur after removal

    • cigarette smoking
    • industrial carcinogen
    • radiation, biologic agents
    • long-term treatment with cyclophosphamide
  28. Testicular cancer, types
    • 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
  29. Tumor markers: b-hCG, AFP
    • b-hCG: always elevated in choriocarcinoma, some nonseminomatous germ cell tumors
    • AFP: increased in embryonal tumors, never in choriocarcinoma or seminoma