Terms in this set (53)
What effect does interleukin-2 have on the kidneys of most chemotherapy patients?
Causes a severe pre-renal azzotemia
What side effect involving the kidney does Mitomycin C cause chemotherapy patients?
HUS - hemolytic uremic syndrome
If you are unable to give allopurinol to a chemotherapy patient with high WBCs and antimetabolites to prevent against uric acid nephropathy, what other protective option is there?
Give furosemide with IV
What renal disease presents with slight proteinuria, eosinophilia, and eosinophils, wbcs, rbcs, and wbc casts in the urine?
Acute interstitial nephritis (aka Allergic interstitial nephritis)
EOSINOPHILIA a buzz term on the boards
Urine sediment has beta-2 microalbuminuria - not the heavy albuminuria seen with other processes.
What antibioptics are the MC culptrits in causing acute intersitial nephritis (AIN)? How does the presentation of AIN caused by NSAIDs differ than other sources?
Beta-lactams (ESP methicillin), TMP-SMX, and rifampin. Fluoroquinolones are another class. Other causes include cimetidine, thiazides, phenytoin, and allopurinol.
NSAID induced AID has nephrotic range proteuinuria with minimal glomerularchanges and presents after use for months (while other forms are more sporatic).
In a patient with glucosuria and normal serum glucose indicating chronic interstitial nephritis, what toxicity should be checked for?
What is the most impressive aspect of NSAID-induced acute nephritis?
High proteinuria - usually in the nephrotic range
Dialysis should start when a patient with chronic renal failure has advancing uremia - this usually means a patient with CrCl < ____.
< 10 mL/min
What is the MC cause of death in a a dialysis patient?
Cardiovascular problems. Infection is second. The MC cause of admissio is thrombosis and/or infection of the vascular access.
Hemodialysis patients have anemia, low vitamin D, low HDL, and high TGs. What can accumulate causing weakness, anemia, and encephalopathy?
Aluminum accumulation from antacid used.
( FYI: Patients have Vitamin D-resistant osteomalacia but dialysis does not cause the loss of Ca or Vitamin D).
What is the most common modality used for dialysis in kids and infants?
Continuous Ambulatory Peritoneal Dialysis - No AV fistula or machine needed. The patientinfuses hypertonic dextrose solution into the peritoneal cavity 4+ times/day. May cause high protein loss (12 gm/day!) and loss of water soluble viatmins (esp folic acid).
Cyclosporine decreases which of the following: T cell proliferation or function? What oral side effect is seen?
Proliferation - however it does not affect the bone marrow.
Gum hyperplasia like in phenytoin - other SE include tremors, nephro/hepato/CNS toxicities, and HTN.
Erythromycin, Ketoconazole, and diltiazem Increase/Decrease Cyclosporin levels?
Increase P-450 system used
Phenytoin, carbamazepine, rifampin, and phenobarbital Increase/Decrease Cyclosporin levels?
Decrease P-450 used (seizure meds and rifampin)
What renal transplant graft rejection preventing medication has a SE of being diabetogenic?
Which renal transplant graft rejection preventing medication affects the bone marrow which can lead to leukopenia. Especially is used with Allopurinol?
Azathioprine - allopurinol increases its levels
Which renal transplant graft rejection preventing medication can lead to hyperlipidemia therefore requiring lipid monitoring?
What orthopedic SE can occur as a complication of renal transplant? Often presents as knee pain.
Aseptic necrosis of the femoral head.
For recurrent stones check the following in the urine: volume, Cr, Ca, Na, urea, uric acid, ____, and ____.
citrate - citrate is a mjor inhibitor of stones (Citrate chelates calcium, RTA leads to acidosis which causes low citrate thus stones).
What type of RTA is linked to renal stones?
Distal Type 1 (and acetazolamide which mimicks it!)
What are the two MC ingestions that cause of increased urinary oxalate and thus calcium oxalate stones?
Vitamin C and Ethylene glycol
Streatorrhea can also cause this because free fatty acids in the bowel chelate calcium allowing the oxalate to be absorbed and excreted in the urine. (think short gut)
What diuretics help in the treatment of renal stones?
thiazides - potassium citrate can als help.
Should you lower dietary calcium intake in patients with calcium renal stones?
NO!!! Common Question on the boards! This increases oxaluria leading to stones.
What shape are the following crystals on microscopy:
Oxalate = Square with X in middle
Sturvite = Coffin Lid
Cystine = hexagon
What infection is MC linked to sturvite renal stones?
Proteus - others include pseudomonas, yeast, and staph
"PYSS---- like PISS"
Most stones form in acidic environments and can be treated by alkalinizing the urine, what two types are the exceptions?
All kinds except for sturvite and calcium phosphate stones
A finding of renal pelvis dilation without uretral dilation on an ultrasound is diagnostic of what?
Ureteropelvic Junction Obstruction (UPJ) - Seen in utero or in infants.
Abdominal Pain after drinking fluids can be a sign of UPJ (ureteropelvic Junction Obstruction). What is the treatment?
Watch it until at least 4-6 months to see if it improves unless the renal pelvis dilates massively (>30 mm). If conservative management has not resulted in resolution of the obstruction by age 4-5 then perform pyeloplasty.
Megaureter refers to dilated ureters > _mm in size.
7 mm - only intervene surgically if there is reflux with recurrent infections or high-grade reflux.
What urological abnormality that is MC in girls shows up as a "cobra head" on IVP?
A ureterocele - the cysctic dilation of the intravesical submucosal ureter looks like a snake's head from the side. If they occur in a duplex system they often present as a febrile UTI. Management varies.
Where does a retrocaval ureter occur?
Occurs when the upper 1/3 of the right ureter passes behind the vena cava and becomes obstructed. It is only clinically significant if the obstruction results in hydronephrosis.
What does VURD syndrome stand for?
Valve, Unilateral, Reflux, Dysplasia - refers to patients with unilateral vesicoureteral reflux from posterior urethral valves. One kidney is affected while the other is fine so renal function is usually preserved.
What are the urological complications that make up Prune Belly Syndrome?
Not just the abdominal wall!
dilation of the prostatic urethra, bladder, and ureters
Many need renal transplant at some point in time, often need vesicostomies with decreased function.
What further workup is needed for a newborn with hypospadias?
TRICK QUESTION - No imaging is required to look at the upper GU system since it is usually an isolated event.
Perform surgery before 2 years of age.
By what age should most foreskins be easily retractable?
4 years old - phimosis can occur if forcible retraction occurs prior to that.
What is posthitis?
prepubital inflamattion and cellulitis of the penis - if it progresses to the glans it is called balantitis. Treat with topical and/or oral antibiotics and steroid cream.
What is the treatment for meatal stenosis?
Ventral meatotomy- look for evidence of straining and assess the strength and angle of the urinary stream for diagnosis - you can't diagnose it just by looking.
Microphallus is defined as having a stretched penile length from the pubis symphysis to the tip of the penis of < ____ cm.
< 2.5 cm
By what age do most children have control of micturition?
4-5 years old = most can control their bladder
What is the most likely cause of incontinence in a 6 year old that presents with normal intentional voiding with continuous urinary leakage?
What is the most likely cause of incontinence in a 6 year old that presents with voiding with bounding up and down on the soles of her feet?
What is the most likely cause of incontinence in a 6 year old with incontinence that presents with incontinence with coughing, sneezing, lifting, exercising, and giggling?
What is the workup of children > 5 years old with daytime incontinence?
Ultrasound of the kidneys and bladder. Perform urodynamic evaluation if you suspect neuropathic abnormailities (rare). Obv get a u/a first.
For sensory defect or detrusor instability causing incontinence in a patient > 5 years old, you can treat the patient with timed voiding or what medication?
For giggling incontinence you can teach perineal exercises or try what two medications?
Anticholinergics or alpha-adrenergic agonists.
What two medications are approved for nocturnal enuresis?
oxybutynin (ditropan - an anticholingeric) & imipramine (a TCA)
NOTE: DDAVP is not longer FDA approved due to safety issues w/hyponatremia.
In testicular torsion, irreversible changes occur within ___ hours. With infarction almost universal within 24 hours.
Note: Contralateral testicular fixation is required as well due to significant risk of bilateral pathology.
A neonate with a painless, swollen, discolored hemiscrotum likely has had what process occur?
Neonatal testicular torsion - in neonates it can involve the entire spermatic cord and testis outside the tunica vaginalis and is called an "extravaginal torsion". Older kids usually have an "intravaginal torsion" that occurs within the tunica vaginalis only. Salvage surgery is rarely successful.
A patient presenting with testicular pain has a blue discoloration on the top portion of the testicle. What is the likely diagnos(es) and treatment?
Torsion or the appendix testis or the appendix epididymis.
Usually see a palpable, tender nodule on the top portion of the testicle. The "blue dot sign" is a buzz term. They usually respond on their own within several days.
What is the difference between "true" undescended testes and "ectopic" testes?
True = intraabdominal or in the inguinal canal
Ectopic = distal to the external inguinal ring but not in the scrotum
What cancer are undescended testes especially at risk for? What age is treatment usually performed?
Treatment usually done by 1-2 years old
FYI: can treat with IM hCG in a series of injections as an alternative
Hernias and hydroceles usually resolve by age __. If not you should have them surgically repaired.
1 years old
Treat inguinal hernias on diagnosis
Varicoceles form on the testivlar vein and pampiniform plexus of the spermatic cord. They are unusual prior to puberty. What is the management?
Repair them if the child has atrophy or retarded frowth of the left testis (usually occur on the left). Also follow with semen analysis.