Renal
WBC casts in urine – AIN or pyelonephritis
Uremia four manifestations for dialaysis
1. HUS micopathic angiopathic hemolytic anemia, platelets clumping and red blood cells come by and sheer thrombocytopenia and anemia, can also be precipitated by enterohemorrhagic e. coli when treated with fluoroquinolones
2. Uremic Pericarditis
3. Platelet dysfunction
4. Asterixis
Manifestations of uremia treated with dialysis
CKD causes: Hypertension and Diabetes Mellitus
Other dialysis indications
Acidosis refractory pH < 7.2
Electrolytes potassium w/ EKG changes temporize with calcium gluconate, D50, insulin, bicarbonate kayexalate
Ingestions: renal failure such as salicylates or ethylene glycol
Overload: volume overload causing pulmonary edema, temporize with nitrates and mega doses of Lasix (IV 160-200mg IV) push slowly to avoid ototoxicity
Uremia – confusion, pericarditis, seizures, platelet dysfunction with severe bleeding, intractable N/V
Intoxications submnemonic
MALE
Methanol
Aspirin
Lithium
Ethylene glycol
Four substances when intoxicated dialyzable
AIN
Nsaids, Diuretics, Antibiotics
FEAR: fever, eosinophilia, azotemia, rash
Azotemia – kidney injury
Acute interstitial nephritis – recently took drugs now has hematuria with white blood cell casts in acute interstitial nephritis or pyelonephritis, rash
ATN
Hypoxia / toxins (shock > pre-renal azotemia BUN / Cr > 20) muddy brown casts, Txt Intravenous fluids, tubules can dry up and necrose
Vignette – went into shock and developed acute kidney injury, microscopic urinalysis muddy brown casts, treated with iv fluids
Renal tubular acidosis – metabolic acidosis anion gap acidosis or nonanion gap metabolic acidosis
Non anion gap metabolic acidosis are diarrhea poop out the bicarb, Renal tubular acidosis
Three types RTA type 1, 2, and type 4
RTA type 1 should H hydrogen, underexcretion of Hydrogen, lock it up, RTA 1 = H+ = stONEs
RTA type 2 = BI = Bicarb two, cannot absorb bicarb properly, makes you acidotic
RTA type 4 = A L D O = hypoaldosterone, hyponatremia, hyperkalemia, aldosterone causes excretion of H + I, absorb sodium, excrete potassium, and hydrogen, when there is no aldosterone you get opposite, hypoaldosteronism hydrogen gets kept, hyperkalemia
Metabolic Alkalosis – check urine chloride, high kidneys keeps going RAAS, Urine chloride low GI problem such as vomiting vomiting acid
Steatorrhea can bind calcium saponification, oxalate + calcium bend at terminal ileum making it insoluble pooping out calcium oxalate, fat binds calcium and oxalate gets reabsorbed goes to kidney and finds calcium in the tubule making calcium oxalate insoluble and making kidney stone
High fat foods predisposes to calcium oxalate kidney stones
Calcium oxalate stones eating a lot of calcium goes to terminal ileum binds all the oxalate and you can poop out calcium oxalate. Low calcium diet, oxalate goes back reabsorb and goes to the kidney. Kidney stones – low Salt, low fat, high calcium, drink a lot of water
Cancers
Elderly male smokes a lot, gross painless hematuria
Renal cell carcinoma or bladder carcinoma
RCC – hematuria flank pain abdominal mass, CT of abdomen and treat with nephrectomy,
no abdominal mass or flank pain, bladder cancer transitional cell carcinoma, carcinogens trapped in urine and trapped in bladder
Bladder cancer – gross painless hematuria in a chronic smoker without signs of RCC – cystoscopy
Irregularly shaped testicle, painless testicle, diagnose with scrotal ultrasound may be a cancer, next step is inguinal orchiectomy do not want to biopsy because of potential for seeding (DO NOT BIOPSY)
Testicular torsion vs epididymitis
Twisting around spermatic cord, acute onset testicular pain, spermatochord is nontender, worse with elevation
Cremasteric reflux, stroke medial of upper thigh, scrotum normall raise, that reflex is absent
Epididymitis stroking scrotum reflex is present, infection will have fever, upon elevation is relieved.
Testicular pain (torsion vs. epididymitis) torsion: acute onset, cord not tender, no cremasteric reflex, worse with scrotal elevation-> dx: if unclear get doppler US (decreased blood flow), if very clear>tx: surgery (bilateral orchiopexy); epididymitis: tender cord, better when elevating scrotum, may have fever
Bilateral orchiopexy because the other one will likely have torsion as well
Epididymitis vs orchietis verse prostatitis
Three can all get inflamed, in a young person verse old person. Young person gonorrhea and chlamydia, older person main culprit is e. coli
Young < 35 older > 35, and sexual history
Young CTX + azithromycin, older fluoroquinolone
Comments
Post a Comment