Koprucki's Kidneys
Patient A's GFR is 47.
Patient B's GFR is 18.
What are their respective CKD classifications?
Patient A- CKD3a
Patient B- CKD4
1- >90
2- 60-89
3a- 45-59
3b- 30-44
4- 15-29
5- <15
What mL on ultrasound indicated urinary retention
300mL
On catheterization- 200 mL
What is USPSTF recommendations on screening for prostate cancer?
GRADE C- patient shared-decision making to undergo PSA screening from ages 55-69
Most common types of renal calculi?
Calcium oxalate 67-75%
Calcium phosphate 16-18%
Uric acid 5-11%
Struvite 2-10%
Cystine <1%
First line imaging study for patient with testicular pain, nausea, vomiting, and absent cremasteric reflex?
Color duplex US
Testicular torsion
A patient with CKD is started on lisinopril, two weeks later his creatinine rises from 1.8 to 2.2. What is the best next step?
Continue the ACE and monitor- allow mild increase in Cr up to 30%, stop if greater or if hyperkalemic
First line treatment for overactive bladder in females?
Beta-3 adrenergic agonists- mirabegron (preferred over antimuscarinics for anti-cholinergic side effects (risk of dementia))
antimuscarinics- oxybutynin
Pelvic floor exercises
Most common renal malignancy in children
Nephroblastoma (Wilms tumor)
Common between 2-5 years. Large abdominal mass, hematuria, HTN
Stages 1-3 chemo, 4-5- surgery/radiation/chemo
What should you tell patients with calcium based stones to do to their dietary intake of calcium to prevent further formation?
maintain normal levels of Calcium
Increase fluid intake, decrease salt
First line treatment for pyelonephritis in patient with no allergies
Cefuroxime or rocephen
Allergies to beta-lactam- cipro, levo, or Bactrim
50 year old male with DM2 and HTN has a GFR of 55 and urine albumin-cr ratio of 330. What is the most important intervention to slow CKD progression?
Ace or Arb for BP control
Name 3 treatment options for acute simple cystitis in a female adult
Nitofurantoin (BID x 5 days), Bactrim (DS tablet BID x 3 days), Fosfomycin (one dose), pivmecillinam
What are the risk factors of urothelial carcinoma of the bladder
Occupational carcinogens (10-20% of all bladder cancers)
Chronic cystitis
HPV
Patient A has a renal calculi of 4mm and UTI
Patient B has a renal calculi of 8mm
Which patient requires urology consultation?
Patient A
Normally:
Stones <5 pass spontaneously
5-10mm- flomax/pain control, pass on own
>10mm- Urology for intervention
Urology if- pain uncontrolled, UTI, AKI, N/V, or not making urine
Patient with gross hematuria in ED- next steps
Initial Airway/breathing/circulation assessment and stabilization
Urology- bladder irrigation, cystoscopy, imaging
According to the American Diabetes Association when should metformin be discontinued in diabetic patients with CKD?
When GFR falls below 30, and dose reduction from GFR of 30-44.
Indications for TURP (or other procedures) in BPH
symptoms refractory to medical therapy
Upper urinary tract compromise- hydronephrosis, renal insufficiency
Recurrent UTIs or calculi, Persistent gross hematuria
First line treatment- Lifestyle- medication changes, no fluid before bed, limit caffeine/alcohol
Alpha-1 adrenergic blockers (flomax) + 5-alpha reductase inhibitors (finasteride)
Most common renal malignancy and first line-treatment option
Renal cell carcinoma
Typically resistant to chemo/radiation
Surgical resection is first line
Staghorn calculi are most commonly composed of what?
Struvite (magnesium ammonium phosphate)
(uncommon, but more common in women with chronic UTIs)
Country of origin of "potpourri"
French, will accept Spanish as it is a French term referring to a Spanish stew
Where do loop, thiazide, and potassium sparing diuretics work in the kidney?
You must get 2/3
Loops- thick ascending limb of loop of Henle on Na-K-2CL transport
Thiazides- in distal convoluted tubule on Na-Cl transport
Potassium-sparing- in distal nephron (connecting tubule and collecting duct) on aldosterone-sensitive sodium channels
At what age should a male infant be referred to pediatric urology for undescended testes?
4 months. Spontaneous descent is rare after 4 months, changes to fertility may begin before one year of age.
Complications include- hernia, testicular torsion, lower fertility, testicular cancer.
Surgical management recommended ASAP after 4 months and completed before age 2 at the absolute latest.
Name the AD neurocutaneous syndrome that presents with bilateral renal cell carcinoma, hemangioblastomas and pheochromocytomas
Von hippel-lindau syndrome
Management of 11mm stone in a G1P0 at 12+2 patient with intractable pain but no infection?
Stent in 1st trimester, delay stone removal for 2nd or 3rd trimester.
Stent exchange is necessary every 4-6 weeks due to higher risk of stent encrustation during pregnancy.
Ideally, delay until after delivery. Can consider for intractable pain or recurrent UTIs.
What is dialysis disequilibrium syndrome?
Development of acute cerebral edema secondary to the rapid extraction of osmotically active substances (urea, NaCl) from the blood
Increased ICP (HA, vomiting, papilledema, AMS)
Risk factors- first dialysis, extremely elevated BUN, metabolic acidosis, neurologic abnormalities, hyperglycemia
Prevented with slow HD and using different solutions