GENITOURINARY TIKI TAKA _________________________ . GLOMERULONEPHRITIS common criteria: _____________________________________ 1- RBCs in urine. 2- Red cell casts in urine.

3- Mild degree of proteinuria (< 2 g. / 24 hs.). 4- Edema. 5- May lead to nephrotic $. 6- Most accurate diagnosis by --> RENAL BIOPSY. * GOOD PASTURE's $YNDROME: ___________________________ . Cough, hemoptysis, shortness of breath & lung findings. . Dx: Best initial test: Anti-basement membrane Abs. . Dx: Most accurate test: Renal biopsy -> Linear deposits. . Tx: PLASMAPHARESIS & steroids. * CHURG STRAUSS $YNDROME: __________________________ . ASTHMA, cough, EOSINOPHILIA + Renal abnormalities. . Dx: Best initial test: CBC for eosinophil count. . Dx: Most accurate test: Renal biopsy. . Tx: Glucocorticoids "prednisone". * WEGENER's GRANULOMATOSIS: ____________________________ . URT infections + LRT infections. . URT infections -> sinusitis & otitis. . LRT infections -> cough, hemoptysis, Abnormal CXR. . It is a systemic vasculitis so it may involve the joint, skin, eye. . Dx: Best initial test: C-ANCA "Anti-neutrophil cytoplasmic Ab". . Dx: Most accurate test: Renal biopsy. . Tx: Steroids & cyclophosphamide. * POLYARTERITIS NODOSA: ________________________ . Systemic vasculitis. . Involvement of all organs EXCEPT LUNGS !!!!! . Renal - myalgia - GI bleeding - purpura - stroke - uveitis - neuropathy. . MULTIPLE MOTOR & SENSORY NEUROPATHY + PAIN. . Dx: Best initial test: ESR & inflammation markers. . Dx: Most accurate test: Renal biopsy or SURAL N. biopsy. . Test for HEPATITIS B & C (Ass. e' PAN). . ANGIOGRAPHY showing BEADING can spare the need for biopsy. . Tx: Steroids & cyclophosphamide. * IgA NEPHROPATHY = BERGER's DISEASE: ______________________________________ . Painless recurrent hematuria. . ASIAN pt. . H/O of very recent viral upper RTI. . Dx: Best initial test: ++ IgA ! . Dx: Most accurate test: RENAL BIOPSY IS ESSENTIAL ! . Normal complement levels. . Tx: Steroids.

* HENOCH - SCONLEIN PURPURA: _____________________________ . Adolescent or child. . Raised, non-tender purpuric skin lesions "buttocks". . Abdominal pain. . Possible bleeding. . Joint pain. . Renal involvement. . Dx: Best initial test: CLINICAL SUSPENSE ! . Dx: Most accurate test: R. biopsy "Not necessary". . Tx: No ttt - Resolves spontaneously. * POST-STREPTOCOCCAL GLOMERULONEPHRITIS = PSGN: ________________________________________________ . Dark urine "Tea-colored or cola-colored". . Periorbital edema & hypertension. . H/O of Throat or skin infections 10 - 20 days ago. . Dx: Best initial test: Anti-streptolysin O test "ASLO", . Anti-DNase & Antihyaluronidase. . Low complement levels. . Dx: Most accurate test: R. biopsy sh'd n't be done bec. blood tests r suffeci ent. . Tx: Antibiotics e.g. PENICILLIN. . CONTROL HYPERTENSION & FLUID OVERLOAD with diuretics. * CRYOGLOBULINEMIA: ____________________ . H/O of HEPATITIS "C" with renal involvement. . Joint pain & pruritic skin lesions & Hepatosplenomegaly. . Dx: Best initial test: Serum cryoglobulin componet levels, . immunoglobulins & light chains, IgM. . Low complement levels esp. "C4". . Dx: Most accurate test: R. biopsy. . Tx: Treat HEPATITIS C with INTERFERON + RIBAVIRIN. * LUPUS (SLE) NEPHRITIS: _________________________ . H/O of SLE !! . N.B. Drug induced lupus spares the kidneys & the brain "V.V.V. imp.". . Dx: Best initial test: ANA & Anti-Ds DNA. . Dx: Most accurate test: RENAL BIOPSY. . R. biopsy is v. imp. in cases of SLE to determine the extent of the disease & ttt. . Tx: ----- Sclerosis only -------------------------------> No ttt. ----- Mild dis., early stage, NON proliferative ----> Steroids. ----- Severe dis. late stage, PROLIFERATIVE --------> MYCOPHENOLATE. * ALPORT $YNDROME: ___________________ . CONGENITAL with family H/O of renal failure. . Recurrent episodes of hematuria. . Eye & ear problems e.g. deafness. . No specific therapy. * HEMOLYTIC UREMIC $YNDROME: ____________________________ . H/O of E-coli 0157:H7 . Intra-vascular hemolysis (fragmented cells on smear). . ++ Creatinine.

. -- platelets. * THROMBOTIC THROMBOCYTOPENIC PURPURA "TTP": _____________________________________________ . HU$ + . Fever + . Neurological abnormalities. . Tx: Plasmapharesis in severe cases. ___________________________ . ARF : PRE-RENAL AZOTEMIA: ___________________________ .. Presentation: _________________ ... Elderly pt with poor oral intake living in nursing homes taking medications e.g., ... NSAIDs, ACE Is & diuretics causing intravascular volume depletion. ... leading to renal glomerular vasoconstriction. .. Causes: ___________ . 1- Hypotension "SBP <90 mmHg". . 2- Hypovolemia "dehydration or blood loss". . 3- Low oncotic pressure " -- Albumin". . 4- Congestive heart failure. . 5- Constrictive pericarditis. . 6- Renal artery stenosis. .. Dx: _______ ... BUN:Creatinine ratio > 20:1. ... Urinary Na is low < 20. ... Fe Na < 1. ... Urine osmolality > 500. ___________________________________________________ . ARF : POST-RENAL AZOTEMIA = OBSTRUCTIVE UROPATHY: ___________________________________________________ .. Causes: ___________ . 1- Stone in the bladder or ureter. . 2- Strictures. . 3- Cancer of the bladder, prostate or cervix. . 4- Neurogenic bladder "Atonic or non-contracting due to MS or DM". .. Dx: _______ ... Similar to pre-renal azotemia. ... Distended bladder on exam. ... Large volume diuresis after passing a urinary catheter. ... Bilateral hydronephrosis on U/$. ______________________________________________________ . ARF : INTRA-RENAL AZOTEMIA = ACUTE TUBULAR NECROSIS: ______________________________________________________ .. Dx: _______

... BUN/Creatinine ratio 10:1. ... Urinary Na > 40. ... Urine osmolality < 350. * TOXIN INDUCED RENAL INSUFFECIENCY: _____________________________________ . Aminoglycosides: Gentamycin, tobramycin, Amikacin (--Mg is suggestive). . Amphotericin. . Contrast agents (--Mg is suggestive). . Chemotherapy e.g Cisplatin. . Urinalysis: MUDDY BROWN or GRANULAR CASTS. * ALLERGIC INTERSTITIAL NEPHRITIS: ___________________________________ . Hypersensitivity reaction to medications e.g. Penicillin or Sulfa drugs. . Phenytoin, Allopurinol, Cyclosporin, Quinidine & Rifampin. . FEVER & RASH & ARTHRALGIA. . Dx: WRIGHT stain or HANSEL's STAIN of the urine ---> EOSINOPHILIA. . WBCs casts are common but RBCs cast are rare. . Tx: Discontinue the offending drug. * RHABDOMYOLYSIS: __________________ . Large volume muscular necrosis. . causes direct toxic effect of myoglobin on the kidney tubule. . H/O of crush injury or seizure. . H/O of prolonged immobility. . H/O of recent start of STATIN for hyperlipidemia. . Best initial test: Urinalysis -> Large amounts of blood with no cells. . Relative absence of RBCs on urine microscopy. . ++ CPK (MOST SPECIFIC FINDING). . Most accurate test: Urine myoglobin > 20000. . Rhabdomyolysis --> ++ K & -- Ca. . In case of hyperkalemia .. Do EKG to exclude arrhythmia. . Tx hyperkalemia with IV Ca gluconate, insulin & glucose. . Tx: BOLUS OF NORMAL SALINE, MANNITOL. . ALKALINIZATION OF URINE. * OXALATE CRYSTAL INDUCED RENAL FAILURE: _________________________________________ . H/O of suicide trial by anti-freeze ingestion "ethylene glycol". . intoxication due to metabolic acidosis & ++ in anion gap. . Best initial Dx: Urinalysis --> ENVELOPE SHAPED OXALATE CRYSTALS. . Best initial Tx: ETHANOL or FOMEPIZOLE with immediate dialysis. * URIC ACID CRYSTAL INDUCED RENAL FAILURE: ___________________________________________ . H/O of chemotherapy for lymphoma causing tumor lysis $. * CONTRAST INDUCED RENAL FAILURE: __________________________________ . H/O of radiological procedure with contrast. . H/O of elderly pt with DM or HTN. . CREATININE just above normal 1.5 - 2.5. . Tx: HYDRATION with Normal saline & Bicarbonate & N-Acetyl cysteine. . NON-IONIC contrast agent is associated with less severity of nephropathy. * NSAIDs INDUCED NEPHROPATHY Mechanism: ________________________________________

. . . .

Direct toxicity & ATN. Allergic interstitial nephritis with eosinophils in the urine. Nephrotic $. Afferent arteriolar VC.

. NEPHROTIC $YNDROMES & THEIR ASSOCIATIONS: ___________________________________________ . CHILDREN -------------------------------> . ADULTS & CANCERS "LYMPHOMA" ------------> . HEPATITIS C ----------------------------> . HIV, HEROIN USE ------------------------> . UN-CLEAR -------------------------------> . STEPS FOR PROTEINURIA EVALUATION: ___________________________________ . Repeat the urine analysis. . Evaluate for orthostatic proteinuria. . Get a protein/creatinine ratio. . Perform a renal biopsy.

Minimal change disease. MEMBRANOUS. MEMBRANOPROLIFERATIVE. FOCAL SEGMENTAL. MESANGIAL.

. INDICATIONS OF DIALYSIS: __________________________ . Hyperkalemia. . Metabolic acidosis. . Uremia with encephalopathy. . Fluid overload. . Uremia with pericarditis. . Toxicity with a dialyzable drug e.g. Lithium , ethylene glycol or Aspirin. . URGE INCONTINENCE: ____________________ . Pain followed by urge to urinate. . Not related to coughing, laughing or standing. . Dx: Urodynamic pressure monitoring. . Tx: Behaviour modification + Anti-cholinergics. . STRESS INCONTINENCE: ______________________ . NO PAIN. . Follow coughing or laughing. . Dx: Observe leakage with coughing. . Tx: KEGEL exercise + Estrogen cream. . SEVERE HYPERKALEMIA: ______________________ . Denoted by PEAKED T waves on EKG. . Tx: I.V. CALCIUM GLUCONATE. . NEPHROLITHIASIS: __________________ . Sudden onset flank pain. . Colicky, may be referred to the scrotum. . Nause, vomiting. . Cola colored urine. . Dx: Non contrast CT Abdomen (Preferred to X-ray as it detects Radio-lucent st ones). . Tx: Relieve the pain by NSAIDs. . Tx: Stones < 5 mm -> pass spontaneously with conservative ttt. . Best conservative ttt is FLUID INTAKE > 2 LITERS / day.

. DEHYDRATION: ______________ . Altered mental status. . Dry oral mucosa. . ++ Na & ++ K. . BUN / Creatinine > 20 "Pre-renal azotemia". . More common in old age due to -- thirst response to dehydration. . Tx: I.V. sodium containing CTYSTALLOIDS = NORMAL SALINE = 0.9 % NaCl. . HERNIATED INTERVERTEBRAL DISK may cause URINE RTENTION due to SEVERE PAIN: ____________________________________________________________________________ . Unilateral radicular pain in a dermatomal distribution. . Bk tendrness due to spasm of the paraspinous muscles. . Cauda Equina $ can be excluded by absence of saddle anesthesia & intact sphin cter tone. . There will be pain on coughing or chest movement. . So, severe pain in a pt.with a mild urinary obstruction, such as BPH, . may cause urinary retention due to inability to Valsalva. . CHLAMYDIAL URETHRITIS: ________________________ . Middle aged female. . H/O of mutliple sex parteners. . Dysuria & urinary frequency. . Urinalysis: Absent bacteriuria. . Urine culture < 100 colonies. . HONEYMOON CYSTITIS: _____________________ . Urinary infection most commonly arises by an ascending route. . Sexual intercourse is one of the most imp. risk factors of un-complicated UTI s. . due to its mechanical effect of introducing uropathogens into the bladder. . RENAL CELL CARCINOMA: _______________________ . Triad of flank pain, hematuria & palpable abdominal renal mass. . Scrotal varicoceles "Lt sided" r seen in 10 % of pts. . Varicoceles typically fail to empty when the pt is recumbent due to tumor obs truction. . So presence of non emptying varicocele make you suspect mass obstruction by a tumor ! . Para-neoplastic symptoms e.g. Thrombocytosis, hypercalcemia & cachexia. . Dx: Abd. CT . . BENIGN PROSTATIC HYPERPLASIA = BPH: _____________________________________ . Lower urinary tract symptoms e.g. frequency. nocturia, hesitancy & weak strea m. . Hypertrophy usually starts at the CENTRAL part of the prostate. . Rectal exam: Smooth & firm enlargement of the prostate. . N.B. prostate cancer rectal ex: (prostate nodules - induration - asymmetry). . 1st initial step of management is placement of a FOLEY's catheter. . Tx of BPH: Alpha blockers. . Tx of severe cases: Surgery TURP. . Current recommendations: All BPH pts sh'd have urinalysis & serum creatinine, . to assess for urinary infection, obstruction or hematuria. . If there is woresening of creatinine, . Abdomial ULTRA$OUND is the initial test of choice to assess for HYDRONEPHROSI

S. . Hydronephrosis is caused by urinary obstruction & renal failure. . HYPERKALEMIA (++ K > 5): __________________________ . Drugs ++ K (ACE Is - NSAIDs - K sparing diuretics e.g. spironolcatone & Amilo ride). . Pseudohyperkalemia (Hemolyzed sample during venipuncture). . Hyperkalemia (K > 6.5) may cause cardiac toxicity . . EKG -> Peaked T waves & progressive widening of the QRS complex. . Tx: IV CALCIUM GUCONATE. . Tx: Insulin - B2 agonists. . Tx: Na HCO3. . Dialysis in severe cases. . REMOVAL OF K FROM THE BODY -----> KAYEXALATE ! . The most common cause of death in RENAL DALYSIS & TRANSPLANTATION: ____________________________________________________________________ . is CARDIOVASCULAR complications. . ANALGESIC NEPHROPATHY: ________________________ . Woman with chronic headaches on NSAIDs. . Presenting with painless hematuria. . NSAIDs -> VC of renal medulla vessels -> RENAL PAPILLARY NECROSIS. . CHRONIC TUBULO-INTERSTITIAL NEPHRITIS. . AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPCKD): ________________________________________________________ . HYPERTENSION + PALPABLE kidneys "BILATERALLY". . Multiple renal cysts & intermittent flank pain. . Liver enlargement due to cystic involvement "Most common extra-renal manifest ation". . Hematuria, UTIs & nephrolithiasis. . Death may occur due to intracranial bleeding caused by rupture of berry anury sm. . GLOMERULOPATHY associated diseases: _____________________________________ . Lymphoma ----------------------------> . Lymphoma complicated by nephrotic $ -> . HIV ---------------------------------> . AFRICAN AMERICANS -------------------> . OBESE -------------------------------> . HEROIN ADDICTS ---------------------->

Membranous nephropathy. Minimal change nephropathy. Focal & segmental glomerulosclerosis. Focal & segmental glomerulosclerosis. Focal & segmental glomerulosclerosis. Focal & segmental glomerulosclerosis.

. MULTIPLE MYELOMA: ___________________ . Old age pt 65 ys with anemia, fatigue & bony pains (back & chest). . Renal insuffeciency due to obstruction of the distal & collecting tubules by, . BENCE JONES PROTEINS "PARA-PROTEINS". . Old pt + bony pain + renal failure + Hypercalcemia = Multiple myeloma. . AMITRIPTYLINE INDUCED URINE RETENTION: ________________________________________ . Amitriptyline is TCA with anticholinergic properties, . it will lead to -- dterusor ms contraction & prevent urethral sphincter relax ation. . leading to urine retention. . Tx: Discontinue Amitriptyline + urinary catheterization.

. OVER-FLOW IN-CONTINENCE: __________________________ . May be due to DM autonomic neuropathy causing a denervated bladder -> urine r etention. . The a-contractile hypotonic bladder gradually overdistends, . When the bladder pressure rises above the urethral pressure, . Urine is lost until the pressure equalizes ! . These events occur in a cyclic manner occuring at day & night. . Exam may reveal a distended bladder. . post-voidal residual urine volume is high. . Associated other D.M. manifestations e.g. gastropathy, nephropathy & retinopa thy. . D.M. is the 1st leading cause of nephropathy, kidney biopsy will show: ________________________________________________________________________ . GLOMERULAR HYPERFILTRATION is the EARLIEST renal abnormality detected. (UW Q! ). . ++ extracellular matrix, basement membrane thickening, mesangial expansion & fibrosis. . DIABETIC MICRO-ANGIOPATHY. (UW Q!) . Proteinuria & progressive -- in GFR. . Glomerulosclerosis. (UW Q!). . HTN is the 2nd leading cause of nephropathy, kidney biopsy will show: _______________________________________________________________________ . Arterio-sclerotic lesions of the afferent & efferent renal arterioles & capil laries. . NO proteinuria. . HEMATURIA: ____________ . Initial "Beginning of urination" -----> Urethral lesion e.g. Urethritis. . Terminal "At the end of voiding" -----> Prostatic or Bladder lesion e.g. cystitis. . Total "during the entire process" ------> Ureters or kidneys lesion. . The presence of clots in urine is more consistent with bladder not renal lesi on. _______________________ . URINARY TRACT STONES: _______________________ 1.CALCIUM OXALATE STONES: __________________________ . Radio-opaque. . envelope shaped on microscopy. . Small bowel disease, surgical resection or chronic diarrhea, . may lead to malabsorption of fatty acids & bile salts, . which are important for chelating calcium, . so, when Calcium is free, it binds with oxalic acid, . forming Ca Oxalate stones. 2.CALCIUM PHOSPHATE STONES: ____________________________ . common in primary hyperparathyroidism. 3.URIC ACID STONES:

____________________ . When urine is acidic. . When there is ++ cell turnover. . Radio-lucent on X-ray. . Tx: Hydration. . Tx: Alkalinization of urine to pH > 6.5 by oral POTASSIUM CITRATE. 4.CYSTEINE STONES: ___________________ . ++ cysteine "Inborn error of metabolism". . +ve family H/O. . Recurrent stones since childhood. . HARD & RADIO-OPAQUE stones. . HEXAGONAL CRYSTALS on urine analysis. . +ve Urinary cyanide nitroprusside test. 5.STRUVITE STONES: ___________________ . Formed when urine is ALKALINE. . Bec. of infection with urease producing bacteria e.g. PROTEUS. . H/O of recurrent UTI. . NEPHROTIC $YNDROME: ______________________ . Proteinuria ( > 3- 3.5 g/day - most imp. criterion). . Hypoalbuminemia. . Edema. . Hyperlipidemia & lipiduria. . Pathology: Altered permeability of the glomerular membrane. . Children : Minimal change disease. . Adults : Membranous glomerulopathy. . Complicated by HYPERCOAGULABILITY -> Thrombo-embolic manifestations. . Accelerated atherosclerosis. . Venous or arterial thrombosis & even pulmonary embolism. . Other complications: Ptn malnutrition - iron resistant microcytic hypochromic anemia. . Other complications: ++ susceptibility to infections & vitamin D defeciency. . POST-OPERATIVE OLIGURIA: __________________________ . Low urine out-put volume with lower abdominal pain. . Most common cause is post-renal i.e. bladder out-let obstruction. . Placement of a bladder catheter can rapidly improve symptoms "1st step done". . Never to start fluids before catheterization as it may worsen the condition. . BLUE TOE $YNDROME = CHOLESTEROL EMBOLIZATION: _______________________________________________ . H/O of cardiovascular disease with recent surgical intervention or angiograph y. . Atherosclerotic plaque may break off & enter the circulation. . Abdominal pain & nausea. . Livedo reticularis = cyanotic dicolouration of the skin . ARF may occur due to renal artery embolization. . ++ urea & creatinine levels. . -- complement levels. . ++ eosinophils. . N.B. BLUE TOE $ sh'd n't be mis-diagnosed with CONTRAST INDUCED NEPHROPATHY: ______________________________________________________________________________ . Absence of livedo reticularis, abd. symptoms, high eosinophils & -- complemen

t. . ACUTE PYELONEPHRITIS: _______________________ . Acute febrile illness. . Costo-vertebral angle tendrness. . Pyuria & bacteriuria. . Initial ttt -> Blood cultures followed by Empirical I.V. Antibiotics. . No response within 72 hours -> Do imaging e.g. U/$ or CT, . to search for underlying pathologies (e.g.obstruction) or complications (e.g. abscess). . Prazosin & TRAZODONE cause PRIAPISM ! . Diabetic pts with renal failure on METFORMIN should stop it as it ++ lactic ac idosis. . SIMPLE RENAL CYST: ____________________ . Age > 50 ys. . Benign, don't require ttt. . Reassurance. . Both IgA Nephropathy & PSGN are major causes of hematuria after an upper RTI: _______________________________________________________________________________ . IgA nephropathy: begins (1-5days) after URTI with normal serum complement. . PSGN : begins 10-15 days after URTI with low serum complement. . MEMBRANO-PROLIFERATIVE GLOMERULONEPHRITIS: ____________________________________________ . caused by persistent activation of the alternative complement pathway. . Microscopy: Dense intra-membranous deposits that stain for C3. . Dipsticks findings in case of UTI: ____________________________________ . Leukocyte esterase -> Pyuria. . Positive nitrites -> Enterobacteriaceae. . The most common culprit organism in UTIs is E-Coli. . ERYTHROPOIETIN THERAPY in cases of ESKD: __________________________________________ . ESKD presents with normocytic normochromic anemia due to -- erythropoietin. . Tx of choice is recombinant erythropoietin. . Started if Hb < 10 g/dl. . Most common side effect is WORSENING OF HYPERTENSION. . Other SE: Headaches & flu-like symptoms. . ESKD ttt options: ___________________ . Dialysis or renal transplantation. . Renal transplantation is more preferred due to better survival rate. . A living related donor is always preferred. . Management of CALCIUM OXALATE STONES: _______________________________________ . 1- ++ fluid intake. . 2- -- Na intake. . 3- THIAZIDE DIURETIC. . 4- -- protein & oxalate intake. . GUESS WHAT ???!!------------> Calcium restriction is not required

. ACUTE EPIDIDYMITIS: _____________________ . Fever. . Painful enlargement of the testes. . Irritative voiding symptoms. . Two types of epididymitis: Sex-transmitted related & non-related. . Sex-transmitted: more common in young pts & associated with urethritis. . Sex-transmitted: pain at the tip of the penis & urethral discharge. . Sex-transmitted: caused by Chlamydia trachomatis & Neisseria Gonorrhea. . NON-sex-transm.: more common in elderly & associated with a UTI. . NON-sex-transm.: No pain at the penile tip - No urethral discharge. . NON-sex-transm.: caused by gram -ve rods e.g. E-coli. . ACUTE PROSTATITIS: ____________________ . Fever, chills, ++ WBCs with bandemia. . Urinary urgency, dysuria & +ve leukocyte esterase. . Pain in the perineal region. . Tender boggy prostate.. . Obtaining a mid-stream urine sample is the 1st step sh'd be done. . Prostatic massage sh'd be avoided as it may lead to infectious spread. . EXOGENOUS ANABOLIC STEROID USE can produce INFERTILITY in MEN: ________________________________________________________________ .By suppressing the production of GnRH, LH & FSH. . ACYCLOVIR -> CRYSTALLURIA with RENAL TUBULAR OBSTRUCTION: ___________________________________________________________ . Acyclovir doesn't produce interstitial nephritis. (Take care - common mistake ). . Acyclovir is poorly soluble in urine & easily precipitates in renal tubules. . It causes tubular obstruction with acute renal failure. . It is due to large parenteral doses of Acyclovir. . Inadequate hydration is a common predisposing factor. . FIBROMUSCULAR DYSPLASIA -> RENAL ARTERY STENOSIS -> RENOVASCULAR HYPERTENSION: ________________________________________________________________________________ . Young adult. . Headache, hypertension & renal bruit. . Medical therapy only with ACEIs is NOT effective. . Tx of choice is: Percutaneous ANGIOPLASTY + STENT. . PERICARDITIS is a common complication of UREMIA (RF): _______________________________________________________ . Chest pain (Non radiating - Retrosternal - Relieved by leaning forward). . EKG (Diffuse ST elevation - PR segment depression). . Pericardial friction rub. . Tx: Hemodialysis. . CASTS in NEPHROLOGY: ______________________ . Muddy brown granular casts -> . Broad & waxy casts ---------> . RBCs casts -----------------> . WBCs casts -----------------> . Fatty casts ---------------->

Acute tubular necrosis. Chronic renal failure. Glomerulonephritis. Interstitial nephritis & pyelonephritis. Nephrotic $.

. RENAL AMYLOIDOSIS: ____________________ . H/O of Rheumatoid arthritis (predisposes to amyloidosis). . Enlarged kidneys & hepatomegaly. . Renal biopsy -> Amyloid deposits with APPLE GREEN BIREFRINGENCE under polariz ed light. . RENAL DISEASE -----> RENAL BIOPSY FINDING: ____________________________________________ . AMYLOIDOSIS -> Amyloid deposits with APPLE GREEN BIREFRINGENCE under polariz ed light. . RPGN "Rapid progressive GN" -> Crescent formation. . GOOD PASTURE's $ -> Linear immunoglobulin deposits (Ani-glomerulat b. membran e Abs). . LUPUS NEPHRITIS -> Granular deposits. . NEPHROTIC $ "MINIMAL CHANGE DISEASE" -> NORMAL LIGHT MICROSCOPY. . IMPORTANT DRUG SIDE EFFECTS: ______________________________ . TACROLIMUS: Nephrotoxicity - hyperkalemia - hypertension - tremors. . CYCLOSPORINE: Same as Tacrolimus + Hirsutism & Gum hypertrophy. . AZATHIOPORINE: Diarrhea - leukopenia - hepatotoxicity. . "M"YCOPHENOLATE -> Bone "M"arrow depression. . RENAL VEIN THROMBOSIS: ________________________ . Important complication of Nephrotic $. . caused by MEMBRANOUS GLOMERULONEPHRITIS (Not minimal change dis.). . Due to loss of ANTITHROMBIN 3 in urine. . Sudden onset of abdominal pain, fever & hematuria. . ACUTE CYSTITIS: _________________ . Healthy, young, non-pregnant woman. " Un-complicated". . Pregnant, v.young, v.old, D.M.,immunocompromized,anatomical abnormality. "Com plicated". . Dysuria, frequency, supra-pubic pain & or hematuria (Hemorrhagic cystitis). . Tx of un-complicated cystitis: NITROFURANTOIN or Oral TMP-SMX. . Tx of complicated cystitis: Levofloxacin or ciprofloxacin. . RENAL TRANSPLANT DYSFUNCTION: _______________________________ . Oliguria - hypertension - ++ creatinine/urea. . Causes: _________ 1- Ureteral obstruction. 2- Acute rejection. 3- Cyclosporine toxicity. 4- Vascular obstruction. 5- Acute tubular necrosis. . Acute rejection is best treated with INTRAVENOUS STEROIDS. . NON-INFLAMMATORY CHRONIC PROSTATITIS: _______________________________________ . Afebrile pts. . Irritative voiding symptoms (frequency, urgency, suprapubic or perineal disco mfort). . Normal physical exam.

. . . .

Normal urine analysis. Expressed prostatic secretions show NORMAL number of leukocytes. culture of the expressed secretionsis NEGATIVE for bacteria. No past H/O of UTIs.

. HEPATO-RENAL $YNDROME: ________________________ . Complication of end stage LIVER disease (e.g. Cirrhosis). . -- GFR in absence of shock, proteinuria or other causes of renal dysfunction. . Failure to respond to 1.5 liters of normal saline. . Most common causes of death are infection & hemorrhage. . Tx: LIVER "NOT KIDNEY" TRANSPLANTATION. . RIRFAMPICIN (Anti-Tuberculous drug): ______________________________________ . Reddish discolouration of urine, saliva, sweat & tears. . Benign drug effect. . Reassure the patient. . UREMIC COAGULOPATHY: ______________________ . Complication of CRF. . Echymosis & epistaxis are the most common presentations. . The main cause is PLATELET DYSFUNCTION. . PT,PTT,Platelet count -> NORMAL. . Bleeding time is prolonged. . Tx: DDAVP ++ the release of factor 8 (Von Willebrand f) from endothelial stor age sites. . PLATELET TRENSFUSION has NOOOOOO EFFECT as they quickly become INACTIVE. . SICKLE CELL TRAIT: ____________________ . YOUNG BLACK MALE with PAINLESS HEMATURIA. . Painless hematuria in EPISODES ! . Caused by PAPILLARY ISCHEMIA. . Reassurance. . DETRUSOR MUSCLE INACTIVITY: _____________________________ . May be caused by 1st generation ANTI-HISTAMINICs due to their ANTI-CHOLINERGI C effects. . They inhibit the action of Acetyl-choline on Muscarinic receptors. . Urine retention occurs due to detrusor ms. failure of contraction. . Other SEs: Dryness of eyes, oral mucosa & rspiratory passags. . GROSS PAINLESS HEMATURIA in an ADULT = BLADDER MASS TUMOR: ____________________________________________________________ . Do a contrast CT abominal scan or IVP to detect the mass. . The presence of erythrocytes in urine sh'd be confirmed microscopically, . to exclude myoglobinuria, hemoglobinuria or porphyria. . Other causes: BEETS large amounts ingestion or Rifampicin ttt.

Dr. Wael Tawfic Mohamed _________________________