MS LEC: GU

What is azotemia?

Increase in BUN and creatinine without symptoms

What is uremia?

Blood poisoning due to elevated nitrogenous waste products

What hormone do kidneys secrete to stimulate RBC production?

Erythropoietin (EPO)

What happens to RBC production in kidney failure?

Decreases leading to anemia

What are key GU assessment symptoms?

Pain, changes in voiding, thirst, fatigue, edema

What are common urinary history questions?

Frequency, urgency, pain, volume, incontinence, nocturia

What is dysuria?

Painful urination

What is urgency?

Sudden strong need to urinate

What is frequency?

Increased urination

What is polyuria?

Excessive urine output

What is nocturia?

Nighttime urination

What is hematuria?

Presence of blood in urine

Difference between gross and microscopic hematuria?

Gross is visible, microscopic is only seen under microscope

What indicates tea-colored urine?

Possible kidney disease

What is flank pain associated with?

Kidney pathology

What are kidney functions?

Acid-base balance, waste excretion, BP regulation, EPO secretion, vitamin D activation

What acid-base imbalance occurs in kidney disease?

Metabolic acidosis

What electrolyte imbalance is common in kidney disease?

Hyperkalemia or hypokalemia

What system regulates BP via kidneys?

RAAS

Relationship between HTN and kidney failure?

HTN can cause kidney failure and vice versa

What vitamin is activated by kidneys?

Vitamin D

What happens to calcium in kidney disease?

Leads to hyperparathyroidism

Normal urine specific gravity?

1.005–1.025 (up to 1.030)

What does low specific gravity (<1.005) indicate?

Diluted urine

Normal urine color?

Yellow to amber

What does glucose in urine indicate?

Diabetes

What does protein (CHON) in urine indicate?

Kidney disease

Why is protein normally absent in urine?

Too large to pass glomerulus

What does WBC in urine indicate?

Infection

What does RBC in urine indicate?

Stones or kidney injury

Normal urine pH?

5–8

Best urine specimen?

First morning, midstream

When is first void discarded?

24-hour urine collection

What is suprapubic aspiration?

Sterile urine collection method

Normal BUN?

7–20 mg/dL

Normal creatinine?

0.7–1.2 mg/dL

Most important kidney function test?

Creatinine

What test measures kidney filtration?

GFR

What is creatinine clearance?

24-hour urine + blood test

What does elevated PSA suggest?

Prostate enlargement or cancer

What is KUB?

X-ray of kidneys, ureters, bladder

Ultrasound prep?

NPO, laxatives, full bladder

Why must bladder be full for ultrasound?

Improves visualization

What is IVP?

Contrast dye imaging of urinary tract

Why is IVP risky?

Iodine is nephrotoxic

What must be assessed before IVP?

Kidney function and iodine allergy

What is retrograde pyelogram?

Dye injected via catheter

Main risk of retrograde pyelogram?

UTI

What is renal angiography?

Dye injected into renal arteries

What is cystoscopy?

Endoscopic bladder exam

What is renal biopsy position?

Prone

Post-biopsy normal finding?

Hematuria within 24 hours

Types of catheterization?

Indwelling and intermittent

How to retrain bladder?

Clamp catheter periodically

What is UTI?

Bacterial infection of urinary tract

Types of UTI?

Urethritis, cystitis, pyelonephritis

Major UTI symptoms?

Dysuria, frequency, urgency, foul urine

Why are women at higher risk for UTI?

Shorter urethra

What is honeymoon cystitis?

UTI after increased sexual activity

What is CAUTI?

Catheter-associated UTI

UTI treatment?

Antibiotics, fluids, analgesics

Common UTI antibiotic?

Fluoroquinolones

Urinary antiseptic?

Fosfomycin

What is glomerulonephritis?

Inflammation of glomeruli

Cause of glomerulonephritis?

Group A beta-hemolytic streptococcus

Diagnostic test?

ASO titer

Classic sign?

Hematuria

Manifestations?

Edema, HTN, oliguria, proteinuria

Treatment?

Bed rest, antibiotics, BP control

What is nephrotic syndrome?

Protein loss in urine

Main feature?

Proteinuria

Why frothy urine?

Protein reduces surface tension

What causes edema?

Hypoalbuminemia

Manifestations?

Anasarca, fatigue, oliguria

Treatment?

Steroids, high protein diet

What does AEIOU stand for in dialysis?

Acid-base, Electrolyte, Intoxication, Overload, Uremia

What is urolithiasis?

Formation of stones in urinary tract

Most common stone type?

Calcium

Cause of struvite stones?

Infection

What is renal colic?

Severe flank pain from stones

Symptoms of stones?

Pain, hematuria, nausea

Management?

Fluids, pain meds, strain urine

What is ESWL?

Shock wave stone fragmentation

Earliest sign of acute renal failure?

Oliguria

Define oliguria?

Types of ARF?

Prerenal, renal, postrenal

Prerenal cause?

Hypovolemia

Postrenal cause?

Obstruction

Phases of ARF?

Oliguric, diuretic, recovery

Oliguric phase findings?

High BUN, creatinine, potassium

Diuretic phase risk?

Electrolyte imbalance

What is chronic renal failure?

Progressive irreversible kidney damage

Main causes?

Diabetes, hypertension

Stages based on GFR?

Renal reserve → insufficiency → failure → ESRD

What is uremic frost?

Crystals on skin

Diet in CRF?

Low protein, low K, low Na

What is hemodialysis?

Blood filtered via machine

Access types?

AV fistula, graft, catheter

What is bruit and thrill?

Signs of functioning fistula

Precautions in AV fistula?

No BP, IV, injections