Part 1

What does A in the mnemonic A WET BED stand for?

Acid-base balance (kidneys excrete hydrogen ions and reabsorb bicarbonate to regulate pH).

What does W in A WET BED stand for?

Water and electrolyte regulation.

What does E in A WET BED stand for?

Erythropoietin production to stimulate red blood cell formation.

What does T in A WET BED stand for?

Toxin removal (urea, creatinine, drugs, and metabolic waste).

What does B in A WET BED stand for?

Blood pressure regulation through the renin-angiotensin-aldosterone system (RAAS).

What does D in A WET BED stand for?

Vitamin D activation into calcitriol for calcium absorption.

What is the best overall indicator of kidney function?

Glomerular filtration rate (GFR/eGFR).

What is the normal GFR?

Approximately 90–120 mL/min/1.73 m².

Why can serum creatinine be misleading in early kidney disease?

It usually does not rise until about 50% of kidney function has been lost.

What three components are used in KDIGO CKD staging?

Cause, GFR, and Albuminuria (CGA).

What is normal albuminuria (A1)?

Less than 30 mg/g.

What is moderately increased albuminuria (A2)?

30–300 mg/g.

What is severely increased albuminuria (A3)?

Greater than 300 mg/g.

What does leukocyte esterase on urinalysis indicate?

White blood cells and possible urinary tract infection.

What do nitrites on urinalysis indicate?

Gram-negative bacteria such as E. coli.

What does protein in the urine suggest?

Glomerular disease or kidney damage.

What can blood in the urine indicate?

Infection, kidney stones, tumors, trauma, or glomerulonephritis.

What is the hallmark urine finding of glomerulonephritis?

RBC casts.

What is the hallmark urine finding of pyelonephritis?

WBC casts.

What is the gold standard diagnostic test for a urinary tract infection?

Urine culture and sensitivity.

When should a urine culture be collected?

Before starting antibiotics whenever possible.

Where should a urine specimen be collected from in a catheterized patient?

The sampling port, never the drainage bag.

What is the first-line imaging study for most kidney disorders?

Renal ultrasound.

What is the gold standard imaging test for kidney stones?

Non-contrast CT KUB.

What is the definitive diagnostic test for glomerular disease?

Renal biopsy.

What is the major complication after a renal biopsy?

Bleeding.

What is the purpose of cystoscopy?

Direct visualization of the urethra and bladder.

What urine color is expected after cystoscopy?

Pink or lightly blood-tinged urine.

What findings after cystoscopy require immediate notification of the provider?

Bright red blood, clots, inability to void, fever, chills, or severe pain.

What is the purpose of continuous bladder irrigation (CBI)?

To prevent clot formation and maintain catheter patency after bladder or prostate surgery.

What should the urine color be during continuous bladder irrigation?

Light pink to clear.

How do you calculate true urine output during CBI?

Drainage minus irrigation infused.

What organism causes approximately 80% of uncomplicated urinary tract infections?

Escherichia coli (E. coli).

Why are women at higher risk for UTIs?

They have a shorter urethra and the urethra is closer to the rectum.

What are the classic symptoms of cystitis?

Dysuria, urinary frequency, urgency, and suprapubic pain.

How may older adults present with a urinary tract infection?

Confusion, falls, delirium, or functional decline.

What urinalysis findings are common with UTIs?

Positive leukocyte esterase, nitrites, pyuria, and bacteriuria.

What are first-line antibiotics for uncomplicated cystitis?

Nitrofurantoin, TMP-SMX, or fosfomycin.

Why should nitrofurantoin not be used for pyelonephritis?

It does not achieve adequate kidney tissue concentrations.

What medication relieves dysuria but does not treat infection?

Phenazopyridine.

What color does phenazopyridine turn the urine?

Bright orange.

When should asymptomatic bacteriuria be treated?

Only during pregnancy or before urologic procedures.

What is the most effective intervention to prevent CAUTIs?

Remove the urinary catheter as soon as it is no longer needed.

What is pyelonephritis?

A bacterial infection of the kidney.

What are the classic symptoms of pyelonephritis?

Fever, chills, flank pain, CVA tenderness, nausea, vomiting, dysuria, urgency, and frequency.

What urine finding strongly suggests pyelonephritis?

WBC casts.

What antibiotics are commonly used for outpatient pyelonephritis?

Fluoroquinolones such as ciprofloxacin or levofloxacin.

What does persistent fever after 48–72 hours of antibiotics suggest?

Abscess, urinary obstruction, or a resistant organism.

What makes pyelonephritis a urologic emergency?

Obstruction with infection.

How is an obstructed infected kidney treated?

Urgent drainage with a ureteral stent or nephrostomy plus antibiotics.

What is the most common kidney stone?

Calcium oxalate stone.

What causes renal colic?

A stone obstructing the ureter.

What are the classic symptoms of renal colic?

Sudden severe flank pain radiating to the groin with hematuria, nausea, and vomiting.

What imaging test is the gold standard for kidney stones?

Non-contrast CT KUB.

Why should all urine be strained when a patient has kidney stones?

To collect the stone for analysis and guide prevention.

What medication is commonly used to help pass ureteral stones?

Tamsulosin.

What is the first-line medication for renal colic pain?

NSAIDs such as ketorolac (if renal function allows).

What two findings make kidney stones a medical emergency?

Stone plus fever or complete urinary obstruction.

What is the most important prevention strategy for kidney stones?

Maintaining adequate hydration.

Should patients with calcium oxalate stones follow a low-calcium diet?

No. They should maintain normal calcium intake while reducing sodium and oxalate.

What is benign prostatic hyperplasia (BPH)?

Benign enlargement of the prostate causing bladder outlet obstruction.

What are the obstructive symptoms of BPH?

Weak stream, hesitancy, dribbling, straining, and incomplete emptying.

What are the storage (irritative) symptoms of BPH?

Frequency, urgency, and nocturia.

What does a smooth enlarged prostate on DRE suggest?

Benign prostatic hyperplasia.

What does a hard nodular prostate suggest?

Prostate cancer.

What is used to measure post-void residual volume?

Bladder scan.

How do alpha-blockers improve BPH symptoms?

They relax smooth muscle in the prostate and bladder neck.

Name common alpha-blockers used for BPH.

Tamsulosin, alfuzosin, doxazosin, terazosin, and silodosin.

What major side effect occurs with alpha-blockers?

Orthostatic hypotension.

When should the first dose of an alpha-blocker be taken?

At bedtime.

How do finasteride and dutasteride work?

They inhibit 5-alpha reductase, decreasing DHT and shrinking the prostate.

How long does it take finasteride to work?

Approximately 3–6 months.

How do 5-alpha reductase inhibitors affect PSA levels?

They lower PSA by about 50%.

What is the immediate treatment for acute urinary retention?

Catheterization.

What is the classic surgery for severe BPH?

Transurethral resection of the prostate (TURP).

What is the goal urine color after TURP with CBI?

Light pink.

What do bright red urine and clots after TURP indicate?

Possible hemorrhage requiring provider notification.

What is glomerulonephritis?

Immune-mediated inflammation of the glomeruli.

What are the classic findings of nephritic syndrome?

Hematuria, RBC casts, mild proteinuria, hypertension, edema, and tea-colored urine.

What are the classic findings of nephrotic syndrome?

Massive proteinuria, hypoalbuminemia, severe edema, hyperlipidemia, and hypercoagulability.

What urine finding is most characteristic of glomerulonephritis?

RBC casts.

What is the definitive diagnostic test for glomerulonephritis?

Renal biopsy.

What medications commonly treat autoimmune glomerulonephritis?

Corticosteroids and other immunosuppressants.

What medications reduce proteinuria in glomerulonephritis?

ACE inhibitors and ARBs.

What is the most sensitive indicator of fluid status in kidney disease?

Daily weight.

How is chronic kidney disease (CKD) defined?

Kidney damage or decreased kidney function lasting at least 3 months.

What are the two most common causes of CKD?

Diabetes mellitus and hypertension.

What electrolyte abnormality is most immediately life-threatening in CKD?

Hyperkalemia.

Why do CKD patients develop anemia?

Reduced erythropoietin production.

How is anemia of CKD treated?

Iron replacement if needed plus erythropoiesis-stimulating agents such as epoetin alfa or darbepoetin alfa.

Why do CKD patients develop bone disease?

Reduced vitamin D activation causes hypocalcemia, secondary hyperparathyroidism, and renal osteodystrophy.

What medications reduce proteinuria and slow CKD progression?

ACE inhibitors and ARBs.

What newer medication class also slows CKD progression?

SGLT2 inhibitors.

When should phosphate binders be taken?

With meals.

What mnemonic indicates the need for dialysis?

AEIOU.

What does A in AEIOU stand for?

Acidosis.

What does E in AEIOU stand for?

Electrolyte abnormalities, especially refractory hyperkalemia.

What does I in AEIOU stand for?

Intoxications.

What does O in AEIOU stand for?

Fluid overload.

What does U in AEIOU stand for?

Uremia.