GIGU Final - Interstitial cystitis, hydronephrosis, nephrolithiasis, pyelonephritis, nephritic, nephrotic, R-PKD, D-PDK

What it interstitial cystitis (IC)?

pain of the bladder - NOT due to infection

is interstitial cystitis chronic or acute?

chronic

do we know what causes IC?

NO

risk factors for IC?

IBS - irritable bowel syndrome

fibromyalgia

symptoms of IC

urgency

frequency increase - think like 60x a day

pain in bladder/pelvis

painful sex

Symptoms exacerbated by food with increased potassium

allergies

Symptoms of IC made worse by

stress

sex

menstrual cycle

UTI

dehydration

change in weather

allergies - think laundry detergent

movement

Tight clothes

what are exam findings for IC

none that are conclusive

painful palpation over urethra

what is the use of the special tests for IC?

to rule out other conditions

- urinalysis

- blood tests

- cystoscopy - help visualize surface anatomy

what is hydropnephosis

swelling in kidneys due to build up of urine

What causes dilation of renal pelvis and calyces

hydropnephrosis

causes of hydronephrosis

Kidney stones

congenital blockage

blood clot

tumor

enlarged prostate

pregnancy

aberrant artery or vein

what is the most common cause of hydronephrosis

kidney stones

symptoms of hydronephrosis

acute presents with pain

higher obstruction (upper urethral or pelvic) causes flank pain

lower obstruction (lower urethral) - pain that radiates to ipsilateral testicle or labia

Anuria - not peeing

exam findings for hydronephrosis

severe- kidney may be palpable

bilateral - lower extremity edema may be seen

obstruction in bladder - may be able to palpate

special tests for hydronephrosis

urinalysis - pyuria, hematuria, and WBC

elevated BUN if both affected

US

Cystoscopy

Pyelograph - contrast medium

MRI

what is nephrolithiasis

kidney stones

risk factors for nephrolithiasis

men

family history of kidney stones

not enough fluid

What is renal colic

pain that follows urinary tract pathway

what conditions predispose you to nephrolithaisis

blocked urinary tract

cystic kidney disease

digestive problems

gout - high uric acid

hypercalciuria

hyperparathyroidism

obesity

what is the MC kidney stone

calcium stones - 80% of time

what is the make up of calcium stones

calcium oxalate

phosphate

what foods predispose you to uric acid stones

fish, shellfish, and meat - 10%

what are struvite stones

magnesium ammonium phosphate stones

what do struvite stones occur

after UTI, will get large quickly

cystine stones are caused by?

caused by cysteine disorder - cystinuria - 2%

symptoms of nephrolithiasis

small stones - asymptomatic

renal colic - sharp pain of back side, lower abdomen, or groin

hematuria

dysuria

Exam findings for nephrolithiasis

costovertebral angle pain with palpation

pt unable to find comfortable position

diaphoresis - excessive sweating

tachycardia

tachypnea

elevated BP

pink tinged urine

Special tests for nephrolithiasis

urinalysis - high minerals, WBC, RBC, bacteria

abdominal xray/KUB (kidney ureter bladder)

CT scan with or w/o contrast

what is pyelonephritis

kidney infection

is pyelonephritis usually acute or chronic

acute

MC cause of pyelonephritis

Lower UTI moving upstream

pyelonephritis is caused MC by ?

bacteria - E. coli - gram negative bacteria

virus

what percent of pyelonephritis self-resolves In how long

80% in 10 days

risk factors of pyelonephritis

women

UTI in bladder

UTI in past 12 months

pregnant

obstruction of bladder

viscera-rectal reflux - urine flows from bladder to ureters (reversed flow)

diabetes - decreased urine output

Spinal cord damage

history of Symtpoms for pyelonephritis

chills

fever

pain of flank

nausea

vomiting

cloudy foul smelling urine (purulent)

painful urination

exam findings

fever

tachycardia

flank tenderness on palpation

+ Murphy's punch

what should you do for a women to make sure it's pyelonerphitis?

pelvic exam to rule out gyno issues

special tests for pyelonephritis

urinalysis - increased WBC

urine culture - bacteria

CT scan/MRI - to look for obstruction

Intravenous pyelogram (IVP) - contrast for X-ray

what is nephritic syndrome

condition that causes damage to glomeruli

what's the difference between nephrotic and nephritic syndrome?

nephrotic - loss of protein in urine

nephritic - loss of protein AND blood in urine

causes of nephritic syndrome in children

post-strep glomerulo-nerphritis

IgA nephropathy (Bergen's disease)

Hemolytic-uremic syndrome (adults too)

what is the MC cause of nephritic syndrome for kids?

IgA nephropathy (Bergen's disease)

what causes hemolytic uremic syndrome?

GI infection (e. Coli, shigella, salmonella)

antigen antibody stress on the kidneys

causes of nephritic syndrome in adults

Good pasture syndrome

Membranoproliferative glomerulo-nephritis

Rapid Progression GN

hemolytic uremic syndrome

pathologies that contribute to mambranoproliferative GN

SLE

Scleroderma

Hep B, C

Malaria

Cancer

what causes good pasture syndrome

(Immune response against collagen that affects lungs and kidneys)

respiratory infection

breathing in hydrocarbons - huffing

what causes rapid progression GN (nephritic)

only attacks kidneys

- viral infection

- smoke or toxic exposure from environment

symptoms for nephritic syndrome

hematuria - Coca Cola pee

oliguria - decreased urine outputs

swelling of face, legs, feet, abdomen

hypertension

blurred vision

Berger's disease**

exam findings for nephritic syndrome

hypertension

excessive fluid retention

abnormal heart/lung sounds

enlarged jugular veins of neck due to elevated venous pressure

special tests for nephritic syndrome

blood test - BUN, electrolytes (potassium/sodium), creatinine

Urinalysis - protein, hematuria

Microscopic evaluation - red blood cell casts - look cylindrical

biopsy

- tests to figure out GN

- ANA titer for Lupus

- antiglomerular basement membrane antibody

what is nephrotic syndrome

condition that causes glomerular damage causing proteins to leak into urine

Primary causes of nephrotic syndrome

Minimal change disease

Focal segmental glomerulo-sclerosis

Membranous nephropathy

secondary causes of nephrotic syndrome (more common in adults)

diabetes

infection - HIV, Hep B/C

Drugs - NSAIDS, lithium

what is the MC cause of kidney failure in US

diabetes

symptoms of nephrotic syndrome

facial swelling

lower extremity edema

ascites

frothy urine

fatigue

weight gain

loss of appetite

exam findings for nephrotic syndrome

edema

tiredness

breathlessness

high BP

ascites

pulmonary crackles

what are special tests for nephrotic syndrome

urine dip stick - proteins

urinalysis - hyperalbuminemia, creatinine

blood test: hypoalbuminemia, hyperlipidemia

kidney biopsy

stages of kidney failure - stage 1

GFR 90 or higher

mild damage

stage of kidney failure - stage 4

GFR 15-29

severe kidney damage

higher BP

renal dialysis

what is polycystic kidney disease? (PKD)

causes cysts on the kidney

what are the two forms of PKD

autosomal dominant

autosomal recessive

what is the most common type of PKD

autosomal dominant

What age is dominant PKD usually diagnosed

30-50

mechanism of PKD 1

codes for protein polycystin - regulates tubular epithelial adhesion and differentiation - defect causing obstruction fluid flow

dominant PKD accounts for what percent of renal disease?

10%

complication of dominant PKD

pain around kidney

high BP

kidney failure

vascular system problems

digestive systems problems - diverticula

urinary tract problem - increased risk of kidney stones

reproductive problems - pre-eclampsia and decreased output

headaches

UTI in men before the age of 50

Symtpoms of dominant PKD

no symptoms until cysts are 1/2 in or larger

Back of flank pain (between ribs and hips)

1/2 of people may be asymptomatic

exam findings for dominant PKD

hypertension

palpation may reveal bilateral flank masses

palpation may reveal nodular hepatomegaly

hematuria

proteinuria

special tests for dominant PKD

US

CT scan - kidney will look moth eaten

Urinalysis - may have RBC if cyst ruptures, proteinuria

Urine may smell like minerals from kidney stone

who does recessive PKD affect?

children

what secondary problem occurs with recessive PKD

respiratory issues due to poor kidney function, threatens life

what percent of babies die within first week if they have recessive PDK

30%

complications of recessive PKD

kidney failure

liver Problems

hypertension

breathing problems

history of symtpoms for recessive PKD

- babies can't say shit

- lots of hospital visits

exam findings for recessive PDK

palpation of enlarged kidneys

growth failure

special tests for recessive PCK

US

CT