Gentio-Urinary Diseases

Acute Renal Failure : (characterized by azotemia, elevated BUN/Cr) 1. Pre-Renal (MCC of acute renal failure) a. Causes: hypovolemia, burns, CHF, V/D b. Sx: oliguria, low Na urine levels 2. Intrinsic (kidney damage) a. Sx: polyuria + Edema b. Causes: glomerular dz, Goodpasture’s, Wegner’s, Post-strep GN, SLE, Vascular disease, ATN c. DX:  BUN: Cr ratio d. DX: increased urine Na, decrease urine osmolality 3. Post-Renal a. BPH is MCC b. Causes: bladder/ureter obstruction

Chronic Renal Failure MCC- Dm Risk: HTN other causes: HTN, GN, PCKD Sx: HTN, neurologic-lethargy, confusion, uremic seizures, N/V/anorexia, anemia, CHF Electrolytes: hyperphosphatemis, hypocalcemia  necrotic skin lesions (calciphylaxis) Tx: ACE-I for HTN

Acute tubular Necrosis **2 main causes: ischemia due to hypovolemia (pre-renal renal failure) or TOXIN

Goodpasture’s syndrome- cough blood + renal failure (kidneys and lungs)

IgA nephropathy- mc sx: gross hematuria **Mcc of primary glonerulnephritis

Alport Syndrome: family hx, chronic renal failure, hearing loss

Nephrotic Syndrome: marked by proteinuria, hypoalbuminemia, edema around eyes/feet/hands, hyperlipidemia Causes: SLE, RA, Wegner’s, primary glomerular disease (MCC) UA- fatty cases suggest nephritic syndrome

RTA (Renal tubular acidosis)- kidneys fail to excrete acids (blood too acidic) 1. Type 1- proximal tubules sx: hypokalemia (low K), renal stones a. Causes: SLE, Sjogren’s syndrome 2. Type 2- distal tubules (Fanconi’s syndrome in children) increased excretion of BICARB into urine 3. Type 4 – low aldoesterone levels sx: hyperkalemia (high K)

Kidney Cancer (renal cell carcinoma) Risks: 6th decade, smoking, males MC SX: gross hematuria (also: flank pain) Charcot’s Triad: flank pain, abdominal mass, hematuria

Polycystic Kidney Disease (congenital) **ass. with Berry Aneurysms **proteinuria, hematuria, flank pain

Bladder Cacner (mc-transitional cell carcinoma) Mc sx: gross hematuria, irregular voiding sx DX: cystography + bx

BPH- prostate hypertrophy **sx: hesitancy, decreased force, dribbling, irritating voiding sx DX: DRE, UA, PVR TX: alpha-1 blockers (“-azosin”); 5alpha-reductase inhibitors Surgery: TURP Testicular Carcinoma (mc soild malignancy in men 18-35 y/o) **mc presentation: palpable scrotal mass

Testicular Torsion- twisting of spermatic cord **Surgical Emergency **sx: pain, scrotal edema, tenderness **dx: US- “blue-black dot” sign

Variocele- infertitility + “bag of worms” dx: US

Phimosis- entrapment of foreskin behind coronal sulcus

Paraphimosis- inability to retract foreskin over glans penis

Cryptorchidism- mc genital problem in ped (undescended testes) **associated with CP, Wilm’s tumor, increased risk of testicular tumor, hypospadias Hydrocele- collection of serous fluid in tunica vaginalis “painless enlarged scrotum” UTI: mcc-E.Coli, mc in male infants, mc in adult women

Acute Cystitis (infection of bladder) Causes are SEEKS PP: staph, E.coli, Enterococcus, Klebsiella, Pseudomonas, Proteus Hx of hematuria, recent cath, urgency, frequency, dysuria, suprapubic pain DX: Urine Culture + UA is gold standard TX: Bactrim, Cipro, tx for pregnant women-Amoxicillin

Pyelonephritis Hx of flank pain, fever, chills, CVA tenderness Causes: BPH, obstruction, immunocompromised DX: UA + Urine culture **admit pt if toxic, intolerant to po antibiotics, pregnant TX: ceftriazone, Cipro

Prostatitis (prostate massage is contraindicated) 1. acute bacterial a. Sexually active- Chlamydia, Gonorrhea b. Not sexually active- E. Coli c. Hospitalization + IV ampicilin and gentamicin then Cipro (po) x 4 weeks 2. chronic bacterial a. Tx: Bactrim (po) b. Sx: irritative voiding sx, more subtle 3. nonbacterial – MCC of prostatitis a. No hx of UTI b. Normal UA, Culture c. Tx: antibiotics x 14 days 4. prostatodynia a. Chronic pelvic pain syndrome  neurological sx b. No hx of UTI c. Increased sphincter tone  voiding dysfunction b/c no urethral relaxation d. Tx: alpha-blockers

Acute Epididymitis: scrotal pain radiated to flank, scrotal swelling + Prehn sign (relief of pain when elevating scrotum) Dx: CBC, UA, Doppler US Tx: Bed rest, Ceftriaxone (if STD), Bactrim (if not STD) Cx: orchitis

Orchitis- w/o hx of UTI  associated with mumps