محاضرة الكلية

• What are the definitions of urinary tract infections (UTIs)?

  • Cystitis: infection of the bladder/lower urinary tract
  • Pyelonephritis: infection of the kidney/upper urinary tract
• What is the most common organism causing UTIs?

  Escherichia coli
• What are some risk factors for urinary tract infections?

  Female gender, DM, Foley catheter use
• What is the management for acute simple cystitis in women?

  • Urine analysis and cultures not always necessary
  • Treat empirically with first-line antibiotics:
  • Nitrofurantoin
  • Trimethoprim-Sulfamethoxazole (Bactrim)
  • Fosfomycin
• What should be done for men with symptoms suggestive of cystitis?

  A urine culture should be performed
• What are the indications for CT abdomen and pelvis in complicated UTIs?

  • Severely ill patients
  • Persistent symptoms despite treatment
  • Suspected urinary tract obstruction
  • Recurrent symptoms shortly after treatment
• What are the inpatient empiric antimicrobial agents for acute complicated UTI?

  Ceftriaxone and Piperacillin-tazobactam
• What is a clue for renal artery stenosis due to fibromuscular dysplasia?

  Young patient with unilateral headache
• What are the screening and diagnostic methods for renal artery stenosis?

  • Screening: Duplex renal ultrasound
  • Diagnostic: CT angiogram or MRA abdomen
• What are the clues for atherosclerosis renal artery stenosis?

  Resistant hypertension, worsening kidney function
• What are the outpatient follow-up intervals for chronic kidney disease (CKD) stages?

  • Stage 3: every 4-6 months
  • Stage 4: every 2-3 months
  • Stage 5: every 4-6 weeks
• What is the definition of chronic kidney disease (CKD)?

  Low GFR for >3 months
• What are the complications of chronic kidney disease?

  • Hyperkalemia
  • Normal Anion Gap metabolic acidosis
  • Anemia of CKD
  • Secondary hyperparathyroidism
  • Proteinuria
  • Fluid overload
• What is the management for hyperkalemia in CKD?

  Low potassium diet, K binders, diuretics
• What is the goal for transferrin saturation in anemia of CKD?

  Transferrin saturation > 30%
• What are the indications for renal replacement therapy?

  • GFR < 20 ml/min
  • Kidney transplant
  • Creation of dialysis access if no transplant
• What is the diagnostic criteria for nephrotic syndrome?

  Heavy proteinuria, hypoalbuminemia, edema, hyperlipidemia
• What is seen in urine microscopy for nephrotic syndrome?

  • Fat drop and Maltese cross under polarized light
• What is the classification of nephrotic syndrome?

  • Minimal Change Disease (MCD): 15-25% of nephrotic syndrome in adults
• What is the significance of dense granular casts in urine microscopy?

  Indicates acute tubular necrosis (ATN)
• What does the presence of WBC casts indicate in urine microscopy?

  Acute interstitial nephritis (ATIN)
• How does the urine analysis differ in prerenal and intrarenal AKI?

  Prerenal has bland microscopy; intrarenal shows casts
• What is the significance of RBC casts in urine microscopy?

  Indicates glomerulonephritis
• What is the typical presentation of nephrotic syndrome?

  Heavy proteinuria, edema, hypoalbuminemia
• What is the role of kidney biopsy in nephrotic syndrome?

  Diagnostic test for nephrotic syndrome
• How does the management of CKD differ based on its stage?

  Follow-up frequency varies by CKD stage
• What findings were observed in the urine analysis for AKI?

  No RBC, + granular casts
• What symptoms did the 55-year-old male with glomerulopathy present with?

  Acute onset SOB and 2+ LE edema
• What was the proteinuria level in the 55-year-old male case?

  5 grams proteinuria
• What did the 40-year-old female with radiculopathy exhibit in her urine analysis?

  Microscopic hematuria with acanthocytes
• What was the complement level in the 40-year-old female case?

  Low complements
• What symptoms did the 60-year-old male with AKI present with?

  Recurrent epistaxis and petichial rash
• What was the complement level in the 60-year-old male case?

  Normal complements
• What are the diagnostic criteria for nephrotic syndrome?

  • Heavy proteinuria (> 3.5g/24 hrs)
  • Hypoalbuminemia
  • Edema
  • Hyperlipidemia
• What is observed in urine microscopy for nephrotic syndrome?

  Fat drop + Maltese cross under polarized light
• What is the diagnostic test for nephrotic syndrome?

  Kidney Biopsy
• What are the classifications of nephrotic syndrome?

  1. Minimal Change Disease (MCD)
  2. Membranous Nephropathy (MN)
  3. Focal Segmental Glomerulosclerosis (FSGS)
• What percentage of nephrotic syndrome cases in adults is Minimal Change Disease (MCD)?

  15-25%
• What are common secondary causes of Minimal Change Disease?

  Hematological malignancies and NSAIDs
• What are the kidney biopsy findings for Minimal Change Disease?

  Normal in light microscopy and immunofluorescence