Disruption of the glomerular basement membrane with leakage of RBS and protein
RBC casts
Brown, smoky coca-cola colored
Non-glomerular
Renal papillae
Sickle cell disease, trait
Tubules are site inflammation caused by NSAIDs and antibiotics
Pink, bright red with ot without clots more likely lower in urinary tract
Increased vascularity from infection or chemical irritation
Evaluation
Confirm blood in urine
Detailed patient and family history
Life Threatening causes
Trauma
Acute glomerulonephritis
HUS
Renal stones with obstruction
Tumor
Hematologic disorders
toxin/xenobiotic
Trauma
Hematuria is “cardinal marker of renal injury, with magnitude of hematuria paralleling the severity of renal injury (except renal pedicle injuries, which may have no associated hematuria
Presence of gross hematuria or significant microscopic hematuria (>50 RBCs/HPF) along with mechanism point to emergent imaging
Testicular Infections/STI – Dr. Scott
Sexually Transmitted Infections
Ulcerative
Painful Ulcers
HSV
HSV-2
Multiple painful lesions
Starts as blisters
Clinical Dx
Acyclovir 400 mg q8h x7-10 days or valacyclovir 1 g q12h x 7-10 days
Chancroid
H. ducreyi
Begins as chancre -> unilateral painful inguinal lymphadenopathy forms (buboes)
>35 (or anal intercours): e. Coli, pseudomanas, TB, enterovacrer, syph
Scrotal elevation
Pain relief
GC/Chlamydia treatment
Orchitis
Testes inflammation
Most commonly mumps
GC, chlamydia, E. coli
Torsion – Dr. Gosser
Ovarian torsion
Most common in reproductive-aged females but is found in females of any age
Risk factors
Ovary > 4cm
Pregnancy
Patients undergoing IVF, patients after tubal ligation
Mechanism: enlarged ovary rotates on the axis of its ligaments leading to twisting of the ligaments restricting lymphatic outflow, swelling that will inhibit venous return that in-turn compromises arterial blood flow.
Requires emergent OB/Gyn consult for operative management
Testicular torsion
Bimodal incidence
Peaks in first year of life and in puberty
Risk Factors
Mechanical: exertional/exercise, trauma
Testicular masses
Undescended testicle
Bell-clapper deformity
Evaluation
Emergent urology consult
UA
US for equivocal cases
TWIST Score
Mechanism
Twisting of the testis on its blood supply
Tunica vaginalis is secured to the scrotal wall on the posterolateral side, prevents movement of the testis
If this attachment occurs too superiorly, this can lead to torsion
Treatment
Manual detorsion (temporizing measure)
Medial to lateral rotation (open book)
Urological consultation for detorsion and orchipexy
Salvage rates
100% at 6 hours
20% at 12 hours
Little to no salvageability at >24 hours
ITE Tox Review – Dr. Eisenstat
Toxicology ITE Prep
self-review
Renal Emergencies – Dr. Thomas
Hyperkalemia and Emergent Hemodialysis
Causes of hyperkalemia
The Kidney
Renal insufficiency
ARF
Addison’s Disease, Adrenal insufficiency
ACEs
ARBs
Intake
Excessive K+ supplementation
Excessive K+ in diet
Dehydration
Prerenal cause of insufficiency
Causes shift in electrolytes with more K+ now extracellular
Tissue Damage
Endocrine
The Lab/Phlebotomy
Hyperkalemia
Generally >5 or 5.5
The serum concentration of K+ is important
The rate of change in the concentration of serum K+ is MORE important
EKG changes
Mild 5.5-6.5 – Peaked T Waves and or Prolonged PR segment
Moderate 6.5-8 – Loss of P Wave, Prolonged QRS complex, ST-Segment elevation, Ectopic beats
Severe >8.0 – Progressive widening of the QRS, Sine wave morphology, V-fib, Asystole, axis deviations, BBB, Fascicular blocks
Therapy
Calcium
Insulin/dextrose
Albuterol
Bicarb
Only really worthy of consideration in setting of metabolic acidosis
![Room9er ["Room Niner"]:](https://room9er.com/wp-content/uploads/2020/03/cropped-Screen-Shot-2020-03-08-at-3.16.16-PM.png)