Orchiopexy recommended at age 6 months

(you want to do it by 6 months to try to preserve function of testicle- also at 6 months because the liver and lings developed more so less adverse effects with anesthesia)

(Within the glomerulus)

Focal segmental glomerulosclerosis

Membranoproliferative glomerulosclerosis

IgA nephropahty 

Membranous nephropathy

(outside of the glomerulus)

Diabetic nephropathy 

Post-infection glomerulonephritis

HIV associated nephropathy

Systemic lupuc erythematosus

Asymptomatic proteinuria

Nephrotic syndrome (proteinuria, hypoproteinuria, hyperlipidemia, edema)

Asymptomatic hematuria

Glomerulonephritis (hematuria, proteinuria, renal failure, HTN)

Acute glomerulonephritis (nephritis with short-term renal failure)

Crescentic glomerulonephritis (nephritis with rapidly progressive renal failure)

Chronic glomerulonephritis (chronic progression of renal failure)

En stage renal disease (irreversible renal failure)

Affects children and adults

Mostly idiopathic

Hereditary

Focal Segmental Glomerulosclerosis- Primary

Treatment

The disease frequently progresses to ESRD within 5-10 years

May reoccur in renal transplant

HTN

Obesity

Sickle cell disease

Hypoxic states

HIV infection (other viral infections- Parvo B19)

IV durg, heroin-induced

Congenital or acquired reduction of renal parenchyma

Reflux nephropathy

Steroids (anabolic)

Lithium

Usually presents with nephrotic syndrome

Can be a primary renal disease or secondary to a systemic disease (SLE, hepatitis B/C, malignancy...) or durg ingestion (penicillamine, gold)

Membranous Glomerulonephritis

Treatment

1/3 progress to ESRD, the remainder enter remission or have slowly declining renal function

Excellent candidates for renal transplant

Most often idiopathic

Asymptomatic hematuria with mild proteinuria or recurrent episodes of gross hematuria

May be concomitant with a upper respiratory infection, GI symptoms or viral illness

Excellent candidates for transplant though disease can effect allograft (30% in 5-10 years) but rarely leads to transplant failure

Prior evidence or AODM, > 10 years

Albuminuria (micro or macro) precedes decline in GFR

Increased abnormal glycosylation of IgG

Predictable trajectory of decline

Other end organ damage common

Diabetic Nephropathy

Treatment

Treatment involves good glycemic control as well as ACE/ARB to decrease Proteinuria and control HTN

Proteinuria

Glomerular hematuria

Usually follows a group A β-hemolytic streptococcal infection (pharyngitis or impetigo) by 1-3 weeks

Usually self-limiting and resolves spontaneously

Proteinuria, edema and hematuria with or without azotemia

Significant decrease in these cases since HAART (highly active retroviral therapy)

HIV associated nephropathy

Treatment

Progressive azotmeia with urinary abnormalities

May present with mild proteinuria, microscopic hematuria, nephrotic syndrome or ESRD

May present as rapid progressice renal insufficiency

Biopsy helps classify disease and stage damage

Claa I-VI (class III, IV have worse prognosis unless disease is "acute" and aggressively treated 

> 3.5 g/day Proteinuria (normal =< 150mg)

Hypoalbuminemia

Hyperlipidemia

Edema

Minimal Change Glomerulopathy

Focal Segmental GLomerulosclerosis

Diabetic Glomerulosclerosis

Membranous Glomerulopathy

Hematuria 

RBC casts

Proteinuria

HTN

Edema

Deteriorating renal function

IgA nephropathy

Lupus Nephritis and Classification (I-V)

Rapidly-progressive glomerulonephritis

Anti-GBM, ANCA disease

Rare <40y/o

33% of men older than 50 years

BPH SxS

Obstructive symptoms

BPH SxS

Irritative symptoms

Physical exam

VS

Skin: testosterone effect evident

Abd: Masses, bruits, ballotable bladder

Physical Exam

GU: tanner staging, testicles, epididymis

Rectal: large, firm, diffusely enlarged prostate 15-20 gms in a young man or 2 fingerbreadths width 

Guaiac negative

Urethral strictures, bladder neck contractures, bladder calculi, and cancers of the bladder or prostate

UTI and neurologic diseases (multiple sclerosis) may also produce like symptoms.

BMP- check renal fxn because kidney may be affected. Therapy is to put a catheter in so that their bladder drains and their bladder fxn improves

1. BUN/Creatinine

2. Glucose

UA

Infection

Hematuria

Proteinuria

Glucosuria

Large postate

Elevated PSA

BPH

If creatinine is abnormal get an ___

BPH

If PSA is abnormal, may want to do a ___

AUA-SI or International Prostate Symptom Score (IPSS)

Abd US- uncommon

IVP/VCUG- uncommon

TRUS- usually urology

Urodynamic studies- usually urology

Flow dynamics

Post-void residual

Alpha-1 blockers: tamsulosin (Flomax), prazosin, terazosin, etal

Alpha-1a blockers: tamsulosin

5^α reductase inhibitors: finasteride, others

Phytotherapy: Saw Pakmetto

In younger men with a muscular problems- alpha blockers are the best

5 alpha reductase inhibitors are best for large prostates.

TURP- resect out the transitional zone/open it up to reduce pressure to get urine to flow through there 

TUIP

Prostatectomy: generally only very large glands (>75gms)

Laser therapy

Hyperthermia (TUMT, TUNA)

Heat tissue and kill the tissue causing it to shrink helping their voiding

Balloon dilation

Stents

Supportive and no specific therapy is available

Frequently causes chronic kidney disease and may progress to ESRD

Anticoagulation may worsen embolic disease

A hypotensive episode

oliguria

rising serum Cr

"muddy brown" granular casts

FENa>1%

Supportive

Volume repletion until euvolemic

Restriction of potassium containing fluids

Avoidance of additional insults (hypotension, NSAIDs, aminoglycosides)

Close observation for need to initiate dialysis therapy

Low ejection fraction

CA disqualifies you for 2 years

Cardimyopathy

Morbid obesity

Terminal illness

HIV, Hep B/C patients are no longer contraindicated

Fever

Irritative voiding symptoms

Painful enlargment of epididymis and scrotum, lower abd pain

Gradual onset of sxs (the more acute the sxs the greater prossibility of testicular torsion)

Inflammation and infection of the epididymis

MCC: gonorrhoeae and chlamydia

UA, urinary and urethral cultures

CBC?

+/- scrotal ultrasound

Antibiotics treatment for offending pathogen

NSAIDs

Scrotal support

65% are > 65 yr old

One first degree relative with ___ double your risk; tow quadruples.

History:

ASx

Obstructive voiding Sx: Urgency, hesitancy, PVD

Hematuria

Pain (bad)

Physical 

Normal

Hard and/or nodular prostate

Prostate Cancer

PSA testing

Not a diagnostic test

Enzyme- CA cells leak 10x the PSA

Sensitive but not specific

Highest concentration is in the TZ

Normal is 0-4 ng/ml (~4-30% CA risk)

4-10 ng/ml (30% CA risk)

>10 ng/ml (~60%)

Free PSA, doubing time, velocity, density, age-adjusted PSA, etc.

Transrectal ultrasonography

Bx

Pelvic CT or MRI

It's rather complicated

Prostatectomy

Radiotherapy

Androgen depravation therapy

Prostate Cancer

Staging- TNM

T1, not clinical

T2, palpable but no spread

T3, beyond capsule

T4, spread to other structures

N1- node involvement

M1, mets