CCFP(EM) Exam: Renal and GU Emergencies
Study online at https://quizlet.com/_hydwbk
1. What are 4 general causes of proteinuria?: Glomerular (inc. permeability)
Tubular (dec. tubular reabsorption)
Overflow (excess production)
Postrenal (inflammation of urinary tract)
2. What is the approach to investigating proteinuria?: Creatinine (serum and urine), and
BUN
Urinalysis:
- Protein + RBC = glomerulonephritis
- Protein + Fatty casts - nephrotic syndrome
- Protein + WBC w/o bacteria = interstitial nephritis
Proteinuria may be falsely elevated in the setting of gross hematuria, highly alkaline urine.
3. What is the approach to follow-up for proteinuria?: If no symptoms, no signs of HTN, and
no signs of systemic illness, f/u with GP.
Otherwise referral to nephrology
4. How do patients with nephrotic syndrome present?: Typically new onset of edema and
with foamy urine.
findings of proteinuria in urine
hyperlipidemia (fatty casts on urine microscopy)
May be hypertensive
5. what is the approach to treating nephrotic syndrome?: fluid restriction
IV diuretics for edema (if Cr normal)
ACEi for BP control
6. What are complications of nephrotic syndrome?: Hypertension
Hypercoagulability (renal vein thrombosis)
7. How would patients with renal vein thrombosis in the setting of nephrotic
syndrome present?: Hematuria, flank pain, and worsening renal function in the context of edema and
proteinuria.
8. What are common causes of hematuria in patients <40 years old?: Glomeru-
lonephritis (<20)
Stone
GU Trauma
, CCFP(EM) Exam: Renal and GU Emergencies
Study online at https://quizlet.com/_hydwbk
Intense exercise
UTI
9. What are common causes of hematuria in patients >40?: Carcinoma (bladder, kidney)
Stone
UTI
BPH (Males)
10. Broadly, what are causes of hematuria?: Systemic: coagulopathy, TTP, DIC, Hemolytic anemia
Glomerular: HUS, Glomerulonephritis, IgA Nephropathy, Lupus
Upper urinary tract: malignancy, urolithiasis, infectious, interstitial nephritis, urethral strictures
Lower urinary tract: UTI, urolithiasis, BPH, prostatitis, AAA (fistula), cath, exercise induced
11. What does the timing of hematuria tell you about the source of the bleed-
ing?: Blood at onset: urethral source
Blood at end: bladder neck, prostatic urethral source
Blood throughout: source proximal to urethra
12. What is the approach to investigating hematuria in the ED?: CBC D, coags, Cr/BUN
Urinalysis ± microscopy (Hematuria >3RBC/hpf; casts, lipids, WBC)
If risk factors (age, smoker, abdo pain) consider CT imaging.
13. What are causes of hematuria mimics and pseudohematuria?: Rhabdomyolysis
Hemolysis
foods (beets, berries, rhubarb)
dyes
medications (rifampin, macrobid)
14. What would indicate rhabdomyolysis on urine microscopy in the setting of
hematuria?: positive for heme, but no RBC's on microscopy
15. What is the approach to treating hematuria in the ED?: ABCDE's
IV fluids ± blood if significant bleeding
reverse coagulopathy if indicated
consider TXA
Treat underlying cause:
Hematuria from bladder: 3-way foley catheter and continuous bladder irrigation until clear
consult urology
Study online at https://quizlet.com/_hydwbk
1. What are 4 general causes of proteinuria?: Glomerular (inc. permeability)
Tubular (dec. tubular reabsorption)
Overflow (excess production)
Postrenal (inflammation of urinary tract)
2. What is the approach to investigating proteinuria?: Creatinine (serum and urine), and
BUN
Urinalysis:
- Protein + RBC = glomerulonephritis
- Protein + Fatty casts - nephrotic syndrome
- Protein + WBC w/o bacteria = interstitial nephritis
Proteinuria may be falsely elevated in the setting of gross hematuria, highly alkaline urine.
3. What is the approach to follow-up for proteinuria?: If no symptoms, no signs of HTN, and
no signs of systemic illness, f/u with GP.
Otherwise referral to nephrology
4. How do patients with nephrotic syndrome present?: Typically new onset of edema and
with foamy urine.
findings of proteinuria in urine
hyperlipidemia (fatty casts on urine microscopy)
May be hypertensive
5. what is the approach to treating nephrotic syndrome?: fluid restriction
IV diuretics for edema (if Cr normal)
ACEi for BP control
6. What are complications of nephrotic syndrome?: Hypertension
Hypercoagulability (renal vein thrombosis)
7. How would patients with renal vein thrombosis in the setting of nephrotic
syndrome present?: Hematuria, flank pain, and worsening renal function in the context of edema and
proteinuria.
8. What are common causes of hematuria in patients <40 years old?: Glomeru-
lonephritis (<20)
Stone
GU Trauma
, CCFP(EM) Exam: Renal and GU Emergencies
Study online at https://quizlet.com/_hydwbk
Intense exercise
UTI
9. What are common causes of hematuria in patients >40?: Carcinoma (bladder, kidney)
Stone
UTI
BPH (Males)
10. Broadly, what are causes of hematuria?: Systemic: coagulopathy, TTP, DIC, Hemolytic anemia
Glomerular: HUS, Glomerulonephritis, IgA Nephropathy, Lupus
Upper urinary tract: malignancy, urolithiasis, infectious, interstitial nephritis, urethral strictures
Lower urinary tract: UTI, urolithiasis, BPH, prostatitis, AAA (fistula), cath, exercise induced
11. What does the timing of hematuria tell you about the source of the bleed-
ing?: Blood at onset: urethral source
Blood at end: bladder neck, prostatic urethral source
Blood throughout: source proximal to urethra
12. What is the approach to investigating hematuria in the ED?: CBC D, coags, Cr/BUN
Urinalysis ± microscopy (Hematuria >3RBC/hpf; casts, lipids, WBC)
If risk factors (age, smoker, abdo pain) consider CT imaging.
13. What are causes of hematuria mimics and pseudohematuria?: Rhabdomyolysis
Hemolysis
foods (beets, berries, rhubarb)
dyes
medications (rifampin, macrobid)
14. What would indicate rhabdomyolysis on urine microscopy in the setting of
hematuria?: positive for heme, but no RBC's on microscopy
15. What is the approach to treating hematuria in the ED?: ABCDE's
IV fluids ± blood if significant bleeding
reverse coagulopathy if indicated
consider TXA
Treat underlying cause:
Hematuria from bladder: 3-way foley catheter and continuous bladder irrigation until clear
consult urology
