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Hypertension Causes

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34661. Postinfectious Glomerulonephritis

nephrotic-range), oliguria, edema, hypertension, and renal insufficiency. Fever is unusual and suggests persistent infection. Renal failure that causes fluid overload with heart failure and severe hypertension requiring dialysis affects 1 to 2% of patients and may manifest as a with hematuria and hemoptysis. Uncommonly, nephrotic syndrome may persist after resolution of severe disease. Clinical manifestations of nonstreptococcal PIGN may mimic other disorders (eg, polyarteritis nodosa, renal emboli (...) . Treatment is supportive. (See also .) Etiology Postinfectious glomerulonephritis (PIGN), a , is the most common cause of a glomerular disorder in children between 5 and 15 yr; it is rare in children < 2 yr and uncommon in adults > 40 yr. Most cases are caused by nephritogenic strains of group A beta-hemolytic streptococci, most notably type 12 (which causes pharyngitis) and type 49 (which causes impetigo); an estimated 5 to 10% of patients with streptococcal pharyngitis and about 25% of those

2013 Merck Manual (19th Edition)

34662. Overview of Glomerular Disorders

or cellular casts) Hematuria, usually in combination with proteinuria (which may be in the nephrotic range); the RBCs are usually dysmorphic and often there are RBC or mixed cellular casts (nephritic urine sediment) is nephrotic urine sediment plus edema and hypoalbuminemia (typically with hypercholesterolemia and hypertriglyceridemia). is nephritic urine sediment with or without hypertension, elevated serum creatinine, and oliguria. Several glomerular disorders typically manifest with features of both (...) and urinalysis A glomerular disorder is usually suspected when screening or diagnostic testing reveals an elevated serum creatinine level and abnormal urinalysis (hematuria with or without casts, proteinuria, or both). Approach to the patient involves distinguishing predominant-nephritic from predominant-nephrotic features and identifying likely causes by patient age, accompanying illness (see Table: and see Table: ), and other elements of the history (eg, time course, systemic manifestations, family history

2013 Merck Manual (19th Edition)

34663. Rapidly Progressive Glomerulonephritis (RPGN)

numerous infectious and connective tissue disorders and also occurs with other primary glomerulopathies. Immunofluorescent staining demonstrates nonspecific granular immune deposits. The condition accounts for up to 40% of RPGN cases. Pathogenesis is usually unknown. Pauci-immune RPGN Pauci-immune RPGN (type 3 RPGN) is distinguished by the absence of immune complex or complement deposition on immunofluorescent staining. It constitutes up to 50% of all RPGN cases. Almost all patients have elevated (...) antineutrophil cytoplasmic antibodies (ANCAs, usually antiproteinase 3-ANCA or myeloperoxidase-ANCA) and systemic vasculitis. Double-antibody disease Double-antibody disease (type 4 RPGN) has features of types 1 and 3, with the presence of anti-GBM and ANCA antibodies. It is rare. Idiopathic RPGN Idiopathic cases are rare. They include patients with either of the following: Immune complexes (similar to type 2) but no obvious cause such as infection, connective tissue disorder, or glomerular disorder Pauci

2013 Merck Manual (19th Edition)

34664. Renal Cell Carcinoma

Renal Cell Carcinoma Renal Cell Carcinoma - Genitourinary Disorders - MSD Manual Professional Edition Brought to you by The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases / / / / IN THIS TOPIC OTHER TOPICS IN THIS CHAPTER Test your knowledge Acute Tubular (...) Necrosis Which of the following is a more common cause of acute tubular necrosis (ATN)? Ethylene glycol poisoning Burns Renal hypoperfusion Rhabdomyolysis NEWS & VIDEOS Antibiotic Delay Leads to Increased Risks in Seniors With UTI FRIDAY, March 1, 2019 (HealthDay News) -- Delaying or withholding antibiotics for older patients with a urinary tract infection (UTI) is associated with an increase in bloodstream infection... 3D Model Male Reproductive System Video How to Catheterize the Urethra in Women

2013 Merck Manual (19th Edition)

34665. Autosomal Dominant Polycystic Kidney Disease (ADPKD)

hematuria may be due to a dislodged calculus or to hemorrhage from a ruptured cyst. Pyuria is common even without bacterial infection; thus diagnosis of infection should be based on culture results and clinical findings (eg, dysuria, fever, flank pain) as well as urinalysis. Initially, BUN and creatinine are normal or only mildly elevated, but they slowly increase, especially when hypertension is present. Rarely, CBC detects polycythemia. Patients with symptoms of cerebral aneurysm require high (...) Reproductive System Video How to do Urethral Catheterization in Males SOCIAL MEDIA Add to Any Platform Loading , MD, MHS, Loma Linda University School of Medicine Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Polycystic kidney disease (PKD) is a hereditary disorder of renal cyst formation causing gradual enlargement of both kidneys, sometimes with progression to renal failure. Almost all forms are caused by a familial genetic mutation. Symptoms

2013 Merck Manual (19th Edition)

34666. Chronic Kidney Disease

, hypertension) Usually CKD AKI = acute kidney injury; CKD = chronic kidney disease Testing includes urinalysis with examination of the urinary sediment, electrolytes, urea nitrogen, creatinine, phosphate, calcium, and CBC. Sometimes specific serologic tests are needed to determine the cause. Distinguishing from CKD is most helped by a history of an elevated creatinine level or abnormal urinalysis. Urinalysis findings depend on the nature of the underlying disorder, but broad ( > 3 WBC diameters wide (...) neuropathies, and seizures. Diagnosis is based on laboratory testing of renal function, sometimes followed by renal biopsy. Treatment is primarily directed at the underlying condition but includes fluid and electrolyte management, blood pressure control, treatment of anemia, various types of dialysis, and kidney transplantation. Prevalence of CKD (stages 1 through 5) in the US adult general population is estimated at 14.8% ( ). Etiology Chronic kidney disease may result from any cause of renal dysfunction

2013 Merck Manual (19th Edition)

34667. Overview of Cystic Kidney Disease

in Males SOCIAL MEDIA Add to Any Platform Loading , MD, MHS, Loma Linda University School of Medicine Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Cystic kidney disease may be congenital or acquired. Congenital disorders may be inherited as autosomal dominant disorders or autosomal recessive disorders or have other causes (eg, sporadic mutations, chromosomal abnormalities, teratogens). Some are part of a malformation syndrome (see Table: ). Table (...) delay Malformations of the head, face, hands, and feet Acquired Multiple cysts Associated with long-term dialysis, usually after > 10 yr High risk of Cysts associated with tumors For example, with renal cell carcinoma or nephroblastoma Solitary simple cysts Low risk of and Associated with aging *Caused by, eg, sporadic mutations, chromosomal abnormalities, teratogens, or unknown mechanisms. ESRD = end-stage renal disease. Last full review/revision January 2018 by Navin Jaipaul, MD, MHS NOTE

2013 Merck Manual (19th Edition)

34668. Prostatitis

incomplete relaxation of the urinary sphincter and dyssynergic voiding. The resultant elevated urinary pressure may cause urine reflux into the prostate (triggering an inflammatory response) or increased pelvic autonomic activity leading to without inflammation. Classification Prostatitis is classified into 4 categories (see Table: ). These categories are differentiated by clinical findings and by the presence or absence of signs of infection and inflammation in 2 urine samples. The first sample (...) Prostatitis Prostatitis - Genitourinary Disorders - MSD Manual Professional Edition Brought to you by The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases / / / / IN THIS TOPIC OTHER TOPICS IN THIS CHAPTER Test your knowledge Acute Tubular Necrosis Which

2013 Merck Manual (19th Edition)

34669. Scrotal Pain

Sometimes biopsy of skin lesions Fever, weight loss, abdominal pain, hypertension, edema Skin lesions including palpable purpura and subcutaneous nodules Can be acute or chronic May cause testicular ischemia and infarction Most common in men aged 40–50 yr Sometimes biopsy of affected organ Referred pain ( , , lower lumbar or sacral nerve root impingement, retrocecal appendicitis, retroperitoneal tumor, postherniorrhaphy pain) Normal scrotal examination Sometimes abdominal tenderness depending on cause (...) injury, straining or lifting, and sexual contact. Review of systems should seek symptoms of causative disorders, including purpuric rash, abdominal pain, and arthralgias ( [Henoch-Schönlein purpura]); intermittent scrotal masses, groin swelling, or both (inguinal hernia); fever and parotid gland swelling (mumps orchitis); and flank pain or hematuria ( ). Past medical history should identify known disorders that may cause referred pain, including hernias, , renal calculi, and risk factors for serious

2013 Merck Manual (19th Edition)

34670. Proteinuria

to Any Platform Loading , MD, David Geffen School of Medicine at UCLA Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Proteinuria is protein, usually albumin, in urine. High concentrations of protein cause frothy or sudsy urine. In many renal disorders, proteinuria occurs with other urinary abnormalities (eg, ). Isolated proteinuria is urinary protein without other symptoms or urinary abnormalities. Pathophysiology Although the glomerular basement (...) large amounts) to pass into the filtrate. Tubular proteinuria results from renal that impair reabsorption of protein by the proximal tubule, causing proteinuria (mostly from smaller proteins such as immunoglobulin light chains rather than albumin). Causative disorders are often accompanied by other defects of tubular function (eg, HCO 3 wasting, glucosuria, aminoaciduria) and sometimes by glomerular pathology (which also contributes to the proteinuria). Overflow proteinuria occurs when excessive

2013 Merck Manual (19th Edition)

34671. Isolated Hematuria

in patients > 50, although younger patients with risk factors may develop cancer. Glomerular disorders can be a cause at all ages. may represent a primary renal disorder (acquired or hereditary) or be secondary to many causes, including infections (eg, group A beta-hemolytic streptococcal infection), connective tissue disorders and (eg, at all ages, [Henoch-Schönlein purpura] in children), and blood disorders (eg, mixed cryoglobulinemia, serum sickness). Worldwide, is the most common form (...) a glomerular disorder), and the skin should be inspected for rashes (suggesting , , or ). Red flags The following findings are of particular concern: Gross hematuria and concurrent proteinuria Persistent microscopic hematuria, especially in older patients Age > 50 and Systemic symptoms (eg, fever, night sweats, weight loss) Interpretation of findings Clinical manifestations of the various causes overlap significantly, so urine and often blood tests are required. Depending on results, imaging tests may

2013 Merck Manual (19th Edition)

34672. Acute Kidney Injury

permanent kidney damage (and hence are potentially reversible) unless hypoperfusion is severe enough to cause tubular ischemia. Hypoperfusion of an otherwise functioning kidney leads to enhanced reabsorption of sodium and water, resulting in oliguria (urine output < 500 mL/day) with high urine osmolality and low urine sodium. Renal causes of AKI involve intrinsic kidney disease or damage. Disorders may involve the blood vessels, glomeruli, tubules, or interstitium. The most common causes (...) and electrolyte management and sometimes dialysis. In all cases of acute kidney injury (AKI), creatinine and urea build up in the blood over several days, and fluid and electrolyte disorders develop. The most serious of these disorders are and (possibly causing pulmonary edema). Phosphate retention leads to hyperphosphatemia. Hypocalcemia is thought to occur because the impaired kidney no longer produces calcitriol and because hyperphosphatemia causes calcium phosphate precipitation in the tissues. Acidosis

2013 Merck Manual (19th Edition)

34673. Priapism

and intervening periods of detumescence. Nonischemic priapism Less commonly, priapism is due to unregulated arterial inflow (ie, high flow), usually as a result of formation of an arterial fistula after trauma. Nonischemic priapism is not painful and does not lead to necrosis. Subsequent erectile dysfunction is common. Etiology In adults, the most common cause (see Table: ) is Drug therapy for In children, the most common causes are Hematologic disorders (eg, , less commonly ) In many cases, priapism may (...) for hemoglobinopathies, , , , and other causes: CBC Urinalysis and culture Hb electrophoresis in blacks and men of Mediterranean descent Many clinicians also do drug screening, intracavernosal ABG testing, and . Penile duplex ultrasonography will show little or absent cavernosal blood flow in men with ischemic priapism and normal to high cavernosal blood flow in men with nonischemic priapism. Ultrasonography may also reveal anatomic abnormalities, such as cavernous arterial fistula or pseudoaneurysm, which usually

2013 Merck Manual (19th Edition)

34674. Approach to the Genitourinary Patient - Evaluating Kidney Function

). Any amount is abnormal. Falsely low or negative results can result from any of the following: Ascorbic acid Ketones Aspirin Levodopa Tetracycline Very high urine pH Dilute urine Hematuria is detected when RBCs lyse on a dipstick test strip, releasing Hb and causing a color change. Range is from negative (0) to 4 + . Trace blood (corresponding to 3 to 5 RBCs/high-power field [HPF]) is normal under some circumstances (eg, exercise) in some people. Because the test strip reagent reacts with Hb, free (...) cascara, diphenylhydantoin, rifampin , methyldopa , phenacetin, phenindione, phenolphthalein, phenothiazines, and senna may make urine appear dark yellow to orange or red) High concentrations of urinary protein cause frothy or sudsy urine. (voiding more often) should be distinguished from (voiding a larger amount than normal) in patients who report excessive urination. Nocturia may be a feature of either but is often the result of excess fluid intake too close to bedtime, , or . Family history

2013 Merck Manual (19th Edition)

34675. Approach to the Genitourinary Patient - Testing

results can result from any of the following: Ascorbic acid Ketones Aspirin Levodopa Tetracycline Very high urine pH Dilute urine Hematuria is detected when RBCs lyse on a dipstick test strip, releasing Hb and causing a color change. Range is from negative (0) to 4 + . Trace blood (corresponding to 3 to 5 RBCs/high-power field [HPF]) is normal under some circumstances (eg, exercise) in some people. Because the test strip reagent reacts with Hb, free Hb (eg, due to intravascular hemolysis) or myoglobin (...) , rifampin , methyldopa , phenacetin, phenindione, phenolphthalein, phenothiazines, and senna may make urine appear dark yellow to orange or red) High concentrations of urinary protein cause frothy or sudsy urine. (voiding more often) should be distinguished from (voiding a larger amount than normal) in patients who report excessive urination. Nocturia may be a feature of either but is often the result of excess fluid intake too close to bedtime, , or . Family history is useful for identifying

2013 Merck Manual (19th Edition)

34676. Approach to the Genitourinary Patient - Physical Examination

results can result from any of the following: Ascorbic acid Ketones Aspirin Levodopa Tetracycline Very high urine pH Dilute urine Hematuria is detected when RBCs lyse on a dipstick test strip, releasing Hb and causing a color change. Range is from negative (0) to 4 + . Trace blood (corresponding to 3 to 5 RBCs/high-power field [HPF]) is normal under some circumstances (eg, exercise) in some people. Because the test strip reagent reacts with Hb, free Hb (eg, due to intravascular hemolysis) or myoglobin (...) , diphenylhydantoin, rifampin , methyldopa , phenacetin, phenindione, phenolphthalein, phenothiazines, and senna may make urine appear dark yellow to orange or red) High concentrations of urinary protein cause frothy or sudsy urine. (voiding more often) should be distinguished from (voiding a larger amount than normal) in patients who report excessive urination. Nocturia may be a feature of either but is often the result of excess fluid intake too close to bedtime, , or . Family history is useful for identifying

2013 Merck Manual (19th Edition)

34677. Approach to the Genitourinary Patient - History

results can result from any of the following: Ascorbic acid Ketones Aspirin Levodopa Tetracycline Very high urine pH Dilute urine Hematuria is detected when RBCs lyse on a dipstick test strip, releasing Hb and causing a color change. Range is from negative (0) to 4 + . Trace blood (corresponding to 3 to 5 RBCs/high-power field [HPF]) is normal under some circumstances (eg, exercise) in some people. Because the test strip reagent reacts with Hb, free Hb (eg, due to intravascular hemolysis) or myoglobin (...) , diphenylhydantoin, rifampin , methyldopa , phenacetin, phenindione, phenolphthalein, phenothiazines, and senna may make urine appear dark yellow to orange or red) High concentrations of urinary protein cause frothy or sudsy urine. (voiding more often) should be distinguished from (voiding a larger amount than normal) in patients who report excessive urination. Nocturia may be a feature of either but is often the result of excess fluid intake too close to bedtime, , or . Family history is useful for identifying

2013 Merck Manual (19th Edition)

34678. Approach to the Genitourinary Patient - Evaluation of the Renal Patient

). Any amount is abnormal. Falsely low or negative results can result from any of the following: Ascorbic acid Ketones Aspirin Levodopa Tetracycline Very high urine pH Dilute urine Hematuria is detected when RBCs lyse on a dipstick test strip, releasing Hb and causing a color change. Range is from negative (0) to 4 + . Trace blood (corresponding to 3 to 5 RBCs/high-power field [HPF]) is normal under some circumstances (eg, exercise) in some people. Because the test strip reagent reacts with Hb, free (...) cascara, diphenylhydantoin, rifampin , methyldopa , phenacetin, phenindione, phenolphthalein, phenothiazines, and senna may make urine appear dark yellow to orange or red) High concentrations of urinary protein cause frothy or sudsy urine. (voiding more often) should be distinguished from (voiding a larger amount than normal) in patients who report excessive urination. Nocturia may be a feature of either but is often the result of excess fluid intake too close to bedtime, , or . Family history

2013 Merck Manual (19th Edition)

34679. Attention-Deficit/Hyperactivity Disorder (ADD, ADHD)

homework). Drug holidays may be tried on weekends, on holidays, or during summer vacations. Placebo periods (for 5 to 10 school days to ensure reliability of observations) are recommended to determine whether the drugs are still needed. Common adverse effects of stimulant drugs include Sleep disturbances (eg, insomnia) Depression Headache Stomachache Appetite suppression Elevated heart rate and blood pressure Some studies have shown slowing of growth over 2 yr of stimulant drug use, but results have (...) Attention-Deficit/Hyperactivity Disorder (ADD, ADHD) Attention-Deficit/Hyperactivity Disorder (ADD, ADHD) - Pediatrics - MSD Manual Professional Edition Brought to you by The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases / / / / IN THIS TOPIC OTHER TOPICS

2013 Merck Manual (19th Edition)

34680. Fabry Disease

, according... 3D Model Cystic Fibrosis: Defective Chloride Transport Video How to do Neonatal Resuscitation SOCIAL MEDIA Add to Any Platform Loading Topic Resources Fabry disease is a , an inherited disorder of metabolism, caused by deficiency of alpha-galactosidase A, which causes angiokeratomas, acroparesthesias, corneal opacities, recurrent febrile episodes, and renal or heart failure. For more information, see . See also . Fabry disease is an deficiency of the lysosomal enzyme alpha-galactosidase (...) A, which is needed for normal trihexosylceramide catabolism. Glycolipid (globotriaosylceramide) accumulates in many tissues (eg, vascular endothelium, lymph vessels, heart, kidney). Diagnosis in males is clinical, based on appearance of typical skin lesions (angiokeratomas) over the lower trunk and by characteristic features of peripheral neuropathy (causing recurrent burning pain in the extremities), corneal opacities, and recurrent febrile episodes. Death results from renal failure or cardiac

2013 Merck Manual (19th Edition)

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