109 - Renal Colic & Haematuria Flashcards Preview

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Flashcards in 109 - Renal Colic & Haematuria Deck (55):

What is the most common malignant kidney tumour?

Renal cell carcinoma


Which type of stone is formed due to dehydration or hypercalcaemia?

  • Calcium stones; Calcium oxolate and Calcium phosphate


What makes up the juxtaglomerular apparatus?

  • Macula densa
  • Lacis cells
  • Juxtaglomerular cells; renin-secreting


What is metabolic acidosis?

The accumulation of any acid other than carbonic acid in the serum, usually with a decrease in HCO3 seen


What are the risk factors for developing TCC?

  • Male over 50 years old
  • White
  • Smoking
  • Chemicals such as β-naphthylamine, chemotherapy
  • Schistosomiasis
  • Chronic infection/irritation of bladder


What are some genetic conditions linked to RCC?

  • Von Hippel Lindau
  • Hereditary (familial) clear cell RCC
  • Hereditary papillary RCC


What are the different types of RCC and where are they found?

  • Clear cell; proximal tubules
  • Papillary; distal convoluted tubules
  • Chromophobe and collecting duct; intercalated cells of CD in medulla
  • Others


What are the criteria for urological referral of haematuria?

  • All patients with visible haematuria
  • All patients with symptomatic non-visible haematuria
  • Patients over 40 with asymptomatic non-visible haematuria


What are the main medical renal causes of haematuria?

  • Glomerulonephritis
  • DiabetesInfection
  • Genetics
  • Autoimmune


Define hyperkalaemia.

A serum K level over 7.0mmol/L


In which part of the nephron is the macula densa found? and what is in close contact to?

It is found in the distal convoluted tubule and is in close contact with the afferent arteriole of its own nephron


What nerve roots contribute to the sympathetic nervous supply of the bladder?

T12-L2, and the pudendal nerves


Apart from TCC, what other cancers can affect the bladder?

  • Squamous cell carcinoma
  • Adenocarcinomas


What are the 4 main types of calculi found in the urinary system?

  1. Calcium
  2. Struvite (Magnesium Ammonium Phosphate)
  3. Uric acid
  4. Cysteine


What are the main causative organisms of UTIs?

  • E. coli; most common
  • Entercoccus faecalis
  • Klebsiella
  • Pseudomonas


Which pole of the kidney is RCC usually found?

Upper pole


Where can Transitional Cell Carcinoma (TCC) develop?

Anywhere from the renal pelvis to the end of the urethra.


What is homeostasis?

The tendency of an organism to regulate its internal conditions, usually by a system of feedback controls, so as to stabilise health and functioning, regardless of outside conditions.


What are the signs and symptoms of RCC?

  • Haematuria
  • Costovertebral pain
  • Palpable mass
  • Paraneoplastic syndromes


What 3 places along the ureters are calculi likely to become stuck?

  1. Pelviureteric junction
  2. Where ureter cross iliac vessels and enters pelvic brim
  3. Vesicoureteric junction


What are the 3 types of Haematuria?

  1. Visible haematuria
  2. Symptomatic non-visible haematuria
  3. Asymptomatic non-visible haematuria


What spinal roots contribute to the parasympathetic nervous supply of the bladder?



What are the treatment options of calculi that are unlikely to pass?

  • Extracorporeal Shock Wave Lithotripsy
  • Ureteroscopy
  • Percutaneous nephrolithotomy (PCNL)
  • Open surgical removal


In what age group do majority of people develop kidney stones first?

30-50 years old


What is the glomerular filtration rate in healthy individuals?

Around 100ml/min


Which organ is the most common site of TCC?

Urinary bladder


What are the symptoms of renal colic?

  • Acute excruciating pain, beginning in the abdomen and radiating to the hypochondium (T10-L1), that is colicky in nature
  • Unable to get into a comfortable position
  • Haematuria
  • Sepsis if caused by infection


What investigations should be performed for conformation of diagnosis of RCC?

  • Dipstick urine
  • Bloods
  • Ultrasound
  • CT scan


Name 2 types of nuclear imaging that can be used to determine the anatomy and function of the kidneys?

  • MAG3
  • DTPA


What 5 hormones affect the amount of Na, Cl, Ca and water reabsorbed by the kidneys?

  1. Angiotensin II
  2. Aldosterone
  3. ADH
  4. Atrial Natriuretic Hormone (ANP)
  5. Parathyroid hormone


What percentage of kidney stones are mineral in nature?



What are the symptoms of TCC?

  • Painless haematuria in 85%
  • Increased urination
  • Urgency
  • Dysuria in 20%


What 3 ways can angiotensin II affect renal physiology?

  1. Vasoconstriction of afferent arteriole causing decrease in glomerular filtration
  2. Enhances Na, Cl and water reabsorption by activating Na-K antipoters
  3. Stimulates Aldosterone release from adrenal cortex, causing P cells to reabsorb more Na, Cl and water and secrete more K.


What is the normal limit of RBC excretion in the urine?

Up to 2RBC per high power field is normal


What is the main cause of cysteine stones forming?

Genetic defect that results in abnormalities in amino acid reabsorbption including cysteine.


What important endocrine functions does the kidney perform?

  • Secretion of renin
  • Production of erythropoietin
  • Activation of Vit D


What transporters and channels are involved in Na movement in the kidneys?

  • Na-K ATPase
  • Na-H exchanger
  • Na-2Cl-K exchanger
  • Na-Cl cotransporter
  • ENac channels


Which investigations would be performed to diagnose TCC of the bladder?

  • Urine cytology
  • Cystoscopy and biopsy; is tumour pedunculated or sessile?
  • CT scan if metastases suspected


What are the risk factors for UTIs?

  • Local infection from GIT or sex
  • Diabetes
  • Indwelling catheters
  • Pregnancy
  • Mechanical obstruction of UT


What are the causes of nephrological haematuria?

  • Glomerular disease
  • Tubulointerstitial disease
  • Renovascular disease
  • Systemic diseases


Which group of patients is a IV urogram (IV pyelogram) not suitable for? (Think diabetics)

Patients on Metformin, as it interacts with contrast


What is the most common form of RCC?

Clear cell - 75% of cases


Which type of stone is precipitated by hyperuricaemia or low urinary pH?

Uric acid stones


What are the initial investigations of renal colic?

  • Urine analysis; mid-stream (MSD) for microscopy and dipstick
  • Blood tests; FBC, U&Es, Ca, Urate and albumin
  • KUB X-Ray
  • CT scan


What are the main surgical causes of haematuria?

  • Stones
  • Tumours
  • Prostatic hyperplasia
  • Urethral stricture


What 2 cells make up the epithelium of the collecting ducts, and what does each 1 do?

  1. Principle cells (P cells); Na reabsorption & ADH stimulated water reuptake
  2. Intercalated cells (I cells); Acid and HCO3 secretion


Which stones are linked to infections from Staphylococci and proteus bacteria?

  • Struvite; these bacteria convert urea into ammonia that crystallises within the tubules


Which type of stone is radio-lucent (can't be seen on X-Ray)?

Uric acid stones


What are the risk factors for Renal Cell Carcinoma (RCC)?

  • Over 50 years old
  • Male
  • Smoking
  • Certain genetic conditions


What are the functions of mesangial cells in the kidney?

Control glomerular filtration as they can contract and constrict the arterioles.


Define Haematuria

The excretion of 3 or more RBC per high power field in freshly voided centrifuged urine, over 3 samples


Define hypernatraemia.

Moderate hypernatraemia is a serum Na over 150 mmol/L

Severe hypernatraemia is a serum Na over 170 mmol/L


Which type of stone are the most likely to form large staghorn calculi?



What are the common benign kidney tumours?

  • Oncocytoma
  • Angiomyolipoma
  • Papillary adenoma


What are the treatment options of RCC?

  • Surgery
  • Tyrosine kinase inhibitors for metastatic clear cell
  • Chemo and radiotherapy not useful