109 - Renal Colic & Haematuria Flashcards Preview

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Flashcards in 109 - Renal Colic & Haematuria Deck (55):
1

What is the most common malignant kidney tumour?

Renal cell carcinoma

2

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

  • Calcium stones; Calcium oxolate and Calcium phosphate

2

What makes up the juxtaglomerular apparatus?

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

2

What is metabolic acidosis?

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

3

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

4

What are some genetic conditions linked to RCC?

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

5

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

6

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

7

What are the main medical renal causes of haematuria?

  • Glomerulonephritis
  • DiabetesInfection
  • Genetics
  • Autoimmune

7

Define hyperkalaemia.

A serum K level over 7.0mmol/L

8

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

9

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

T12-L2, and the pudendal nerves

10

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

  • Squamous cell carcinoma
  • Adenocarcinomas

10

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

10

What are the main causative organisms of UTIs?

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

11

Which pole of the kidney is RCC usually found?

Upper pole

13

Where can Transitional Cell Carcinoma (TCC) develop?

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

13

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.

15

What are the signs and symptoms of RCC?

  • Haematuria
  • Costovertebral pain
  • Palpable mass
  • Paraneoplastic syndromes

16

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

17

What are the 3 types of Haematuria?

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

18

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

S2-S4

19

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

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

19

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

30-50 years old

20

What is the glomerular filtration rate in healthy individuals?

Around 100ml/min

22

Which organ is the most common site of TCC?

Urinary bladder

23

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

24

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

  • Dipstick urine
  • Bloods
  • Ultrasound
  • CT scan

25

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

  • MAG3
  • DTPA

26

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

27

What percentage of kidney stones are mineral in nature?

90%

28

What are the symptoms of TCC?

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

29

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.

31

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

Up to 2RBC per high power field is normal

32

What is the main cause of cysteine stones forming?

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

33

What important endocrine functions does the kidney perform?

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

34

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

35

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

36

What are the risk factors for UTIs?

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

38

What are the causes of nephrological haematuria?

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

40

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

Patients on Metformin, as it interacts with contrast

41

What is the most common form of RCC?

Clear cell - 75% of cases

42

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

Uric acid stones

43

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

44

What are the main surgical causes of haematuria?

  • Stones
  • Tumours
  • Prostatic hyperplasia
  • Urethral stricture

45

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

46

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

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

47

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

Uric acid stones

49

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

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

50

What are the functions of mesangial cells in the kidney?

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

51

Define Haematuria

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

52

Define hypernatraemia.

Moderate hypernatraemia is a serum Na over 150 mmol/L

Severe hypernatraemia is a serum Na over 170 mmol/L

53

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

Struvite

54

What are the common benign kidney tumours?

  • Oncocytoma
  • Angiomyolipoma
  • Papillary adenoma

55

What are the treatment options of RCC?

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