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GU / GYN & Renal > B&B Renal: Other > Flashcards

B&B Renal: Other Flashcards

1
Q

Cystitis

UTIs

A

Bladder infection
* Lower urinary tract

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2
Q

Pyelonephritis

UTIs

A

Kidney infection
* Upper urinary tract

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3
Q

UTI

Etiology

A
  • E. coli: 75-90% of cases
  • Proteus mirabilis
    * Urease-producing –> struvite kidney stones
  • Klebsiella pneumoniae
  • Staphylococcus saprophyticus
  • Enterococcus faecalis

Typically enteric bacteria

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4
Q
  • Dysuria
  • Frequnecy
  • Urgency
  • Suprapubic pain
  • No systemic symptoms
  • Usually normal plasma WBC count

Signs & Symptoms

A

Cystitis

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5
Q
  • Systemic symptoms: fever, chills
  • Flank pain
  • CVA tenderness
  • Urine: hematuria; WBC casts

Signs & Symptoms

A

Pyelonephritis

Ascending infection –> will also have cystitis symptoms

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6
Q

UTI

Diagnosis

A
  • Urinalysis
    • Cloudy urine
    • Leukocyte esterase –> produced by WBCs in urine
    • Nitrites –> 90% of UTI bugs convert nitrates to nitrites
    • > 10 WBC/hpf
  • Urine culture
    • > 100,000 CFUs
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7
Q

UTI

Risk Factors

A
  • Women: 10x more likely than men
    * Shorter urethra, closer to fecal flora
  • Sexual activity
  • Urinary catheterization
  • Diabetes
  • Pregnancy
  • Infants with vesicoureteral reflux
    • Abnormal insertion of ureters into bladder
    • Chronic backflow of urine back into ureters
  • Urinary obstruction
    • Anatomic abnormalities in children
    • Bladder tumors in adults
    • Enlarged prostate in older mens
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8
Q

UTI

Treatment

A

Fluoroquinolones: ciprofloxacin, levofloxacin, ofloxacin
* Nitrofurantoin: used in pregnancy

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9
Q

Chronic Pyelonephritis

UTIs

A
  • Consequence of recurrent pyelonephritis
    • Children w/ vesicoureteral reflux
    • Adults w/ recurrent kidney stones
  • Results in kidney injury
    • Corticomedullary scarring
    • Blunted calyces
    • Renal thyroidization: tubules contain eosinophilic material, look like thyroid on LM
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10
Q

Cystic Kidney Diseases

A
  1. Multicystic Dysplastic Kidney
  2. Autosomal Recessive PKD
  3. Autosomal Dominant PKD
  4. Medullary Cystic Kidney Disease

PKD = Polycystic Kidney Disease

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11
Q

Multicystic Dysplastic Kidney

Cystic kidney Diseases

A

Abnormal ureteric bud-mesenchyme interaction in gestation
* Kidney replaced with cysts
* No / little functioning renal tissue
* Absent ureter
* Unilateral –> remaining kidney hypertrophies
* Bilateral –> Potter’s syndrome
* Oligohydramnios
* Failure of lung maturation
* Compression of face / limbs
* Not compatible with life
* Spontaneous congenital abnormality
* Not-inherited, unlike other cystic kidney diseases

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12
Q

Autosomal Recessive PKD

PKD

A
  • Occurs in infants; rare
  • Bilateral –> Potter’s syndrome
  • Renal failure
  • High BP
  • Key associations:
    * Liver disease: fibrosis, cysts
    * Portal hypertension: ascites
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13
Q

Autosomal Dominant PKD

PKD

A
  • Occurs in adults; more common
  • Microscopic cysts present at birth
    • Cysts are too small to visualize with U/S
    • Kidneys appear normal at birth
  • Cysts develop over many years
  • Inherited mutation: APKD1 or APKD2 gene
  • Key assocation
    • Berry aneurysm –> subarachnoid hemorrhage
    • Liver cysts
    • Mitral valve prolapse
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14
Q
  • Young adult
  • High BP
  • Hematuria
  • Renal failure
  • Fx of sudden death (aneurysm)

Presentation

A

Autosomal Dominant PKD

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15
Q

Medullary Cystic Kidney Disease

Cystic Kidney Diseases

A
  • Autosomal dominant disorder
  • Cysts develop in medullary collecting ducts
    • Most patients do not have cysts
  • Fibrosis of kidneys –> small, shrunken kidneys
    • Kidneys are enlarged in other cystic diseases
  • Often associated with early-onset gout
    • Due to inability to properly filter uric acid
  • Renal failure
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16
Q

Types of Kidney Stones

Kidney Stones

A
  1. Calcium
  2. Struvite
  3. Urate
  4. Cystine
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17
Q
  • Flank pain (between ribs & hip)
  • Colicky pain (waxes & wanes in severity)
  • Hematuria

Signs & Symptoms

A

Kidney Stones

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18
Q

Kidney Stones

Risk Factors

A
  • High amount of stone substance in blood
    • Hypercalcemia
    • Hyperuricemia
  • Low urine volume
    • Usually from dehydration
    • Increases concentration of urine substances
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19
Q

Calcium Stones

Kidney Stones

A
  • Most common type of kidney stone (80%)
    • Calcium oxalate: most common
    • Calcium phosphate
  • Key risk factors:
    • Hypercalcemia
    • High oxalate levels in blood
  • Radiopaque –> visible on X-Ray, CT
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20
Q

Calcium Stones

Risk Factors

A

Most common etiology: idiopathic hypercalciuria
* Hypercalcemia (hyperparathyroidism)
* High oxalate levels
* Crohn’s disease
* Gastric bypass patients
* Ethylene glycol –> produces oxalate
* Vitamin C abuse –> produces oxalate

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21
Q

Calcium Stones

Treatment

A
  • Most stones pass on their own
  • Larger stones that do not pass require surgery
  • Recurrent stone formers may take prophylactics
    * TZ diuretics: decrease Ca2+ in urine
    * Citrate: binds Ca2+, inhibits stone formation
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22
Q

Dietary Sodium

Calcium Stones

A
  • Sodium balance
    • Sodium intake increases ECV –> turns off RAAS
    • Inactive RAAS decreases Na+ resorption in PCT
    • Decreased Na+ resorption reduces Ca2+ resorption in PCT
  • More serum [Na] = more urine [Ca]
    • High Na diet –> increased risk of stone
    • Low Na diet –> prevents stone formation
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23
Q

Struvite Stones

Kidney Stones

A
  • 2nd most common type of kidney stone: 15%
    • NH3-Mg-PO4 stones
  • Consequence of UTI
    • Urease-positive bacteria: Proteus, Staph, Klebsiella
    • All hydrolyze urea to ammonia
    • Alkaline urine –> promotes stone formation
  • Can form staghorn calculi
    • Stones form a cast of renal pelvis & calyces
    • Cannot pass on their own –> require surgery
    • Untreated –> bacterial reservoir
      * Results in recurrent infections
  • Radiopaque –> visible on X-Ray, CT
24
Q
  • UTI symptoms: dysuria, frequency
  • Mild flank pain
  • Hematuria
  • Large, branching staghorn stone on imaging

Presentation

A

Staghorn Calculi

25
Q

Uric Acid Stones

Kidney Stones

A
  • Caused by high uric acid in urine or acidic urine
    • H+ + Urate- –> Uric Acid
    • Lowest urine pH is in distal tubule / CD
  • Radiolucent stones –> not visible on X-Ray
    • Can see with CT scan
26
Q

Uric Acid Stones

Risk Factors

A
  • High uric acid levels
    * Gout
    * Leukemia
    * Myeloproliferative disease
  • Acidic urine –> precipitates uric acid
    • Chronic diarrhea
  • More common in hot, arid climates
    • Low urine volume & pH more common
27
Q

Uric Acid Stones

Treatment

A

Dissolve stone
* Hydration
* Alkalization of urine: HCO3-

28
Q

Cystine Stone

Kidney Stones

A
  • Seen in children with cystinuria
    * Tubular defect –> impaired cystine resorption
  • Also form staghorn calculi
  • Treatment: hydration & alkalinzation of urine
29
Q

Renal & Bladder Tumors

Urinary Tract Tumors

A
  1. Renal Cell Carcinoma (RCC)
  2. Wilms’ Tumor
  3. Renal Angiomyolipoma
  4. Transitional Cell / Urothelial Carcinoma (TCC / UC)
  5. Squamous Cell Carcinoma (SCC)
  6. Adenocarcinoma
30
Q

Most common kidney tumor
* Epithelial tumor
* Commonly arises from proximal tubule cells

Renal Tumors

A

RCC

31
Q
  1. Sex: M > F
  2. Age: 50-70 years
  3. Cigarette smoking
  4. Obesity

Risk Factors

A

RCC

32
Q
  • Classic triad (< 10% of patient):
    * Hematuria
    * Palpable abdominal mass
    * Flank pain
  • Many patients have fever, weight loss
  • Many pts are asymptomatic until advanced disease
    * 25% have mets / advanced disease at presentation

Presentation

A

RCC

33
Q
  • Invades renal vein
    • Can block drainage of spermatic vein on left
    • Left varicocele = classic finding
    • Not right –> R. spermatic drains directly to IVC
  • Spreads through venous system
  • Common sites for mets:
    • Lungs
    • Bone
  • Can also spread to retroperitoneal lymph nodes

Spread / Metastases

A

RCC

34
Q
  • Polycythemia –> increased Hct
    • EPO production by tumor
  • Hypercalcemia
    • Tumor production of PTH-related peptide
    • Increased Ca resorption from bone
  • Hypertension
    • Renin production by tumor
  • Cushing’s Syndrome
    • ACTH production by tumor
    • Look for weight gain, HTN, hyperglycemia

Paraneoplastic Syndromes

A

RCC

35
Q

Most common type of RCC

Pathology

A

Clear cell carcinoma
* Cells filled with glycogen & lipids

36
Q

RCC

Genetics

A

Associated with chromosome 3 gene deletion
* Von-Hippel-Lindau (VHL) gene
* Sporadic mutation
* Single tumor
* Older patient, usually smoker
* Inherited mutation
* Younger patient
* Multiple, bilateral tumors

37
Q

VHL Disease

RCC

A

Autosomal dominant VHL gene inactivation
* Diffuse tumors:
* RCC
* Cerebellar hemangioblastoma
* Retinal hemangioblastoma

38
Q

RCC

Treatment

A
  • Surgical resection in early disease
  • Poorly responsive to CTX / radiation
  • Recombinant cytokine: IL-2
    * Side effects: hypotension, fevers, chills
39
Q

Most common renal malignancy of young children
* Proliferation of metanephric mesenchyme
* Embryonic glomerular structures

Renal Tumors

A

Wilms’ Tumor

40
Q

Wilms’ Tumor

Genetics

A

Associated with loss of function mutation in chromosome 11
* WT1 tumor suppressor gene
* May be sporadic, often part of a syndrome

41
Q

WAGR Syndrome

Wilms’ Tumor

A

WT1 gene deletion in chromosome 11
* Wilms’ tumor
* Aniridia = absence of iris
* Visual problems
* Genital anomalies
* Cryptorchidism
* Ambiguous genitalia
* Mental retardation

42
Q

Benign tumor of blood vessels, smooth muscle, and fat in young children
* Associated with tuberous sclerosis

Renal Tumors

A

Renal Angiomyolipoma

43
Q

Most common tumor of urinary tract system
* Most common type of bladder cancer
* Locations:
* Bladder: most common
* Also can occur in renal calyces, pelvis, ureters
* Often multifocal & recurrent
* “Field defect”: damage to entire urothelium

Urinary Tract Tumors

A

Transitional Cell Carcinoma (TCC)

44
Q
  • Smoking
  • Cyclophosphamide
  • Phanacetin
  • Aniline dyes (hair dyes)
  • Workplace exposures:
    • Rubber, textiles, leather
    • Naphthaline (industrial solvent)
    • Painters, machinists, printers

Risk Factors

A

TCC

45
Q

TCC

Diagnosis

A

Cytoscopy & biopsy

46
Q

TCC

Treatment

A
  • Surgical resection
  • Radiation
  • CTX: combination Tx with platinum-based regimens
    * Cisplatin
    * Carboplatin
47
Q

SCC

Bladder Cancers

A
  • Rare bladder cancer
  • Requires chronic inflammation of bladder
  • Key risk factors:
    * Recurrent kidney stones / cystitis
    * UTI with Schistosoma haemotobium
48
Q

Schistosoma haematobium

SCC

A

Trematode found in Africa & Middle East (Egypt)
* Acquired from freshwater containing larvae
* Penetrate skin & migrate to liver for maturation
* Adult infect bladder
* Usually causes hematuria
* Chronic bladder infection can result in SCC

49
Q

Adenocarcinoma

Bladder Cancers

A
  • Very rare bladder cancer
  • Glandular prolieration in bladder
  • Occurs in special circumstances
    * Urachal remnant
    * Long history of cystitis
    * Bladder exstrophy
50
Q
  • Syndrome caused by muscle necrosis
  • Can lead to renal failure & death
A

Rhabdomyolysis

51
Q

Causes of Muscle Damage

Rhabdomyolysis

A
  1. Intense physical exercise –> especially if dehydrated
  2. Crush injuries: trauma
  3. Drugs: statins, fibrates
52
Q

Muscle Contents

Rhabdomyolysis

A
  • Creatine kinase
    • Elevated levels are hallmark of rhabdo
  • Aldolase
  • LDH
  • AST / ALT
53
Q

Muscle Contents

Rhabdomyolysis

A
  • Creatine kinase
    • Elevated levels are hallmark of rhabdo
  • Aldolase, LDH, AST / ALT
  • Potassium & phosphate
    * Hyperkalemia & hyperphosphatemia in rhabdo
  • Purines –> metabolized to uric acid in liver
    * Can lead to hyperuricemia
  • Myoglobin –> binds oxygen for use by muscle
    * Contains heme
54
Q

Renal Toxicity

Myoglobin

A
  • Obstructs tubules
  • Toxic to proximal tubular cells
  • Vasoconstriction –> especially in medulla
    • Leads to hypoxia
55
Q
  • Muscle pain
  • Weakness
  • Dark urine

Presentation

A

Rhabdomyolysis
* Dark urine due to myoglobin

56
Q

Rhabdomyolysis

Diagnosis

A
  • Creatine kinase
    * Normal: <250 IU/L
    * Rhabdo: >1,000 IU/L
  • Urinalysis for heme
    • Positive dipstick = hemoglobin or myoglobin
  • Microscopy for RBCs
    • No evidence of RBCs

GU / GYN & Renal (23 decks)

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