109 - Renal colic + Haematuria

Question 1

what is the pathology definition of haematuria?

Answer 1

3 or more RBCs per high powered view in freshly voided + centrifuged urine

Question 2

What are the 3 classifications of haematuria?

Answer 2

VH - visible
s-NVH - symptomatic non visible
a-NVH - asymptomatic non visible

Question 3

What are the 2 types of malignant tumour found in the kidneys?

Answer 3

RCC - 85% - Renal cell carcinoma
- Clear cell RCC. Papillary, chromophobe, collecting duct.

TCC - Transitional cell carcinoma
- supperfucial disease, muscle invasive, extravesicle fat spread

Both have haematuria as a symptom

Question 4

What are the risk factors of renal tumours?

Answer 4

Smoking
Chemical exposure
Chemo
Schistosomiasis - parasitic infection from sub tropical water

Question 5

What are kidney stones made up from?

Answer 5

90% mineral
7% water
3% organic matter

Question 6

What mineral types can make up kidney stones?

Answer 6

Mostly calcium oxalate or calcium phosphate
urates
struvite

Question 7

What is the management of renal colic - kidney stones passing?

Answer 7

under 4mm pass spontaneously
4-6mm - 50% pass
if no obstruction can go home

If obstructed - may become septic

• Extracorporal shock wave lithotripsy
• Ureteroscopy
• PCNL - Percutaneous nephrolithotomy

Question 8

What investigations can you do if you suspect renal colic?

Answer 8

Urine analysis - dipstick, midstream, pregnancy (ectopic?) test
Blood tests 
Imagine - Ulttrasound
Plain KUB X ray
Non-contract CT - BEST
IVU - intravenous urogram

Question 9

Where are 3 regions that a kidney stone night get stuck when passing out of the body?

Answer 9

Pelvi-uteric junction
Pelvic inlet
Vesico-ureteric junction

Question 10

How does renal failure effect homeostasis?

Answer 10

Sodium balance - sodium increases - high Bp, oedema, Raised JVP

Water balance - oedema

Question 11

How does renal failure effect Fluid + Electrolyte control?

Answer 11

The kidney usually in highlyu involed via:
ADH
Aldersterone
Macula densa
Renin

• can get high K levels - cardiac arrest

Question 12

How does renal failure affect endocrine function?

Answer 12

Kindey produces EPO which stimulates RBC production, so in failure less EPO produced - anaemia

Question 13

How does renal failure affect metabolic function?

Answer 13

Kindey failure leads to bone disease
1 alpha hydroylase produced in the kidneys is necessary in Vit D metabolism, which is needed to absorb Ca for bones.

Phosphate levels increase in kidney failure

Low Ca is detected by the parathyroid gland - produces PTH which causes bones to release Ca - brittle bones