Hematuria Flashcards Preview

CRRAB 2 > Hematuria > Flashcards

Flashcards in Hematuria Deck (23):
1

Urine Dipstick

most common screening test for blood and protein in urine
False negative --> formalin or high Vit C
False positive --> alkaline urine or contamination

2

Hematuria

2 RBCs in field for adult
5 RBCs in field for children

3

Causes of Hematuria

FREQUENT
Transient unexplained
UTI
Stones
Cancer
LESS FREQUENT
Exercise, trauma, endometriosis, Sickle cell, PKD

4

Risk factors for urinary malignancy

>35 yrs old
Smoking or chemical exposure
Gross hematuria
chronic cystitis
cyclophosphamide

5

Red Urine

Red sediment in urine = hematuria
Red supernatant in urine = not hematuria (need dipstick for heme)
negative for heme - porphyria, phenazopryidine, beets
positive for heme - myoglobinuria (plasma clear), hemoglobinuria (plasma red)

6

Beeturia

Betalaine - redox indicator
- protected by oxalate
- decolored by ferric ions, hydrochloric acid and colonic bacteria

7

Glomerular vs Extraglomerular Bleeding

Glomerular
- RBC casts
- Proteinuria
- Dysmorphic appearing red cells
- Smokey brown or cola color urine
Extraglomerular
- Clots

8

Microscopic hematuria in children

Glomerulopathies: IgA nephropathy, Alport's, post-infectious glomerulonephritis
Hypercalciuria
Nutcracker syndrome (L renal vein compression by aorta and SMA)

9

Evaluation of microscopic hematuria in children

Asymptomatic with no protein--> benign/observe
Asymptomatic with protein --> quantify protein with 1st morning void --> consider nephrology if abnormal

10

Urolithiasis

12% of men and 5% of women develop symptomatic stone by 70
80% of stones are calcium (most oxalate)
Sx: flank pain, ab pain, colicky, hematuria, N/V

11

Treatment of urolithiasis

Pain meds, hydrate, tamsulosin, nifedipine
Ureteroscopy
ESWL
Pyelolithotomy --> staghorn caliculi

12

Calcium Kidney stones

dumbbell shaped
Risk factors: hypercalciuria, hyperuricosuria, hypocitraturia, low urine volume, increased oxalate excretion

13

Hypercalcuria

absorptive = autosomal dominant (elevated calcitriol levels)
fasting = bone loss (resorptive)
renal - renal leak

14

Hypocitraturia

chronic diarrhea (metabolic acidosis)
renal tubular acidosis
high protein diet
Topiramate - creates non-anion gap acidosis

15

Hyperoxaluria

increased oxalate absorption --> low calcium diet, absorptive hypercalciuria

16

Workup for Calcium stone

Plasma Ca levels
PTH
Electrolytes
Serum uric acid
24 hr urine collection

17

Dietary treatment of calcium stone

2 L of water
restrict salt --> it drives Ca excretion
Protein --> limit the acid load
Calcium --> maintain so oxalate doesn't concentrate in urine
Oxalate --> limit

18

Medical treatment of calcium stone

Thiazides --> decrease Ca in urine
Potassium citrate
Orthophosphate
Allopurinol
Calcium carbonate

19

Uric acid stone

40% of stones in hot, arid climates with low urine volume and low urine pH
Tx: alkalize urine, give allopurinol

20

Struvite stones (infection)

Coffin-lid stones
increased ammonia production and increased urine pH
Urease (+) organisms (Klebsiella, proteus)
Tx: chronic antibiotic use (pts usually have instrumentation), Acetohexemic acid, ESWL
- high incidence of stone formation with residual calculi after ESWL

21

Cysteine Stones

Hexagonal crystals
Autosomal recessive trait --> impaired cystine transport --> decreased proximal tubular re-absorption and increased excretion of cystine
SUBTYPES
I/I = parents excrete normal amount
II/II = parents excrete large amount
III/III = parents excrete intermediate amount
VERY DIFFICULT TO TREAT MEDICALLY

22

ESWL Complications

instrument obstruction
reversible damage to blood vessels and tubules (degree of injury relates to # of shocks, energy level, and size of kidney)

23

Medical therapy efficacy

decreases stone formation rate --> doesn't clean up stone fragments