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D&T3 Exam 1 > Hematuria-Petrany > Flashcards

Hematuria-Petrany Flashcards

(61 cards)

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1
Q

Imaging Tests

What to look for

A

Lesions of kidneys, collecting system, ureters, bladder

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2
Q

Cystoscopy

Characteristics

A

Entire bladder seen

May see source of bleeding in bladder or from one or both ureters

Only test to visualize urethra and prostate

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3
Q

Nephrolithiasis

Options for immediate expulsive therapy

A

Shock wave lithotripsy

Ureteroscopic lithotripsy with laser probes

Percutaneous nephrolithotomy

Laproscopic stone removal

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4
Q

Cystine shape

A

Hexagonal

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5
Q

Nephrolithiasis

Confirmatory Tests

Abdominal plain radiograph

A

See radiopaque stones (calcium, struvite, cystine)

Misses uric acid stones or small stones

May be reasonable for hx of previous radiopaque stones

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6
Q

Symptomatic microscopic or gross hematuria in children

Evaluation

A

Hx of trauma, perineal irritation?

Sxs of sickle cell or hemophilia?

Rarely cause by medications

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7
Q

Ca oxalate shape

A

Octahedron, envelope

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8
Q

Symptomatic microscopic or gross hematuria in children

Evaluation

Deafness and family hx of hematuria

A

Alport syndrome

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9
Q

Ammonium magnesium Phosphate crystal shape

A

Coffin lid (struvite stone)

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10
Q

Children- Gross Hematuria

MC causes

A

UTI

Meatus irritation

Trauma

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11
Q

Transient Hematuria

Common causes

A

MC no causes found

Fever, trauma, exercise

UTI (usually with pyuria and bacteriuria too)

If >50 think MALIGNANCY

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12
Q

Hematuria

If evaluation negative…

A

Cause likely mild glomerulopathies or intermittent stones

Follow pts with repeat urinalysis and maybe cytology

NOT RECOMMENDED to screen asymptomatic pts for microscopic hematuria

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13
Q

Persistent Hematuria in Children

Postinfectious glomerulonephritis

A

Post GABH strap infxn (tonsillitis, impetigo)

Hematuria resolves in 3-6 mos

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14
Q

CT Urography (CT scan and IVP combined)

Characteristics

A

High sensitivity

High radiation dose

DO NOT use in pregnant women (use US)

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15
Q

Macroscopic hematuria (gross hematuria)

Define

A

Visible with the naked eye

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16
Q

Malignancy

Risk factors

A

Age >50

Smoking

Analgesic abuse

Male

Gross hematuria (higher risk than micro but either could be ass.)

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17
Q

Urinalysis

Glomerular bleeding

A

Red cell casts

Proteinuria (>500mg/day)

Dysmorphic cells

Absence of these does not exclude

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18
Q

Hematuria in Children

A

Microscopic hematuria common finding

Children hematuria=>5RBCs/hpf

Isolated asymptomatic hematuria usually benign in children

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19
Q

Children- Gross Hematuria

Less common causes

A

Stones

Sickle cell

Coagulopathy

Glomerular disease

Meds

wilm’s tumor

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20
Q

Preferred imaging in children

A

US over spiral CT

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21
Q

Microscopic hematuria

Characteristics

A

Incidental finding

More than 2 RBCs/hpf abnormal

False neg not a problem but may have false pos with dipstick so do micro if pos

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22
Q

Nephrolithiasis

Stone likelihood of passing

A

Determined by size and location

<4mm pass spontaneously

> 10mm will not

Refer for active rx if not passed in 4-6 wks

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23
Q

Nephrolithiasis

Differential

A

Ectopic pregnancy

AAA

Acute intestinal obstruction

Appendicitis

Drug seeking

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24
Q

Persistent Hematuria in Children

Hypercalcuria

A

High urinary calcium/creatinine ratio

Hematuria can be seen

More seen in south than north

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25
Persistent Hematuria in Children Alport Syndrome
X linked (seen in males) Hearing loss, ocular abnormalities, progressive renal failure over time Heterozygous females have hematuria without progressive kidney disease
26
Hematuria in Children Causes of transient hematuria
UTI Trauma Fever Exercise
27
Nephrolithiasis Evaluation after acute episode
Try to prevent recurrence Thorough history for risk factors Identify stone type (examine stone or urine sediment for crystals)
28
Nephrolithiasis What meds are used to help pass stones
Antispasmodic agents Ca channel blockers Alpha blockers
29
Symptomatic microscopic or gross hematuria in children Evaluation Unilateral flank pain radiating to groin
Suggests obstruction (stone)
30
Asymptomatic isolated microscopic hematuria in children Evaluation
Check BP and urinalysis weekly X 2 then q 3 months Check urine culture Further work up if BP inc, gross hematuria or proteinuria If persists for 1 yr check for hypercalcuria, check relatives (BMD, hereditary nephritis), sickle trait, nutcracker syndrome
31
Only test that visualizes urethra and prostate
Cystoscopy
32
If isolated (no proteinuria or renal insufficiency) persistent hematuria think...
IgA nephropathy Alport syndrome (hereditary nephritis) Thin basement membrane nephropathy (benign familial hematuria)
33
Nephrolithiasis Symptoms
Pain (from obstruction, mild to excruciating,may wax and wane) Nausea, vomiting May be asymptomatic Only symptom may be stone passing
34
Renal ultrasound Characteristics
Not sensitive for small tumors
35
Symptomatic microscopic or gross hematuria in children Evaluation Flank pain with fever
Pyelonephritis
36
If isolated (no proteinuria or renal insufficiency) transient hematuria think...
Post infectious glomerulonephritis Exercise induced hematuria
37
Persistent Hematuria in Children Nutcracker syndrome
L renal vein compression by aorta and sup mesenteric artery Can also have proteinuria
38
Nephrolithiasis MC stone
>80% calcium oxalate
39
Nephrolithiasis Acute therapy
Pain control (NSAIDs, opioids) Hydration Meds to pass stone Strain urine and save any stones
40
Symptomatic microscopic or gross hematuria in children Evaluation Hx of pharyngitis or impetigo 2-3 wks earlier
Poststreptococcal glomerulonephritis
41
Symptomatic microscopic or gross hematuria in children Evaluation New incontinence, dysuria, frequency, urgency
UTI
42
Nephrolithiasis When to use immediate expulsion therapy
Pts with sepsis, acute renal failure, anuria, relentless pain and nausea
43
Struvite stones Characteristics
"Staghorn Calculus" Infxn induced usually don't cause pain F>M (UTI?) Should be removed
44
Nephrolithiasis Risk Factors
Urine composition Prior nephrolithiasis Family Hx Gastric bypass/bariatric surgery Acyclovir Low fluid intake Acidic urine Upper tract UTI
45
Cystoscopy When to use
ALL adults with unexplained hematuria Video-assisted flexible cystoscopy under local anesthesia
46
Macroscopic hematuria (gross hematuria) Characteristics
Red or brown urine If clots, lower tract source Color change doesn't reflect large degree of blood loss Centrifuge to see if truly blood
47
Renal biopsy and cystoscopy in children
Rarely needed Consider biopsy if progressive disease
48
Nephrolithiasis Confirmatory Tests US
PROCEDURE OF CHOICE for those needing to avoid radiation (pregnancy) May miss small stones and urethral stones
49
Nephrolithiasis Hematuria
Usually gross hematuria Present in most pts but absence doesn't rule out Present in 95% day one and 65% day four
50
Urinalysis Extraglomerular bleeding
Not common BLOOD CLOTS. Clots never come from glomerular disease
51
Nephrolithiasis When do you have dysuria and urgency?
When stone in distal ureter
52
Extraglomerular Disease If absence of symptoms or signs...
No cause of low level hematuria that requires immediate diagnosis Repeat in a few days to determine transient or persistent
53
Persistent Hematuria in Children IgA nephropathy
Renal biopsy diagnosis Usually gross hematuria, previous GI or Resp illness, (-) FHx
54
Microscopic hematuria Define
Visible with microscopic examination of urine
55
Asymptomatic microscopic hematuria with proteinuria in children Evaluation
Check serum creatinine and 24 hr urine for protein If elevated, significant renal disease very likely and further w/u indicated (serum C3, C4, albumin, CBC, ASO tiger, ANA, imaging, renal biopsy)
56
Uric Acid shape
Rhomboid
57
Urine cytology
90% sensitivity for bladder cancer; not good for upper tract cancers
58
Glomerular disease Characteristic findings
Proteinuria, RBC casts, renal insufficiency Do kidney biopsy
59
Nephrolithiasis Confirmatory Tests (gold standard)
Non-contrast helical CT scan (GOLD STANDARD!) 100% specific Picks up stones missed by KUB or IVP Can find alternative dx if not stones Faster than IVP
60
Nephrolithiasis Confirmatory Tests Intravenous pyelogram (IVP)
Previous best (not anymore) Lower sensitivity, higher radiation than CT
61
Hematuria in Children Causes of Persistent Hematuria
IgA nephropathy Thin basement membrane disease (benign familial hematuria, AD) Alport syndrome (hereditary nephritis) Postinfectious glomerulonephritis Hypercalcuria Nutcracker syndrome

D&T3 Exam 1 (19 decks)

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