Painless and Occult Hematuria

Question 1

likely pathology for benign heavy exercise hematuria

Answer 1

likely related to decreased renal blood flow leading to nephron ischemia, increased permeability, subsequent passage of RBCs
common in swimmers, track athletes, lacross players
also predominance of NSAID use for atheletes

Question 2

follow up indications for heavy exercise hematuria

Answer 2

rule out infection in your evaluation (UA, culture and sensitivity)
rest 48-72 hours and recheck

Question 3

how do NSAIDs contribute to kidney damage

Answer 3

inhibition of cyclooxygenase within the kidney, reducing the production of prostaglandins that normally protect the kidney by modulating renal vasoconstriction –> leads to renal ischemia

Question 4

specific effects of NSAIDs ibuprofen | indomethacin and celcoxib on the kidney

Answer 4

ibuprofen - decreases GFR compared to acetominophen

indomethacin and celecoxib decrease free water clearance

Question 5

parameters for negative hematuria

Answer 5

presence of less than 3 RBCs/hpf is negative for hematuria

Question 6

false positives for dipstick test for hematuria

Answer 6

myoglobinuria, hemoglobinuria
high alkaline urine (ph>9)
ascrobic acid (vit C)
when in doubt: confirm with microscopy

Question 7

trauma to the kidneys, while rare d/t their anatomic location, may occur in what type of injuries

Answer 7

blunt force, rapid decelration

Question 8

pt suspected of trauma to the kidneys with hematuria and urobilogen that are hemodynamically stable do/do not require radiographic evidence

Answer 8

DO NOT require radiographic evidence

fractured ribs or penetrating trauma increases suspicion

Question 9

important cause of hematuria-inherited - that increases risk of renal papillary necrosis, FSGN, Renal medullary carcinoma

Answer 9

sickle cell trait

Question 10

T/F - the risk of renal medullary carcinoma is higher in SCD than in SCT

Answer 10

false - higher in sickle cell trait

Question 11

risk factors for transitional cell cancer of ureter and bladder

Answer 11

male
greater than 35 yo
current or former tobacco user
analgeisc abuse
exposure to chemicals or dyes (benzenes, aromatic amines)
exopsure . to carcinogenic agents (alkylating agents)

Question 12

top of differential for painless hematuria until proven otherwise

Answer 12

cancer

Question 13

evaluation procdure for suspected malignancy based on painless hematuria

Answer 13

complete history
evaluate with culture and sensitivity to r/o infection 
confirm with microscopy 
serum eval of renal function, BUN, Cr
radiographic evidence
ultrasound vs CTU

Question 14

pros and cons of using USG for examination of UG system

Answer 14

pros:
no radiation
lower cost
very good for tumors >3cm in size, cysts and hydronephrosis
cons:
may miss other causes of hematuria such as small stones, small bladder mass less than 3cm, urothelial transitional cell tumor

Question 15

pros and cons of using CTU for examination of UG system

Answer 15

pros: highly senstiive for renal calculi, able to detect small renal parenchymal masses, aneurysm, renal and perirenal abscesses, more info from one test
consL higher doses ofradioation, exposure to contrast agents, higher cost

Question 16

recommendations for cytoscopy

Answer 16

primary care: perform after negative US or IVP

AUA: all pt with risk factors for urologic malignancies regardless of age

Question 17

pros and cons of cytoscopy

Answer 17

evaluates the bladder directly
better able to assess bladder wall for microstructural changes
can ID urethral stricture disease, benign hyperplasia and bladder masses
cons:
invasive, requires sedation, risk of post-procedure UTI

Question 18

appearance of RBC if cause of hematuria is glomerular=related

Answer 18

dysmorphic - gets fucked up going through the glomerulus

Question 19

causes of chronic glomerulonephritis

Answer 19

glomerular scarring
cortical tubular atrophy
interstitial inflammation
interstitial fibrosis
atherosclerosis

Question 20

vascular/hemodynamic effects of activation of RAAS

Answer 20

vasoconstriction of afferent arterioles
icnreased glomerular pressure - hyperfiltration
–> direct glomerular damage

Question 21

in differentiating acute vs chronic kidneys, after performing a detailed history, what finding on USG would indicate chronic kidneys

Answer 21

reduced kidney size

Question 22

RBC casts or dysmorphic RBCs on urinalysis are indicative of what type of kidney injury

Answer 22

glomerulonephritis
differentiates from bph, tumors, stones, ect because casts are part of nephrons and dysmorphic RBCs were strained through the filtration membrane of the glomerulus

Question 23

causes of proteinuria that are benign

Answer 23

<1-2g/day
fever, exercise, obesity, sleep apnea, emotional stress and CHF
orthostatic proteinuria only occurs with standing

Question 24

what is the mechanism of damage in hypertensive nephropathy

Answer 24

RAAS and HTN

Question 25

risk factors for hypertensive nerphosclerosis

Answer 25

being african american APOL1 - functional gene for apoliporpotein L2 expressed in podocyte accounts for increased risk in AA smoking, male , hypercholesterolemia, duration of HTN, low brith weight and preexisting renal injury

Question 26

signs of hypertensive nephrosclerosis

Answer 26

HTN, microhematuria, moderate proteinuria

Question 27

what therapy can delay the progression of hyeprtensive nephrosclerosis to end stage kidney disease

Answer 27

blood pressure control

Question 28

imbalance between syntehsis and degradation of the ECM causes expansion fo the mesangium in what form of nephropathy

Answer 28

diabetic

Question 29

type 1 diabetes is unique from type 2 because tubular, interstiital and vascular lesions occur

Answer 29

in parallel as opposed to type 2, where development of albuminuria with little change in the nephron is typical