Flashcards in Renal Deck (115)
How does cystitis present?
dysuria, urinary freq, urgency, suprapubic pain
NO SYSTEMIC SIGNS
What are the lab findings in cystitis? what is the gold standard of Dx of cystitis?
urinalysis: cloudy urine > 10WBC/hpf
dipstick: (+) leukocyte esterase (pyruria) & nitrites (bacteria convert nitrates to nitrites)
GOLD STANDARD=> culture: >100k cfu
Name the 5 MCC of cystitis
E. coli (80% in ALL population groups)
Staph saprophyticus (in sex, active female but E. coli is #1)
If pt presents w/ cystitis Sx & ammonia scented urine, what is the cause?
Proteus mirabilis => alkaline urine w/ ammonia scent
If urinalysis is done w/ urethritis Sx but urine culture is negative, what is most likely cause? what is the dominating sign of urethritis?
Dysuria is dominant sign of urethritis => sterile pyruria due to Chlamydia trachomatis or N. gonorrhoeae
Patient w/ fever, flank pain, WBC casts & leukocytosis along with cystitis Sx has what? what are the MCC?
pyelonephritis from ascending infection from =>
E. coli (90%)
Why does pyelonephritis cause flank pain?
inflammation of the capsule of the kidney
Define chronic pyelonephritis. What is common causes?
interstitial fibrosis & atrophy of tubules due to multiple bouts of acute pyelonephritis
MCC are vesicoureteral reflux in kids;
obstruction in adults such as BPH or cervical CA
Chronic pyelonephritis assoc w/ vesicoureteral reflux leads to what w/in the kidney?
cortical scarring w/ blunted calyces;
scarring at both poles is characteristic
Describe the H&E stain of chronic pyelonephritis. what does it resemble?
atrophic tubules w/ eosinophilic proteinaceous material resembling thyroid follicles => waxy casts in urine
What are the risk factors of nephrolithiasis? how does it present?
risks are high [ ] of solute in urinary filtrate along w/ low urine volume
presents as colicky pain w/ hematuria & unilateral flank tenderness
what is the cause & Tx of the MC type of kidney stone?
Ca+ oxalate &/or Ca+ phosphate stone =>
usually idiopathic hypercalciuria but other causes must be worked up
Tx is hydrochlorothiazide => Ca+ sparing diuretic
What autoimmune dz is assoc w/ Ca+ oxalate &/or Ca+ phosphate stones?
What is MCC & Tx of the 2nd most common type of kidney stone?
Ammonium Mg+ phosphate stone =>
infection w/ urease-positive organisms (Proteus vulgaris or Klebsiella) causes alkaline urine leading to stone
Tx is surgical removal bc of size & ABx to eradicate the pathogen
What 2 types of stones can form stag horn calculi? where do they form? what can they cause?
Ammonium Mg+ phosphate & cysteine stones can cause staghorn calculi in the renal calyces=>
nidus for UTI
Name some risk factors for the only radiolucent kidney stone. who is it MC seen in?
hot, arid climates w/ low urine volume & acidic pH;
MC in pt w/ gout but also in hyperuricemia
Who is likely to have hyperuricemia & more uric acid stones besides gout pt? Tx in these pt
Dz w/ high nuclear turnover such as leukemia or myeloproliferative d/o
Tx is hydrate & alkalinize the urine (KHCO3); allopurinol can also be given
What is a rare cause of nephrolithiasis MC seen in kids? what is it assoc w/?
cysteine stone => cystinuria
genetic defect of tubules resulting in decreased reabsorption of cysteine
What are MCC of chronic renal failure?
DM, HTN, glomerular dz
Clinical features of chronic renal failure
HTN (salt & water retention);
hyperkalemia w/ anion gap metabolic acidosis;
What is Tx for chronic renal failure?
dialysis or renal transplant
How will a patient's kidney on dialysis present grossly? Is any increase risk of dz assoc?
cysts develop w/in shrunken end-stage kidneys during dialysis => increase risk for renal cell CA
Uremia from chronic renal disease causes what?
azotemia results in nausea, anorexia, pericarditis, platelet dysfxn (inh adhesion & aggregation), encephalopathy w/ asterixes, urea crystals deposit in skin
Anemia from chronic renal disease is due to what?
decreased EPO production by renal peritubular interstitial cells
hypocalcemia in chronic renal disease is due to what?
decreased alpha-1-hydroxylation of vitamin D by proximal renal tubule cells & hyperphosphatemia
Renal osteodystrophy in chronic renal dz is due to what?
secondary hyperPTH causing osteitis fibrosis cystica from elevated PTH leading to Ca+ resorption causing "burn out" of bone;
osteomalacia => cannot mineralize bone;
osteoporosis => slow degradation of Ca+
What makes up a angiomyolipoma? What is it assoc w/?
Hamartoma of blood vessels, smooth muscle & adipose tissue
Renal cell carcinoma arises from what tissue? what is the triad of Sx?
hematuria, palpable mass, flank pain => all 3 rarely occur together
In renal cell CA, what systemic Sx may be present? what can it produce?
fever, weight loss, paraneoplastic syndrome
EPO can cause polycythemia;
renin causes HTN;
PTHrP leading to hypercalcemia;
ACTH causing Cushing's