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Flashcards in Renal Deck (115)
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How does cystitis present?

dysuria, urinary freq, urgency, suprapubic pain



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)
Kleb pneumoniae;
Proteus mirabilis;
Enterococcus faecalis


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%)
Klebsiella species
Enterococcus faecalis


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?

Crohn dz


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;
renal osteodystrophy


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

Tuberous sclerosis


Renal cell carcinoma arises from what tissue? what is the triad of Sx?

kidney tubules

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


Staging of renal cell CA is based on what?

T => size & involvement of renal vein (risk of hematogenous spread to lungs & bone)

N=> spread to retroperitoneal lymph nodes