Urine disorders Flashcards Preview

FERGU > Urine disorders > Flashcards

Flashcards in Urine disorders Deck (25):
1

Polyuria

>3L/day
>250mosmol/L --> osmotic diuresis
water diuresis (cant concentrate urine)

2

DDx of hematuria

Benign mass: oncocytoma, angiomyolipoma, BPH
Malignant mass: RCC, transitional CC, squamous CC, prostate adenocarcinoma
Stones: staghorn calculi, calcium stones, uric acid stones
infective: pyelonephritis, cystitis, urethritis
Trauma
Renal: IgA nephropathy, thin basement membrane disease, hereditary nephritis
Iatrogenic: traumatic catheterization, radiation, renal biopsies, ESWL

3

Upper tract hematuria

total time during urination
nausea, vomiting, stones, renal colic

4

Bladder hematuria

total time during urination
voiding symptoms - cystitis, bladder stone, carcinoma in situ

5

Prostate hematuria

Initial/terminal, most urine is not bloody
BPH - painless, voiding sx

6

Urethral hematuria

initial/terminal blood

7

GU-specific hematuria causes

Glomerulonephritis: reddish-brown, tea-coloured
- dysmorphic RBC
- RBC/granular casts
- proteinuria
- RTI

Calculi
RCC: hematuria, flank pain, abdominal mass palpable
TCC: hematuria, dysuria, frequency
UTI

8

Systemic hematuria causes

Miliary TB - pulmonary sx
Clots: more severe bleeding
CT disease
Coagulopathy - anticoagulant therapy

9

Approach to hematuria - general

image everyone with any kind of hematuria
- except women <40, female, non-smoker, no exposures) with UTI, stones
Retrograde pyelogram: allergy to contrast, poor renal fxn

10

Cystoscopy

gold standard for urinary bladder neoplasm

11

Approach to symptomatic hematuria

renal colic: CT KUB
Trauma: CT IVP
flank pain with fever or hematuria: US
-if shows mass: CT renal mass
- obs but no visible stone: CT IVP or cystoscopy + retrograde pyelogram

12

Approach to painless hematuria

US - rule out stones, hydronephrosis, mass
if mass - CT renal mass
if no mass - CT IVP or C&P
urinanalysis shows casts - renal biopsy

13

DDx for flank pain

AAA
abdominal aortic dissection
appendicitis
ectopic pregnancy
- FOUR EMERGENCIES

14

Pathogenesis of ureteric calculi

Supersaturation
Nucleation
Lack of stone inhibitors - mucoproteins, citrate, Mg, RNA peptides
Crystal aggregation
Stasis
Urine pH changes: uric acid in low pH, struvite in high pH

15

Types of stones

Calcium - 75% - oxalate, phosphate
Infection - 15% - Mg-ammonium-phosphate, staghorn calculi
Uric acid 10-15%
Cystine stones 1%

16

S&S of renal calculi

renal colic pain
upper ureter and kidney --> flank pain, may radiate to thigh
lower ureter, bladder, urethra --> suprapubic pain, may radiate to genitals
hematuria
nausea & vomiting
voiding symptoms
diuresis, chills
oliguria/anuria
writhing
fever
staghorn calculi - renal failure
infection

17

Approach to renal calculi

CT KUB gold standard
if contraindicated use US
serial KUB to follow stone

18

Management of renal calculi

Fluids, pain management
passive: 8mm 20%
alpha-blockers may help

19

Indications for acute intevention of renal calculi

high fever
unremitting pain or nausea
renal failure

20

Extracorporeal shockwave lithotripsy (ESWL)

shockwaves
upper ureter and kidney stones <1.5cm
CI in pregnancy

21

Retrograde ureteroscopy, lithoscopy, basket extraction, stent

Ureteroscope to visualize stone, fragment with laser, collect with basket extraction, stent ureter for healing
<2cm along entire kidney and ureter
used in pregnancy

22

Anterograde pc nephrolithotomy

pc access to kidney to break up stone
>2cm in kidney

23

Open nephrolithotomy /ureterolithotomy

used when less invasive measures failed

24

Nephrectemy

poor/nonfunctioning kidney with large stone

25

Long-term treatment of chronic nephrolithiasis

increased fluid intake
decrease animal protein, sodium excretion
increase citrate intake