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Elaina: last minute renal > UTI, cancer, nephrolithiasis > Flashcards

UTI, cancer, nephrolithiasis Flashcards

1
Q

cause of cystine stones?

A

cystinuria; genetic disorder (genes SLC3A1/7A9)

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2
Q

which stone is characterized by a smooth-edged ground-glass appearance?

A

cystine stones

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3
Q

which stone is characterized by being a “stag-horned” stone often >2 cm?

A

struvite stone

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4
Q

how do we prevent struvite stones?

A

prevent UTI!

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5
Q

which population is most prone to uric acid stones?

A

diabetics, obese (those with low urine PH via insulin resistance)

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6
Q

how do we treat both cystine & uric acid stones?

A

increase urine pH with potassium citrate

cystine may also be treated with chelating agent (tiopronin)

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7
Q

will decreasing calcium in the diet decrease the risk of developing calcium oxalate stones?

A

NO; it may even increase risk (low Ca+ leads to increase in absorption of oxalate from diet therefore increasing urinary oxalate excretion)

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8
Q

what medication must we avoid in patients who are prone to kidney stones?

A

thiazide diuretics; may cause supersaturation of urine

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9
Q

test of choice for diagnosing nephrolithiasis?

A

non-contrast CT…we can determine the stone type based on radiographic density

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10
Q

if we go ahead and try to diagnose our kidney stone with xray, what will we miss?

A

uric acid and cystine stones

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11
Q

test of choice for patients who shouldn’t be exposed to radiation? (ie. pregnancy)

A

ultrasound

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12
Q

why is intravenous pyelogram no longer the test of choice?

A

potential contrast reactions, lower sensitivity, and higher radiation exposure when compared to CT

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13
Q

what other easy, non-invasive test may be useful for diagnosing kidney stones?

A

24 hour urine analysis can tell us chemistries of stones

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14
Q

your patient is on his fourth bout of calcium-oxalate proven nephrolithiasis. his blood calcium is normal. what is the likely cause?

A

idiopathic hypercalciuria

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15
Q

if you suspect urosepsis, what is the treatment of choice?

A

emergent decompression (ureteral stent or nephrostomy tube)

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16
Q

which stones pass spontaneously?

A

those less than 5 mm

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17
Q

why may NSAIDS be a good thing to prescribe our patients with nephrolithiasis?

A

they decrease uteral smooth muscle tone, thereby directly treating the mechanism of pain (ureteral spasm)

also give opioid!

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18
Q

you have decided lithotripsy is your best option for management of your patient’s kidney stone, what must you ensure prior to treatment?

A

discontinue NSAIDS, they will increase risk of bleeding

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19
Q

what two medications are useful in facilitating stone passage?

A

alpha blocker (tamsulosin/flomax) and CCB (nifedipine)

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20
Q

when should we consider a urology consult?

A

acute renal failure, urosepsis, anuria, anatomic abnormalities, concomitant pyelonephritis, when the stone is over 10 mm, and if they have not passed the stone in 4-6 weeks

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21
Q

what is the treatment of choice for larger stones over 2 cm, including staghorn calculi?

A

percutaneous nephrolithotomy

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22
Q

what is the treatment of choice for most middle and distal ureteral stones?

A

rigid and flexible ureteroscopy with or without stent placement

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23
Q

which type of stone is most likely to recur?

A

calcium stones; 1/3 will experience stone recurrence within 5 years

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24
Q

how do we prevent recurrences of calcium stones?

A

1) decrease animal protein intake
2) decrease oxalate intake (rhubarb, spinach, nuts, seeds)
3) decrease sodium intake
4) increase fluid intake (over 2 L)

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25
Q

are long-term complications of kidney stones common?

A

no! nephrolithiasis only makes up about 3.2% of ESRD

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26
Q

where does wilms tumor (nephroblastoma) arise from?

A

the primitive cells of the renal cortex

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27
Q

what should you begin to consider working up if your 3-5 year old presents with HTN?

A

wilms tumor

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28
Q

25 percent of wilms tumor may present with what type of anomalies?

A

genetic anomolies;

1) absence of iris (aniridia)
2) enlargement of one side of face
3) genitourinary complications

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29
Q

diagnostic test of choice for wilms tumor?

A

CT scan

do not biopsy, significant changes stage of cancer!

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30
Q

treatment for wilms tumor? prognosis?

A

surgery/chemotherapy, sometimes radiation

90% 5 year survival rate and good response to treatment!

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31
Q

what makes of 95 percent of kidney cancers?

A

renal cell carcinoma

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32
Q

triad of symptoms for renal cell carcinoma?

A

flank pain, palpable flank mass, painless hematuria

33
Q

major risk factor for kidney cancers?

A

smoking!

34
Q

what genetic disorder may predispose a patient to renal cell carcinoma?

A

von hippel-lindau disease

35
Q

exposure to which products may increase one’s risk of developing RCC?

A

asbestos, cadmium, or petroleum

36
Q

how does RCC typically grow in the kidney?

A

spherical, well-circumscribed mass in the cortex of the kidney arising from the epithelial lining of the proximal tubule

37
Q

diagnostic test of choice for staging RCC? test of choice with concern for METS?

A

CT for diagnosis

MRI if concern for mets; XRAY if concern of spread to bone

38
Q

only cure for RCC?

A

surgery! by resection or ablating with cryotherapy or embolization of the arteries to deprive of O2 supply (LARGE tumors)

39
Q

how do we treat stage 4 RCC?

A

palliative :(

40
Q

most common type of RCC?

A

clear cell RCC (appear pale under the microscope)

41
Q

if you note “finger-like projections” under microscope when you are suspecting RCC, what type is most likely?

A

papillary RCC; second most common

42
Q

what type of kidney cancer arises from the blood vessels or connective tissue of the kidney?

A

renal sarcomas

43
Q

what type of chemical exposure puts you at risk for transitional cell cancer?

A

aniline dyes (leather woodwork)

44
Q

what is the pattern of growth of urothelial carcinoma (bladder cancer)?

A

proliferation of cells along fibrovascular core; papillary pattern of growth

45
Q

are most urothelial carcinomas invasive?

A

no! though there is a high rate of recurrence (80 percent)

46
Q

what is a key defining feature that differentiates bladder cancer and RCC from the presentation of nephrolithiasis?

A

the cancers will have PAINLESS hematuria

47
Q

how do we treat CIS and low grade papillary urothelial cancer?

A

immune therapy BCG..the TB vaccine

48
Q

how do we treat recurrent CIS or invasive urothelial carcinoma?

A

resect all or part of the involved bladder

49
Q

what is the prognosis of urothelial cancer if caught early?

A

almost 100 percent once treated..continue monitoring cytology of urine!

unless it invades muscle then 60 percent 5 year survival

50
Q

what stage is it when cancerous cells are in the inner lining tissue of the bladder?

A

zero

51
Q

what stage is it when the tumor has spread through the bladder to the fat around the bladder?

A

three

52
Q

besides the bladder, where else may transitional cell cancer commonly occupy?

A

renal pelvis

53
Q

a UTI in a male is considered…

A

a complicated UTI

54
Q

what is the most common type of nosocomial infection? what is the greatest risk factor?

A

catheter induced UTI

duration is the greatest risk factor

55
Q

why may children develop UTI?

A

urine can flow backwards instead of out the urethra

56
Q

why may men develop UTI?

A

prostate enlargement can cause narrowing of the urethra; urine can collect in bladder and predispose them

57
Q

how will we differentiate pyelonephritis from acute cystitis?

A

these patients will be ILL with fever, chills, nausea/vomiting, CVA tenderness

58
Q

if your patient has purulent vaginal discharge, what is the likely diagnosis?

A

urethritis (chlamydia, HSV, gonorrhea) or vaginitis (yeast, trichomoniasis)

59
Q

what is interstitial cystitis?

A

painful sensation when the bladder wall fills up

60
Q

what is the name for greater than 5 WBC per high powered field?

A

puria

61
Q

how many bacteria of the same organism must be found on urinalysis to diagnose UTI?

A

100,000

62
Q

what two key findings will be found on urinalysis of UTI?

A

leukocyte estrase, nitrites (bacteria convert nitrates to nitrites)

63
Q

you’re looking at urinalysis of a suspected case of acute cystitis and see proteinuria. whats going on?

A

this is indicative of kidney disease

64
Q

if we see epithelial cells in the urine on urinalysis, what should we do?

A

recheck! it probably was not a midstream clean catch

65
Q

treatment for acute cystitis?

A

bactrim for infection, pyridium for pain (dont use longer than 2 days)

66
Q

who must we admit when we suspect UTI?

A

pregnant women

67
Q

first line treatment for pyelonephritis?

A

cipro or other fluoroquinolone

avoid nitrofurantoin (what we may use in cystitis) because it does not achieve adequate renal tissue levels

68
Q

risk factors for males developing UTI?

A

uncircumcised, anal intercourse

69
Q

what is the most common cause of UTI in elderly women?

A

loss of estrogen causing change in vaginal flora; prescribe estrogen cream

also uterine/bladder prolapse

70
Q

how may UTI present in the elderly?

A

confusion, altered mental status, urinary incontinence

71
Q

pregnant women have what percentage of risk for developing UTI?

A

40 percent!

  • screen in first trimester
  • if UC positive, treat and repeat every trimester
  • suppressive therapy after 2 or more courses of ABX
72
Q

how do we treat UTI in pregnancy?

A

nitrofurantoin x 7 days

73
Q

what childhood demographic most often develops UTI?

A

white children; UTI makes up for 7% of fevers in children under 2 yrs

74
Q

what signs of UTI may present in newborns?

A

jaundice, vomiting, fever, failure to thrive

75
Q

how do we treat UTI in children?

A

cephalosporins! 2nd or 3rd generation

76
Q

catheter-associated bacteriuria definitions (symptomatic vs. asymptomatic)

A

symptomatic: UC greater than 1,000
asymptomatic: UC greater than 100,000

77
Q

do we treat asymptomatic UTIS?

A

ONLY is pregnant, post renal-transplant, or prior to urologic procedures

do NOT treat diabetics, elderly, residents in LTC facilities, patients with indwelling catheters, or spinal cord injury

78
Q

patients with UTI should avoid what as initial therapy?

A

pyridium; the neon orange pee will skew urine culture

Elaina: last minute renal (2 decks)

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