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VF1 - Block 3 > Week 9 > Flashcards

Week 9 Flashcards

1
Q

RBC casts

Dysmorphic RBC

A

Nephritic syndrome

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2
Q

dipstick only detects what kind of protein?

A

albumin

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3
Q

Granular casts

A

Pathonemonic for Acute tubular necrosis

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4
Q

WBC casts

A
  • Renal infection - e.g. pyelonephritis
  • Remember, white cells indicate UTI. But a cast MUST indicate it’s a kidney process.
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5
Q

Dark yellow/brown urine

A

Bile pigments due to liver problems

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6
Q

Dipstick positive for blood can be due to these 3 things

A
  1. RBCs in the urine
  2. Free heme (due to hemolysis)
  3. Myoglobin (due to muscle cells dying)
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7
Q

Patient is acidodic but the urine is alkalotic

A

renal tubular acidosis

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8
Q

Utility of dipstick nitrites

A
  • Helpful when they are present, not very useful when they’re not
  • Good screening test for UTI. Presence of Nitrites = UTI present. Absence = still can’t rule it out.
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9
Q
A
  • RBCs in the urine
  • Nephritic syndrome
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10
Q
A
  • Dysmorphic RBCs
  • Nephritic syndrome
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11
Q
A
  • WBCs in the urine
  • They’re bigger than RBCs
  • They have granular appearance
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12
Q

Squamous epithelium in the urine indicates…

A

It wasn’t a clean catch

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13
Q

renal tubular epithelial cells in the urine indicate…

A

acute interstitial nephritis

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14
Q
A
  • Granular casts
  • Pathonemonic for acute tubular necrosis
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15
Q
A
  • Fatty Casts
  • Indicates LOTS of protein in the urine
  • nephrotic syndrome
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16
Q
A
  • RBC casts
  • Nephritic syndrome
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17
Q

Urine casts indicate the problem MUST be located where?

A

the kidney

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18
Q

most common crystals found in acidic urine

A

calcium oxalate crystals

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19
Q
A
  • calcium oxalate crystals
  • most common crystals seen in acidic urine
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20
Q

Definition of CKD

A
  • Chronic = 3 months or longer
  • Kidney disease = evidence of kidney damage or reduced function
    • GFR < 60
    • Serum creatnine elevated
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21
Q

Two most important predictors of prognosis with CKD

A
  • GFR
  • Albuminuria levels
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22
Q

How is CKD classified?

A
  • Based on GFR
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23
Q

Two most important risk factors for CKD - these account for the majority of CKD cases

A
  • Diabetes
  • Hypertension
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24
Q

Most important cause of morbidity/mortality in people with CKD

A
  • Cardiovascular disease
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25
Q

Pathophysiology of CKD

A
  • Some initial damage –> podocyte injury/loss –> protein leakage –> increased protein reabsorption –> vasoactive substances –> inflammatory cell recruitment –> damage/scarring –> more recruitment –> more scarring and so on and so forth
    • When you have increased protein reabsorption, it releases vasoactive substances that damage the glomerulus/recruit inflammatory cells
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26
Q

What factors account for kidney disease progression

A
  • Severity of disease
  • Blood Pressure disturbances
  • Magnitude of proteinuria
  • Degree of tubule interstitial scarring
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27
Q

Complications of CKD

A
  • Anemia
  • Mineral Bone Disease
  • Metabolic Acidosis
  • **Cardiovascular complications**
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28
Q

Pathophysiology of anemia from CKD

A
  • Decreased EPO
  • Hepcidin from liver
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29
Q

Pathophysiology of mineral bone disease in CKD

A
  • Kidney is responsible for activating vitamin D.
  • Vitamin D helps to absorb calcium. So you get low levels of calcium often and phosphorous retention –> Increase in PTH –> bone damage
  • Ultimately this causes calcification in the small vessels –> cardiovascular complications
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30
Q

Pathophysiology of metabolic acidosis in CKD

A
  • Kidney responsible for excreting H+
  • Damaged kidney –> buildup of H+
  • This further damages bone b/c excess H+ is buffered in the bone
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31
Q

Guidelines for slowing progression of CKD

A
  • Control BP
    • Limit Salt
    • Use medications
  • Control glycemic load
  • ACEs and ARBs
    • To reduce hyperfiltration in the glomerulus
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32
Q

Managing acidosis from CKD

A
  • Give sodium bicarb
  • But careful not to give too much sodium
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33
Q

Managing anemia from CKD

A
  • Iron replacement therapy if needed
  • Give EPO
    • But do NOT replace hemoglobin all the way back to “normal.” This is associated with mortality and is why EPO has a black box label.
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34
Q

Managing mineral bone disease in CKD

A
  • Control phosphorous through the diet
  • Give phosphorous binders
  • Vitamin D supplements
  • Control PTH either with medication or removal of PTH gland
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35
Q

When to initiate dialysis?

A
  • Mostly based on clinical symptoms: weight loss, fatigue, excessive sleep, itchy skin
  • Used to say a GFR < 10 was reason, but a study shows that no difference in outcomes b/w dialysis at GFR of 10 vs. 7
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36
Q

hydronephrosis

A
  • Buildup of urine in the kidney
  • See with Ureterpelvic Junction Obstruction
  • May see with calculi in the ureter (stones)
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37
Q

normal urine specific gravity

A

1.007 - 1.01

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38
Q

normal urine osmolality in hypervolemic state

A

less than 100

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39
Q

normal urine sodium levels (when not volume depleted)

A

greater than 20

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40
Q

If the urine sodium levels are less than 20, what is the kidney trying to do?

A

Hold onto sodium to hold onto water. It’s either a low-volume state or low effective circulating volume.

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41
Q

orthopnea

A

SOB when lying down

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42
Q

paroxysmal nocturnal dyspnea

A

SOB during the night that is so bad it wakes you up

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43
Q

normal urine osmolality levels in euvolemic state

A

less than 300

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44
Q

BPH arises from the _____ zone

A

transitional

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45
Q

Prostate Cancer arises from the ____ zone

A

peripheral

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46
Q

The key histologic finding in prostate cancer is…

A

loss of basal cells

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47
Q

Pathologic features of BPH

A
  • Overgrowth of either stroma or epithelial cells
  • In contrast to prostate cancer, you’ll still see two epithelial cell types – secretory cells and basal cells
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48
Q

Gleason Scoring System is based on…

A
  • Architectural changes
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49
Q

What distinguishes grades 3, 4, and 5 in the gleason scoring system?

A
  • Grade 3 = well differentiated
  • Grade 4 = moderately differentiated
  • Grade 5 = poorly differentiated
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50
Q

Gleason Scoring system outcomes

A
  • We give two numbers based on the predominant pattern in the microscopic findings and then add these numbers
  • Best score: 3 + 3 = 6/10
  • Worst score: 5 + 5 = 10
51
Q

Gleason Group Grade came about because…

A
  • A gleason score of 7 can have very different outcomes depending on the pattern
  • 3 + 4 is a pretty slow-growing cancer whereas a 4 + 3 is pretty aggressive. But a gleason score of 7 didn’t reflect this important distinction.
52
Q

Gleason Group Grades

A
  • Grade 1 = Gleason score of 6
  • Grade 2 = gleason score of 3 + 4
  • Grade 3 = gleason score of 4 + 3
  • Grade 4 = gleason score of 8
  • Grade 5 = gleason score of 9 - 10
53
Q

The most common site of urinary tract disease

A

bladder

54
Q

Benign disease of the urinary tract

A
  • cystitis = inflammation of the bladder
55
Q

Cystitis cause

A
  • Most commonly: bacterial infection
56
Q

Most common urinary tract malignancy

A

urothelial carcinoma

57
Q

Etiology of urothelial carcinoma

A
  • Smoking
  • Synthetic dyes
58
Q

_____________ represents flat non-invasive high-grade urothelial carcinoma

A
  • Urothelial carcinoma in-situ
59
Q

_____ tumors have both oncogenic and tumor suppressor mutations, while ______ tumors have just tumor suppressor mutations

A
  • Papillary
  • Flat
60
Q

Tx of superficial urothelial carcinomas

A
  • Topical intravesicular therapy
  • i.e. chemo
61
Q

Tx of deep urothelial carcinomas (have invaded the muscle layer)

A
  • cystectomy (bladder removal)
62
Q

True/False: If left untreated, Carcinoma In Situ will progress to an invasive tumor.

A

True

63
Q

Low grade vs. high grade urothelial carcinoma features

A
  • Low grade = small nuclei, no pleomorphism.
  • High grade = pleomorphism (nuclei are different sizes and shapes), high mitotic activity, hyperchromasia (nuclei are darker).
64
Q

Main difference in behavior b/w low-grade vs. high-grade urothelial tumors

A
  • Low grade = high risk of recurrence but low risk of metastasis
  • High grade = high risk of recurrence AND high risk of metastasis
65
Q

Xanthogranulomatous Pyelonephritis

A
  • Presents with a renal mass, but this is due to an inflammatory process, it’s NOT a neoplasm
  • Clinical features: fever, renal mass, abdominal pain, hematuria
  • Microscopically: LOTS of inflammatory cells
66
Q

Oncocytoma definition

A
  • Benign epithelial neoplasm in the kidney
67
Q

Gross pathology of oncoytoma

A
  • Brown
  • Central stellate scar (white stripe down the middle)
68
Q

Microscopic findings of oncocytoma

A
  • Lots of pink cytoplasm
69
Q

Angiomyolipoma def’n

A
  • benign neoplasm of renal parenchyma
70
Q

Angiomyolypoma is composed of 3 things

A
  • blood vessels
  • smooth muscle
  • fat
71
Q

classic triad of symptoms for renal cell carcinoma

A
  • hematuria
  • flank pain
  • renal mass
72
Q

Most common renal malignancy of childhood

A

Wilms Tumor/Nephroblastoma

73
Q

Wilms Tumor presentation

A
  • large abdominal mass with abdominal pain, hematuria, and/or urinary obstruction
74
Q

Microscopic pathology of Wilms Tumor

A
  • Very BLUE tumor
  • Mimics fetal kidney
75
Q

Ureteropelvic Junction Obstruction

A
  • Obstruction where renal pelvis meets the ureter
  • Primary symptom: increased flank pain with fluid intake
76
Q

increased flank pain with fluid intake

A

ureteropelvic junction obstruction

77
Q

Tx for ureteropelvic junction obstruction

A

pyeloplasty - cut the ureter, remove the strictured site, stitch it back to renal pelvis

78
Q

gold standard test for suspected stone

A

non-contrast CT

79
Q

Tx for stones

A
  • Most of the time just monitor and it passes on its own
  • If fever, you need to do surgery
80
Q

Staghorn calculus

A
  • A stone fills the entire renal pelvis
  • These are fairly asymptomatic but MUST BE OPERATED ON - they are strongly associated with mortality if not treated
81
Q

Pyelonephritis classically presents as

A

a UTI that progresses to pyelonephritis

82
Q

lobar nephronia

A
  • CT finding associated with pyelonephritis
83
Q

presentation of acute urinary stone

A
  • severe flank pain
  • hematuria
  • radiating pain
84
Q

when to treat an upper urinary tract stone?

A
  1. any ureteral stone
  2. renal stone for pain, infection, obstruction, or if “Staghorn”
  3. Elective to prevent future problems
85
Q

Area of prostate where BPH arises

A

transitional zone

86
Q

area of prostate where prostate cancer arises

A

peripheral zone

87
Q

BPH symptoms

A
  • problems with voiding urine
    • weak stream
    • hesitancy
  • Sensation of needing to pee is increased
    • Nocturia
    • Urgency
88
Q

Diagnostic results of BPH

A
  • Enlarged prostate
  • High PSA
89
Q

Tx of BPH

A
  • Alpha blockers
    • relax the smooth muscle of the prostate
  • 5-alpha reductase
    • Decrease DHT and prostate size
  • TURP
    • Surgical procedure where you go in and scrape away prostate
90
Q

Two classic presentations of prostate cancer

A
  1. person has no signs/symptoms and just has an elevated PSA on routine labwork
  2. Come to doctor due to voiding problems progressing over time. Prostate exam reveals very firm prostate. PSA is extremely high.
91
Q

Main screening tool for prostate problems

A

PSA (bloodwork)

92
Q

Symptoms of prostate cancer

A
  • Most often asymptomatic
  • Can otherwise mimic BPH.
  • hematuria, bone pain, pelvic pain.
93
Q

Risk factors for prostate cancer

A
  • Age
  • African American
  • Genetics – BRCA gene is implicated in prostate cancer
94
Q

How to diagnose prostate cancer?

A
  • Biopsy and MRI
95
Q

Tx of prostate cancer

A
  • Frequently we just monitor prostate cancer. People are often likely to die from something else before they die of prostate cancer.
  • Prostatectomy if needed
  • Ablation
  • Radiation
96
Q

Main side effects of prostatectomy

A

leaky urine

sexual dysfunction

97
Q

Most common site of metastasis from prostate cancer

A

bone

98
Q

Prostatitis

A
  • Inflammation of the prostate
99
Q

Diagnosis of prostatitis

A
  • More than 10 WBCs in the urine (high power field)
  • Frequent urination
100
Q

What should you AVOID when someone comes in with prostatitis?

A
  1. do not massage prostate
  2. do not catheterize
101
Q

Sympathetic control of bladder is from what nerve?

A

hypogastric

102
Q

hypogastric nerve

A

sympathetic control of the bladder

103
Q

parasympathetic nerve that controls the bladder

A

pelvic nerves

104
Q

pelvic nerves

A

parasympathetic control of the bladder

105
Q

somatic control of the bladder from what nerves?

A

pudendal

106
Q

pudendal nerves

A
  • somatic control of the bladder
  • S2,3,4 keeps the pee off the floor
107
Q

Pontine Micturition Center

A
  • The part of the pons that controls peeing
108
Q

Process of adult voiding (peeing)

A
  1. You relax your urinary sphincter - this is under voluntary control
  2. This generates negative pressure in the urethra, which triggers AUTOMATIC contraction of the bladder
  3. Bladder neck opens - also automatic
  4. voiding occurs
109
Q

Uroflow

A

Chair you sit on and it measures the rate of urine flow

110
Q

Post-Void residual volume (PVR)

A
  • Ultrasound can compute this
  • Useful diagnostic measure
111
Q

“I cannot Pee” Causes

A
  • Weak bladder
  • Obstruction/difficulty relaxing sphincter
  • Coordination, innervation, or awareness gone
112
Q

Clinical features that indicate some obstruction as the cause of difficulty peeing

A
  • hesitancy
  • slow stream
  • prolonged stream
  • straining to urinate
  • intermittent stream
  • feeling of incomplete emptying
  • terminal dribbling
113
Q

clinical features that indicate a problem with storage of urine

A
  • frequent urination
  • urgent urination
  • urge incontinence
  • nocturia
114
Q

Stress vs. urge incontinence

A

Stress = something makes you leak (running, lifting heavy things)

Urge = can’t get to the bathroom in time

115
Q

Bladder size after voiding should be

A

Less than your age

116
Q

3 causes of elevated PSA

A
  1. BPH
  2. Infection (UTI or prostatitis)
  3. Urethral instrumentation/trauma (recent catheterization)
117
Q

Von Hippel Lindau syndrome

A
  • Mutation in VHL –> tumors/cancers
    • VHL is a tumor suppressor gene
  • Associated with renal cell carcinoma
118
Q

risk factors for painless gross hematuria

A

tobacco use

exposure to dyes

119
Q

Hallmark of acute interstitial nephritis

A

eosinophils

120
Q

Classic history for acute interstitial nephritis

A

someone taking a drug that causes a hypersensitivity reaction

121
Q

what are some common drugs associated with acute interstitial nephritis?

A
  • Drugs derived from sulfa-structures
  • Bactrim
  • Furosemide
  • proton pump inhibitors (omeprazole)
  • NSAIDs
  • penicillin class (nafcillin)
122
Q

combined hematuria and proteinuria

A

this is glomerular nephritis until proven otherwise

123
Q

Acute Tubular Necrosis vs. Acute Interstitial Nephritis

A
  • AIN is almost always caused by drugs
    • Key finding of AIN = eosinophils
  • ATN is usually caused by ischemia to the kidney or drugs
    • Key finding = granular casts

VF1 - Block 3 (7 decks)

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