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All the things > 12.5 - 12.7: Nephrolithiasis and Chronic Renal Failure > Flashcards

12.5 - 12.7: Nephrolithiasis and Chronic Renal Failure Flashcards

1
Q

UTIs are defined as an infection of what three organs?

A

Urethra, Bladder, or Kidney

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2
Q

True or false: sex is a risk factor for UTIs

A

True

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3
Q

What are the s/sx of cystitis? Are systemic signs usually present?

A
  • Dysuria, frequency, urgency, and suprapubic pain

- Usually no systemic signs

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4
Q

What will a UA show with cystitis?

A

Cloudy urine with more than 10 WBC/hpf

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5
Q

What will a urine dipstick test show with a cystitis?

A

Positive leukocyte esterase and nitrites

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6
Q

What will a culture show with cystitis?

A

More than 100,000 colony forming units

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7
Q

What are the 5 bacteria that cause UTIs? Which is most common?

A
  • E.coli
  • Staph saprophyticus
  • Klebsiella pneumoniae
  • Proteus mirabilis
  • Enterococcus faecalis
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8
Q

Ammonia scented urine = what infx?

A

Proteus mirabilis

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9
Q

What is sterile pyuria? What does this suggest?

A

Pyuria with negative urine cultures

Suggests urethritis d/t chlamydia or gonorrhea

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10
Q

What is a major, physiological risk factor for the development of pyelonephritis?

A

Vesicoureteral reflux

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11
Q

What are the s/sx of pyelonephritis? (4)

A
  • Fever
  • Flank pain
  • WBC casts
  • Leukocytosis
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12
Q

What causes the flank pain with pyelonephritis?

A

Sensitization of the nerves that innervate the capsule of the kidney

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13
Q

What are the three most common pathogens of pyelonephritis?

A
  • E.coli
  • Klebsiella
  • Enterococcus faecalis
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14
Q

What is chronic pyelonephritis, and what causes it?

A

Interstitial fibrosis and atrophy of tubules d/t multiple bouts of acute pyelonephritis, usually coincides with vesicoureteral reflux

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15
Q

What is the characteristics scarring pattern in the kidneys of vesicoureteral reflux?

A

Scarring of upper and lower poles

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16
Q

What are the histological characteristics of atrophic tubules 2/2 chronic pyelonephritis?

A

Eosinophilic proteinaceous material within the atrophic tubules, that appear like the colloid of the thyroid

“thyroidization”

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17
Q

What is thyroidization?

A

Eosinophilic proteinaceous material within the atrophic tubules, that appear like the colloid of the thyroid

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18
Q

What types of casts are seen in the urine with chronic pyelonephritis?

A

Waxy casts

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19
Q

What, very generally, are the two risk factors for the development of nephrolithiasis?

A
  • High concentration of solute

- Low urine volume

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20
Q

How fast are stones passed?

A

Within a few hours

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21
Q

What is the most common type of renal calculi?

A

Ca oxalate and/or Ca phosphate

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22
Q

What are the causes of Ca oxalate renal stones?

A

Idiopathic hypercalciuria, but also hypercalcemia and related causes

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23
Q

What GI disease tends to produce Ca oxalate renal calculi? Why?

A
  • Crohn’s disease

- Damage to the enterocytes increases oxalate reabsorption, leading to Ca crystallization

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24
Q

What is the treatment for Ca oxalate crystals? Why?

A

HTZ–Ca sparing diuretic

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25
Q

What diuretics are absolutely contraindicated with Ca oxalate stones? Why?

A

Loop diuretics, since these will increase tubular Ca levels

26
Q

What is the most common cause of ammonium magnesium phosphate renal calculi? Why?

A

Infection with urease positive organisms (e.g. proteus vulgaris or Klebsiella)

This leads to alkalinization of the urine

27
Q

What is the treatment for ammonium magnesium phosphate renal calculi?

A

Surgical removal of stone and eradication of pathogen

28
Q

What is the classic shape of ammonium magnesium phosphate renal calculi?

A

Staghorn

29
Q

What is significant about uric acid crystals in terms of detection?

A

Radiolucent

30
Q

What are the only radiolucent renal calculi?

A

Uric acid crystals

31
Q

What are uric acid renal calculi associated with?

A
  • Hot climate
  • acidic pH
  • Gout
  • Myeloproliferative disease
32
Q

Why are uric acid stones associated with myeloproliferative diseases?

A

Increased cellular turnover leads to increase in uric acid

33
Q

What is the treatment for uric acid stones?

A

Hydration and alkalinization of the urine (K HCO3)

-Allopurinol with gout

34
Q

In whom are Cysteine crystals usually seen? Why?

A

Children d/t cystinuria

35
Q

What is the defect in hereditary cystinuria?

A

Genetic defect of tubules that results in decreased reabsorption of cystine (and COAL amino acids)

36
Q

What are the characteristics of cystine calculi?

A

Staghorn calculi

37
Q

What is the treatment for cysteine renal calculi?

A

Hydration and alkanization of the urine

38
Q

What is a staghorn calculus? What are the two types calculi that forms these?

A

Renal calculus that involves the entire calyx

Cysteine
AMP stones

39
Q

What types of stones are seen with alkaline urine? Acidic?

A

Alkaline = ammonium, magnesium, phosphate

Acidic = uric acid stones

40
Q

End stage kidney failure results from damage to what part of the kidney?

A

Any-glomerular, tubular, inflammatory or vascular insults

41
Q

What are the three most common causes of ESRD?

A
  • DM
  • HTN
  • Glomerular disease
42
Q

Why does uremia cause platelet dysfunction?

A

Uremia Inhibits platelet adhesion aggregation

43
Q

What, generally, is uremia?

A

Increased nitrogenous waste products within the blood

44
Q

What are the s/sx of uremia? (heart, hematological, CNS, skin)

A
  • Pericarditis
  • Platelet dysfunction
  • Encephalopathy with asterixis
  • Deposition of urea crystals in the skin
45
Q

What is asterixis?

A
  • a tremor of the hand when the wrist is extended
  • caused by abnormal function of the diencephalic motor centers in the brain, which regulate the muscles involved in maintaining position.
46
Q

What are the latin roots of asterixis?

A 
a = not
Asterixis = fixed position
47
Q

What, generally, causes asterixis?

A
  • Metabolic encephalopathy
  • Acute respiratory failure
  • Hepatic encephalopathy
48
Q

Why is the HTN with uremia?

A

Retention of salt and water

49
Q

What is the metabolic disturbance common to uremia?

A

Hyperkalemia with metabolic acidosis

50
Q

What is the hematological abnormality with uremia? Why?

A

Anemia d/t loss of EPO

51
Q

What cells produce EPO?

A

Renal peritubular, interstitial cells

52
Q

Why is there hypocalcemia seen with uremia? (2)

A
  • Decreased 1-alpha-hydroxylase

- Hyperphosphatemia will bind Ca

53
Q

What are the cells that contain 1-alpha-hydroxylase?

A

Renal peritubular, interstitial cells

54
Q

What causes the osteitis fibrosa cystica with renal failure?

A

Loss of Ca leads to increased PTH, which causes bone resorption

55
Q

What causes osteomalacia in renal dysfunction?

A

Cannot mineralize the osteoid made by the osteoblasts

56
Q

What is the main cause of osteoporosis with ESRD?

A

Leaching of Ca from bone over time d/t acidosis and the use of bone as buffer

57
Q

What are the two treatment options for ESRD?

A
  • Dialysis

- Renal transplant

58
Q

What happens to the kidneys with chronic dialysis?

A

Shrunken kidneys with cysts

59
Q

Patients who are on chronic dialysis are at an increased risk for what cancer?

A

Renal cell carcinoma

60
Q

How can you differentiate cysts 2/2 PKD and from dialysis in ESRD?

A
  • PKD = large kidneys with cysts

- ESRD = small, fibrotic kidney with cysts

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