9

Question 1

When and why should you order a cytology vs cytoscopy when a patient presents with gross hematuria?

Answer 1

Why: There is a much higher likelihood for a urological cancer

When:

• Less than 50 + no risk factors: Cytology only (cytoscopy only if cytology produces neoplastic cells)
• Greater than 50 or risk factors: Cytology + Cytoscopy

Question 2

What are the key promoters of stone crystallization (3)? What are the key inhibitors (2)?

Answer 2

Promoters: Low pH, sodium magnesium and uric acid

Inhibitors: High urine flow rates and citrate

Question 3

Name the types of kidney stones (4)

Answer 3

1. Calcium
2. AMP (Ammonium, Magnesium, Phosphate)
3. Uric Acid
4. Cystine

Question 4

1. Calcium stones can be paired with what other minerals (2)?
2. What are some causes for calcium stones?
3. At what pH do calcium stones precipitate (hi/lo)?
4. How do we treat calcium stones?

Answer 4

1. Phosphate or Oxalate
2. Cause: Increased oxalate absorption; ethylene glycol (anti-freeze) consumption
3. Hi pH w/ phosphate; Lo pH w/ oxalate
4. Treat w/ hydration, thiazides or citrate

Question 5

1. What usually causes AMP stones?
2. What happens as a result of this cause?
3. What pH does precipitation occur?
4. Treatment?

Answer 5

1. Urease “+” bugs (Proteus mirabils, Klebsiella, Staph sapro.)
2. Urea is hyrdolyzed to ammonia, alkanilizing urine, cause adult Staghorns
3. High
4. Treat bug and surgery

Question 6

1. What causes Uric acid stones?
2. Key point about testing for Uric acid stones
3. At what pH do they preceipitate
4. Treatment?

Answer 6

1. Uricemia (often associated with high protein diet)
2. radiolUcent: show up on CT/ ultrasound but NOT X-ray
3. Low
4. Treat via alkanlization of urine

Question 7

1. How do patients get Cystine stones?
2. At what pH do they precipitate?
3. What forms?
4. Treatment?

Answer 7

1. Children get these stones via hereditary means (autosomal recessive)– can’t reabsorb cystine in PCT.
2. low pH
3. Staghorn in childen
4. Treat via urine alkalinization