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Brenner > Ch 37 UTO > Flashcards

Ch 37 UTO Flashcards

1
Q

dilation of the renal pelvis and calices proximal to the point of obstruction

A

Hydronephrosis

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2
Q

refers to blockage of urine flow due to a functional or structural derangement anywhere from the tip of the urethra back to the renal pelvis that increases pressure proximal to the site of obstruction

A

Obstructive uropathy

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3
Q

functional or pathologic parenchymal damage in obstructive uropathy

A

Obstructive nephropathy

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4
Q

Between the ages of 20 and 60 years, urinary tract obstruction was more frequent among

A

Women
uterine cancer and pregnancy

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5
Q

Above the age of 60 years, UTO more common among?

A

Men
prostatic disease

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6
Q

Acute Upper urinary tract [ureter or ureteropelvic junction (UPJ)] obstruction may present with

A

Renal Colic

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7
Q

Acute Lower tract (bladder or urethra) obstruction may present with

A

Disorders of micturition

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8
Q

A common renal complication of multiple myeloma

A

Myeloma kidney or myeloma cast nephropathy

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9
Q

2 Intrinsic intramural processes that cause obstruction

A
  1. failure of micturition
  2. Failure of ureteral peristalsis (rare)
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10
Q

Drug that cause intrinsic intramural obstruction by interfering with bladder contraction

A

Anticholinergic agents

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11
Q

Drug which may mediate an α-adrenergic increase in urethral sphincter tone, resulting in increased bladder outlet resistance

A

Levodopa

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12
Q

Chronic use of this drug
can cause severe cystitis with subsequent ureteral obstruction

A

Tiaprofenic acid (Surgam)

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13
Q

Chronic infection of this organism leads to irreversible ureteral or bladder fibrosis and obstruction

A

Schistosomiasis (bilharziasis)

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14
Q

Which ureter is affected more in the temporary form of obstruction usually observed in pregnancy

A

Right

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15
Q

4 Conditions in pregnancy that may predispose to obstructive uropathy and acute kidney injury

A
  1. multiple fetuses
  2. polyhydramnios
  3. incarcerated gravid uterus
  4. solitary kidney
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16
Q

Second most common cause of extrinsic obstructive uropathy in women

A

Cervical AdenoCA

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17
Q

Preferred imaging to screen for obstructive uropathy in advanced cases of endometriosis

A

CT scan

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18
Q

most common cause of urinary tract obstruction in men aged 50 years and older

A

BPH

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19
Q

Top 2 most common causes of malignant genitourinary tumors causing urinary tract obstruction

A
  1. Cervical CA
  2. Bladder CA
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20
Q

Chronic pancreatitis with pseudocyst formation causes

A

left ureteral obstruction

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21
Q

Acute pancreatitis may result in

A

right-sided obstruction

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22
Q

Most common vascular cause of urinary obstruction

A

Abdominal aortic aneurysm

23
Q

Retroperitoneal fibrosis usually involves which part of the ureter?

A

middle third

24
Q

Elevated levels of these 2 risk factor proteins are present in the urine from obstructed kidneys

A
  1. neutrophil gelatinase-associated lipocalin (NGAL)
  2. β2-microglobulin
25
Q

Preferred screening modality when obstruction is suspected

A

Ultrasonography

26
Q

Ultrasonography is both highly sensitive and highly specific in detecting hydronephrosis, with the rates approaching

A

90%

27
Q

Hydronephrosis detected as a dilated collecting system. On UTZ it appears as

A

anechoic central area surrounded by echogenic parenchyma

28
Q

False negative results in UTZ (UTO) - 8

A
  1. first 48 hours of obstruction
  2. When hydronephrosis is absent despite obstruction evaluated by CT
  3. Dehydration
  4. Staghorn calculi
  5. Nephrocalcinosis
  6. Retroperitoneal fibrosis
  7. Misinterpretation of caliectasis as cortical cysts
  8. Tumor encasement of the collecting system
29
Q

This new imaging technique provides information about renal stiffness related to fibrosis (i.e., chronic obstruction)

A

Renal elastography

30
Q

Imaging used to differentiate between obstructive or nonobstructive dilatation of the collecting duct system

A

Duplex doppler ultrasonography

31
Q

Diagnostic study of choice for the evaluation of the patient with acute flank pain

A

noncontrast-enhanced helical CT

32
Q

Can visualize a dilated collecting system without the requirement for contrast enhancement

A

Non contrast CT

33
Q

Exception to using a noncontrast CT

A

nephrolithiasis secondary to HIV protease inhibitors –> indinavir

Reason: These stones are not radiopaque, and signs of obstruction may be minimal or absent

thus the diagnosis may be missed with US and noncontrasted CT scan

34
Q

Imaging to establish the diagnosis in Nephrolithiasis 2° to HIV protease inhibitor –> Indinavir

A

Contrast-enhanced CT

35
Q

Imaging to diagnose upper urinary tract obstruction and providing information on the differential renal function (DRF) of both kidneys

A

Isotopic renography or renal scintigraphy

36
Q

Clearance of the isotope from the collecting system which indicate obstruction

A

T½: < 15 minutes (normal)
> 20 minutes (obstruction)
15-20 minutes (equivocal)

37
Q

In patients with severely impaired renal function, use of gadolinium during MRI results ro increased risk of developing this toxicity

A

Nephrogenic systemic fibrosis (NSF)

38
Q

Because of the risk of NSF, gadolinium contrast media should be avoided in patients with what stage of CKD?

A

CKD stage 4 or 5

39
Q

Defines the functional effect of upper urinary tract dilatation by measuring the hydrostatic pressures in the renal pelvis and bladder during infusion of a saline and contrast mixture into the renal pelvis via a catheter

A

Whitaker test

40
Q

In whitaker test, what is the renal pelvic pressure that is considered obstructed?

A

Renal pelvic pressure (cm H2O):
< 15: nonobstructed
15 - 22: equivocal
> 22: obstructed

41
Q

This procedure defines the lower level of the obstruction

A

Retrograde pyelography

42
Q

This procedure establishes the proximal level of obstruction

A

Antegrade pyelography

43
Q

Blocks the hyperemic response

A

Indomethacin

44
Q

Critical to afferent vasodilation

A

Prostaglandins

45
Q

Obstruction of the left kidney augments?

A
  1. AFFERENT renal nerve activity from the LEFT kidney
  2. EFFERENT nerve activity to the RIGHT kidney
46
Q

2 phases of UUO

A
  1. Early hyperemic phase
  2. Late vasoconstrictive phase
47
Q

Afyer how many hours does renal blood flow declines progressively in unilateral obstruction?

A

3 hours

48
Q

After how many hours does renal plasma flow, GFR, and intratubular pressures have all dropped below normal values?

A

24 hours

49
Q

The only cell death at early time points following the onset of obstruction, such as at 24 hours occurs at?

A

the very tip of the papilla, where focal necrosis may be observed

50
Q

Following release of 24 hours of UUO, volume excretion from the postobstructed kidney, what happens tp the FeNa?

A

FENa may be twentyfold higher than normal

51
Q

What is the effect of obstruction on membrane expression of transporter proteins responsible for apical sodium entry and of basolateral sodium exit

A

downregulates

52
Q

major signaling mechanism by which obstruction downregulates Na+ transport

A

halt in urine flow

53
Q

Represents a particularly important mediator of salt wasting in bilateral obstruction

A

ANP

54
Q

This natriuretic peptide is markedly elevated in bilateral, but not in unilateral obstruction

A

ANP

Brenner (4 decks)

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