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CRRAB 2 > Hematuria > Flashcards

Hematuria Flashcards

1
Q

Urine Dipstick

A

most common screening test for blood and protein in urine
False negative –> formalin or high Vit C
False positive –> alkaline urine or contamination

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2
Q

Hematuria

A

2 RBCs in field for adult

5 RBCs in field for children

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3
Q

Causes of Hematuria

A 
FREQUENT
Transient unexplained
UTI
Stones
Cancer 
LESS FREQUENT
Exercise, trauma, endometriosis, Sickle cell, PKD
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4
Q

Risk factors for urinary malignancy

A 
>35 yrs old
Smoking or chemical exposure
Gross hematuria
chronic cystitis
cyclophosphamide
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5
Q

Red Urine

A

Red sediment in urine = hematuria
Red supernatant in urine = not hematuria (need dipstick for heme)
negative for heme - porphyria, phenazopryidine, beets
positive for heme - myoglobinuria (plasma clear), hemoglobinuria (plasma red)

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6
Q

Beeturia

A

Betalaine - redox indicator

  • protected by oxalate
  • decolored by ferric ions, hydrochloric acid and colonic bacteria
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7
Q

Glomerular vs Extraglomerular Bleeding

A 
Glomerular
- RBC casts
- Proteinuria
- Dysmorphic appearing red cells
- Smokey brown or cola color urine
Extraglomerular
- Clots
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8
Q

Microscopic hematuria in children

A

Glomerulopathies: IgA nephropathy, Alport’s, post-infectious glomerulonephritis
Hypercalciuria
Nutcracker syndrome (L renal vein compression by aorta and SMA)

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9
Q

Evaluation of microscopic hematuria in children

A

Asymptomatic with no protein–> benign/observe

Asymptomatic with protein –> quantify protein with 1st morning void –> consider nephrology if abnormal

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10
Q

Urolithiasis

A

12% of men and 5% of women develop symptomatic stone by 70
80% of stones are calcium (most oxalate)
Sx: flank pain, ab pain, colicky, hematuria, N/V

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11
Q

Treatment of urolithiasis

A

Pain meds, hydrate, tamsulosin, nifedipine
Ureteroscopy
ESWL
Pyelolithotomy –> staghorn caliculi

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12
Q

Calcium Kidney stones

A

dumbbell shaped

Risk factors: hypercalciuria, hyperuricosuria, hypocitraturia, low urine volume, increased oxalate excretion

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13
Q

Hypercalcuria

A

absorptive = autosomal dominant (elevated calcitriol levels)
fasting = bone loss (resorptive)
renal - renal leak

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14
Q

Hypocitraturia

A 
chronic diarrhea (metabolic acidosis)
renal tubular acidosis
high protein diet
Topiramate - creates non-anion gap acidosis
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15
Q

Hyperoxaluria

A

increased oxalate absorption –> low calcium diet, absorptive hypercalciuria

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16
Q

Workup for Calcium stone

A 
Plasma Ca levels
PTH
Electrolytes
Serum uric acid
24 hr urine collection
17
Q

Dietary treatment of calcium stone

A 
2 L of water
restrict salt --> it drives Ca excretion
Protein --> limit the acid load
Calcium --> maintain so oxalate doesn't concentrate in urine
Oxalate --> limit
18
Q

Medical treatment of calcium stone

A 
Thiazides --> decrease Ca in urine
Potassium citrate
Orthophosphate
Allopurinol
Calcium carbonate
19
Q

Uric acid stone

A

40% of stones in hot, arid climates with low urine volume and low urine pH
Tx: alkalize urine, give allopurinol

20
Q

Struvite stones (infection)

A

Coffin-lid stones
increased ammonia production and increased urine pH
Urease (+) organisms (Klebsiella, proteus)
Tx: chronic antibiotic use (pts usually have instrumentation), Acetohexemic acid, ESWL
- high incidence of stone formation with residual calculi after ESWL

21
Q

Cysteine Stones

A

Hexagonal crystals
Autosomal recessive trait –> impaired cystine transport –> decreased proximal tubular re-absorption and increased excretion of cystine
SUBTYPES
I/I = parents excrete normal amount
II/II = parents excrete large amount
III/III = parents excrete intermediate amount
VERY DIFFICULT TO TREAT MEDICALLY

22
Q

ESWL Complications

A

instrument obstruction
reversible damage to blood vessels and tubules (degree of injury relates to # of shocks, energy level, and size of kidney)

23
Q

Medical therapy efficacy

A

decreases stone formation rate –> doesn’t clean up stone fragments

CRRAB 2 (21 decks)

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