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HMS Homeostasis II > Hematuria > Flashcards

Hematuria Flashcards

1
Q

90% of uncomplicated UTIs are caused by ____.

A

90% of uncomplicated UTIs are caused by E. coli.

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2
Q

The diagnosis of a UTI in a young, otherwise healthy, non-pregnant woman with symptoms of acute uncomplicated cystitis may be made. . .

A

. . . clinically.

All other forms of UTI require testing.

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3
Q

Findings of glomerular biopsy antibody staining in ANCA-associated nephropathy

A

No antibodies! Antibodies and immune complex deposition are not a part of the pathology of ANCA-associated nephropathies.

For this reason this is also sometimes called “pauci-immune glomerulonephritis”

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4
Q

Transient hematuria is seen in

A
  • Vigorous exercise
  • Sexual intercourse
  • Menstruation
  • Mild trauma
  • UTI
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5
Q

Pathotypes of E. coli

A
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6
Q

Pathogenesis of UPEC infection

A
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7
Q

In men, a UTI may spread to the . . .

A

. . . prostate and epididymis

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8
Q

Questions to ask when evaluating hematuria

A
  1. Is it really blood?
  2. Is it microscopic or macroscopic?
  3. Is it transient or sustained?
  4. Is it painful or painless?
  5. Is it glomerular or non-glomerular?
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9
Q

Patient presents via telemedicine with what you believe to be glomerulonephritis. You are only able to followup several months later, but decide to biopsy. This is what you see. What was the likely etiology?

A

Post-infectious glomerulonephritis

The very sparse deposition suggests subepithelial ICs that formed in tandem with subendothelial ICs, but the subendothelial portion has been clearned up by invading neutrophils during the patient’s glomerulonephritic episode.

This may present with mild hematuria.

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10
Q

Organisms that commonly cause uncomplicated UTIs

A
  • E. coli
  • Proteus mirabilis
  • Klebsiella pneumoniae
  • Staphylococcus saprophyticus (in young, sexually active women)
  • Enterococcus
  • Note that most of these are fecal flora
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11
Q

Mechanisms of glomerular damage in glomerulonephritis

A
  1. In-situ immune complex formation in the sub-epithelial space due to direct IgG against glomerular basement membrane antigens
  2. Ectopic immune complex formation and deposition in the sub-endothelial space (may be IgG, IgA, or poly-Ig as seen in Lupus), sometimes with sparse accompanying subepithelial deposits
  3. ANCA-associated disease. Exact mechanism is not known, but neutrophil hyperactivation is suspected.
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12
Q

Diagnosing ADPKD

A
  • Ultrasound or CT showing unusually large # of cysts given individual’s age
  • PKD1 or PKD2 genotyping
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13
Q

What is the likely disease process in this biopsy?

A

IgA nephropathy

Note the loss of capillary loops and expanded mesangium

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14
Q

Acute uncomplicated pyelonephritis

A

Renal infection in a woman with a normal GU tract that presents with evidence of a UTI, as well as evidence for upper tract disease including costovertebral angle tenderness, fever, nausea, or vomiting.

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15
Q

Looking for bacteriuria

A
  • Dipstick for nitrate
  • Urine culture (~1-2 days)
  • Urine gram stain (only 50% sensitive)
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16
Q

Patient presents with nephritic syndrome two weeks following streptococcal infection. Biopsy is performed yielding the below. What is the likely etiology?

A

Post-infectious glomerulonephritis

Note the spotty, “starry night” pattern of the IgG and C3

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17
Q

Virulence factors of UPEC

A
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18
Q

Red flags that your hematuria is probably glomerular in origin

A
  • Proteinuria
  • Renal dysfunction (elevated creatinine and BUN, reduced GFR)
  • Acanthocytic red cells
  • NOT crenated red cells
  • Red cell cast
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19
Q

Which is a faster onset: Acute nephritic syndrome, or rapidly progressive nephritic syndrome?

A

Acute.

Go figure. Terrible nomenclature.

20
Q

Treating acute uncomplicated pyelonephritis

A
21
Q

Treating anti-GBM disease and Goodpasture’s syndrome

A
  • Plasmaphoresis to remove anti-basement membrane antibody
  • Immunosuppression
22
Q

Hematuria – Is it really blood? What else can cause red urine?

A
23
Q

Cyclophosphamide

A

Chemotheraueptic that may cause kidney damage, resulting in hemorrhage in the renal tubules and hematuria

24
Q

Proliferation of parietal epithelial cells in Bowman’s capsule during glomerulonephritis

A

If the glomerular basement membrane is damaged by infiltrating neutrophils (as it often is in GM), then neutrophils and macrophages may enter the urinary space and induce proliferation of parietal epithelial cells.

This may lead to massive proliferation and a “fibrocellular crescent” which encircle the glomerular channels and compresses them to one wall of Bowman’s capsule.

25
Q

Nitrite production

A

Only happens in Gram negative bacteria, so all Gram positive will be missed

26
Q

Time between infection and GN in infection-related GN

A

1-6 weeks

27
Q

Treating ADPKD

A
  • Dialysis or transplantation for ESRD
  • RAAS inhibition (most important)
  • V2 blockers (vaptans)
  • mTOR inhibition (rapamycin)
  • Somatostatin analogues
  • Statin therapy
28
Q

Complicated urinary tract infection

A

A symptomatic infection of the urinary tract in individuals with functional or structural abnormalities: foreign bodies, pregnancy, immunosuppression, strictures, tumor, clot, stones, etc etc. Anything that makes the infection more difficult to treat or likely to recurr.

29
Q

Things that might cause macroscopic hematuria

A
  • Neoplasms
  • Nephrolithiasis
  • Trauma
  • Papillary necrosis
30
Q

Things that might cause microscopic hematuria

A
  • All the causes of macroscopic hematuria
    • Neoplasms
    • Nephrolithiasis
    • Trauma
    • Papillary necrosis
  • Plus:
    • Hypercalciuria
    • Polycystic kidney disease
    • Sickle cell
    • Glomerular disease
31
Q

Autosomal dominant polycystic kidney disease

A
  • Very common (1:1000 - 1:400)
  • Caused by PKD1 or PKD2 mutation
  • Proteins found on monocilia, control flow mechanosensation
  • Outpouchings develop in tubules, eventually leading to cyst formation
  • Liver is often also affected and displays many cysts on CT, however liver does not usually fail
32
Q

Immunofluorescent staining patterns of the three mechanisms of glomerulonephritis

A
33
Q

The Nephritic syndrome

A
  • Glomerular hematuria
  • Proteinuria (usually sub-nephrotic range, <3.5 g/day)
  • Hypertension
  • And sometimes. . .
    • Kidney dysfunction
    • Edema
    • Oliguria
34
Q

In the nephritic syndrome, you might find immune complexes ___. In the nephrotic syndrome, you might find immune complexes ___.

A

In the nephritic syndrome, you might find immune complexes in the sub-ENDOthelial space. In the nephrotic syndrome, you might find immune complexes in the sub-EPIthelial space.

35
Q

Presentation of ADPKD

A
  • Usually starts w/ hypertension in mid 50’s-60’s, or even earlier
  • Increased abdominal girth
  • Abdominal and flank pain
  • Hematuria
  • Early satiety due to stomach compression
  • Cerebral aneurysms (associated in certain families)
36
Q

Bacteriuria

A
  • Significant bacteriuria: >100,000 organisms per mL in clean voided specimen
  • Asymptomatic bacteriuria: Significant bacteriuria in the absence of clinical symptoms
  • Symptomatic Abacteriuria: Acute urethral syndrome with clinical symptoms of UTI without significant bacteriuria on culture – often indicates a viral STD
37
Q

Acute uncomplicated cystitis

A

Symptomatic bladder pain in a young woman with a normal GI tract who dysuria, frequency, hematuria, and suprapubic pain.

38
Q

“Categories” of UTI classification

A

Lower tract vs upper tract

Complicated vs uncomplicated

39
Q

Pyuria

A
  • Start with voided mid-stream urine
  • Unspun > 10 WBC/μL
  • Centrifuged specimen > 5 WBC/hpf
  • Presence of leukocyte esterase on the dipstick (not terribly sensitive)
40
Q

In order for Goodpasture’s syndrome to develop, you need. . .

A
  1. Formation of an anti-basement membrane antibody in the serum
  2. Damage to pulmonary epithelium that exposes the basement membrane (this is usually smoking).
41
Q

Treating asymptomatic bacteriuria

A
42
Q

anti-GBM disease vs Goodpasture’s syndrome

A

When renal limited damage, it is anti-GBM disease.

When renal and lung damage (pulmonary hemorrhage), it is Goodpasture’s syndrome.

43
Q

Half of young women who present with typical symptoms of bacteriuria will. . .

A

. . . not have “significant bacteriuria.” They will only have a small elevation in urine bacteria.

But, if you wait, they will. The symptoms appear before the clinical threshhold. So, you should not hold back antibiotics even if they lack “significant bacteriuria”.

But, you should also think about symptomatic abacteriuria.

44
Q

Workup for hematuria

A
  • Dip stick
  • Urinalysis
45
Q

IgA nephropathy

A
  • Most common cause of nephropathy worldwide
  • Associated with Hx of recent upper respiratory infection
  • Related to IgA glycosylation
  • Under-glycosylated IgA tends to be observed in this nephropathy
  • These deposits tend to form in the mesangium
  • Presents w/ mesangial expansion and capillary loop loss
46
Q

Painful urination

A

Usually indicates nephrolithiasis or a UTI, but can also indicate papillary necrosis

47
Q

Treating acute uncomplicated cystitis

A

HMS Homeostasis II (35 decks)

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