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► Med - Pathology > Hematuria and Nephrolithiasis > Flashcards

Hematuria and Nephrolithiasis Flashcards

1
Q

Is a positive dipstick test for hematuria confirmatory for blood?

A

No. A further microscopic confirmation is required.

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2
Q

What are the imposters of hematuria?

A
  • Free hemoglobinuria
  • Myoglobinuria
  • Menstrual contamination
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3
Q

Can hematuria be caused by anticoagulant therapy?

A

Not usually - only when there is massive overdose

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4
Q

What is the definition of microscopic hematuria?

A

≥ 2 RBC’s/hpf

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5
Q

What are some sequelae of gross hematuria?

A
  • Acute urinary retention due to clot formation

- Anemia from pronounced loss

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6
Q

What is gross hematuria often associated with?

A

Urologic Cancer

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7
Q

What are the main glomerular causes of microscopic hematuria in those below 50 years old?

A

IgA Nephropathy
Alport’s Syndrome
Thin Basement Membrane Disease
Mild Focal GN

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8
Q

What are the main glomerular causes of microscopic hematuria in those above 50 years old?

A

IgA Nephropathy
Alport’s Syndrome
Mild Focal GN

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9
Q

What are some of the risk factors of urologic cancer?

A
  • Cigarette smoking
  • Occupational exposures: Leather, dye, rubber/tire manufacturing industries
  • Phenacetin use (analgesic)
  • Aristolochic acid use (herbal diet agent)
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10
Q

What features suggest glomerular hematuria?

A
  • RBC casts
  • Dysmorphic RBC’s, acanthocytes
  • Proteinuria (ratio > 0.3 or >300mg/day)
  • Elevated renal indices (BUN, Creatinine)
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11
Q

What features suggest non-glomerular hematuria?

A
  • Isomorphic RBC’s
  • No proteinuria
  • Normal renal indices
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12
Q

What is a major technique used for the management of gross hematuria?

A

Large bore Foley catheterization

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13
Q

What is the typical patient with kidney stones in NA?

A

White males

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14
Q

What time of the year is the rate of kidney stones the highest?

A

In the summer

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15
Q

What is the presentation with a stone in the upper ureter?

A

• Flank pain, upper anterior abdominal pain

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16
Q

What is the presentation with a stone in the lower ureter?

A

• Groin pain, ipsilateral testicular/labial pain

17
Q

What is the composition of most kidney stones?

A

Calcium

18
Q

What are the other possibilities for the composition of kidney stones?

A

• 10-15% Uric acid
• 10-15% Magnesium ammonium phosphate a.k.a. Struvite
•

19
Q

How does kidney stone formation occur?

A

Stone formation starts with supersaturation with nucleation as the key phase

20
Q

What factors can promote stone formation?

A
  • Increased urinary ion excretion

* Decreased urine volume

21
Q

What compounds are promoters of stone formation?

A

Hydrogen ions (low pH), sodium, magnesium, uric acid

22
Q

What substances prevent stone formation?

A

Citrate

23
Q

What is the major cause of nephrolithiasis?

A

Hypercalciuria

24
Q

What is the most common cause of hypercalciuria?

A

Idiopathic - familial

25
Q

What are some other causes of hypercalciuria?

A
  • Hyperparathyroidism
  • Vitamin D excess
  • Sarcoidosis (D3 production in granulomas)
  • Glucocorticoid excess
26
Q

What is the interaction of Ca2+ and oxalate in the GI tract?

A
  • Dietary calcium binds with oxalate and impedes absorption

* Any unbound oxalate absorbed in colon

27
Q

What happens to absorbed oxalate?

A
  • Absorbed oxalate excreted
  • Excreted oxalate binds to urinary calcium
  • Can lead to stone formation
28
Q

How does low dietary Ca lead to kidney stones?

A

Low dietary Ca means that oxalate is more easily absorbed unimpeded to be excreted in the kidney which leads to increased stone formation

29
Q

What are the causes of uric acid stones?

A
  • Chronic metabolic acidosis

* Low urinary pH (

30
Q

What causes the formation of struvite stones?

A

Bacterial infection. Main cause is Proteus mirabilis

31
Q

How do struvite stones affect the urine?

A

Results in ammonia and persistently alkaline urine, promotes struvite formation

32
Q

What is the cause of cystine stones?

A

Cystinuria - autosomal recessive disorder that is rare

33
Q

What is the preferred imaging method for kidney stones?

A

CT scan without contrast preferred

34
Q

In what situations is medical management of kidney stones reasonable?

A
  • Small stones (less than 5 mm)
  • Distal ureteral location
  • Adequate pain control with analgesics
  • No associated UTI or localized obstruction
35
Q

In what situations is interventional management of kidney stones reasonable?

A
  • Larger stones (>6mm), especially proximal
  • Not passing after 4 weeks of medical therapy
  • Intractable pain
  • Associated UTI or localized obstruction
36
Q

What is done to prevent future Ca2+ stones?

A
  • Low sodium, low animal protein diet
  • NORMAL dietary calcium
  • Medication: thiazide diuretic
37
Q

What is done to prevent future uric acid stones?

A
  • Low purine, low animal protein diet

* Medication: sodium bicarbonate, potassium citrate and allopurinol

► Med - Pathology (203 decks)

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