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D&T3 Exam 1 > Hematuria-Petrany > Flashcards

Hematuria-Petrany Flashcards

1
Q

Imaging Tests

What to look for

A

Lesions of kidneys, collecting system, ureters, bladder

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2
Q

Cystoscopy

Characteristics

A

Entire bladder seen

May see source of bleeding in bladder or from one or both ureters

Only test to visualize urethra and prostate

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3
Q

Nephrolithiasis

Options for immediate expulsive therapy

A

Shock wave lithotripsy

Ureteroscopic lithotripsy with laser probes

Percutaneous nephrolithotomy

Laproscopic stone removal

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4
Q

Cystine shape

A

Hexagonal

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5
Q

Nephrolithiasis

Confirmatory Tests

Abdominal plain radiograph

A

See radiopaque stones (calcium, struvite, cystine)

Misses uric acid stones or small stones

May be reasonable for hx of previous radiopaque stones

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6
Q

Symptomatic microscopic or gross hematuria in children

Evaluation

A

Hx of trauma, perineal irritation?

Sxs of sickle cell or hemophilia?

Rarely cause by medications

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7
Q

Ca oxalate shape

A

Octahedron, envelope

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8
Q

Symptomatic microscopic or gross hematuria in children

Evaluation

Deafness and family hx of hematuria

A

Alport syndrome

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9
Q

Ammonium magnesium Phosphate crystal shape

A

Coffin lid (struvite stone)

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10
Q

Children- Gross Hematuria

MC causes

A

UTI

Meatus irritation

Trauma

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11
Q

Transient Hematuria

Common causes

A

MC no causes found

Fever, trauma, exercise

UTI (usually with pyuria and bacteriuria too)

If >50 think MALIGNANCY

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12
Q

Hematuria

If evaluation negative…

A

Cause likely mild glomerulopathies or intermittent stones

Follow pts with repeat urinalysis and maybe cytology

NOT RECOMMENDED to screen asymptomatic pts for microscopic hematuria

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13
Q

Persistent Hematuria in Children

Postinfectious glomerulonephritis

A

Post GABH strap infxn (tonsillitis, impetigo)

Hematuria resolves in 3-6 mos

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14
Q

CT Urography (CT scan and IVP combined)

Characteristics

A

High sensitivity

High radiation dose

DO NOT use in pregnant women (use US)

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15
Q

Macroscopic hematuria (gross hematuria)

Define

A

Visible with the naked eye

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16
Q

Malignancy

Risk factors

A

Age >50

Smoking

Analgesic abuse

Male

Gross hematuria (higher risk than micro but either could be ass.)

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17
Q

Urinalysis

Glomerular bleeding

A

Red cell casts

Proteinuria (>500mg/day)

Dysmorphic cells

Absence of these does not exclude

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18
Q

Hematuria in Children

A

Microscopic hematuria common finding

Children hematuria=>5RBCs/hpf

Isolated asymptomatic hematuria usually benign in children

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19
Q

Children- Gross Hematuria

Less common causes

A

Stones

Sickle cell

Coagulopathy

Glomerular disease

Meds

wilm’s tumor

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20
Q

Preferred imaging in children

A

US over spiral CT

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21
Q

Microscopic hematuria

Characteristics

A

Incidental finding

More than 2 RBCs/hpf abnormal

False neg not a problem but may have false pos with dipstick so do micro if pos

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22
Q

Nephrolithiasis

Stone likelihood of passing

A

Determined by size and location

<4mm pass spontaneously

> 10mm will not

Refer for active rx if not passed in 4-6 wks

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23
Q

Nephrolithiasis

Differential

A

Ectopic pregnancy

AAA

Acute intestinal obstruction

Appendicitis

Drug seeking

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24
Q

Persistent Hematuria in Children

Hypercalcuria

A

High urinary calcium/creatinine ratio

Hematuria can be seen

More seen in south than north

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25
Q

Persistent Hematuria in Children

Alport Syndrome

A

X linked (seen in males)

Hearing loss, ocular abnormalities, progressive renal failure over time

Heterozygous females have hematuria without progressive kidney disease

26
Q

Hematuria in Children

Causes of transient hematuria

A

UTI

Trauma

Fever

Exercise

27
Q

Nephrolithiasis

Evaluation after acute episode

A

Try to prevent recurrence

Thorough history for risk factors

Identify stone type (examine stone or urine sediment for crystals)

28
Q

Nephrolithiasis

What meds are used to help pass stones

A

Antispasmodic agents

Ca channel blockers

Alpha blockers

29
Q

Symptomatic microscopic or gross hematuria in children

Evaluation

Unilateral flank pain radiating to groin

A

Suggests obstruction (stone)

30
Q

Asymptomatic isolated microscopic hematuria in children

Evaluation

A

Check BP and urinalysis weekly X 2 then q 3 months

Check urine culture

Further work up if BP inc, gross hematuria or proteinuria

If persists for 1 yr check for hypercalcuria, check relatives (BMD, hereditary nephritis), sickle trait, nutcracker syndrome

31
Q

Only test that visualizes urethra and prostate

A

Cystoscopy

32
Q

If isolated (no proteinuria or renal insufficiency) persistent hematuria think…

A

IgA nephropathy

Alport syndrome (hereditary nephritis)

Thin basement membrane nephropathy (benign familial hematuria)

33
Q

Nephrolithiasis

Symptoms

A

Pain (from obstruction, mild to excruciating,may wax and wane)

Nausea, vomiting

May be asymptomatic

Only symptom may be stone passing

34
Q

Renal ultrasound

Characteristics

A

Not sensitive for small tumors

35
Q

Symptomatic microscopic or gross hematuria in children

Evaluation

Flank pain with fever

A

Pyelonephritis

36
Q

If isolated (no proteinuria or renal insufficiency) transient hematuria think…

A

Post infectious glomerulonephritis

Exercise induced hematuria

37
Q

Persistent Hematuria in Children

Nutcracker syndrome

A

L renal vein compression by aorta and sup mesenteric artery

Can also have proteinuria

38
Q

Nephrolithiasis

MC stone

A

> 80% calcium oxalate

39
Q

Nephrolithiasis

Acute therapy

A

Pain control (NSAIDs, opioids)

Hydration

Meds to pass stone

Strain urine and save any stones

40
Q

Symptomatic microscopic or gross hematuria in children

Evaluation

Hx of pharyngitis or impetigo 2-3 wks earlier

A

Poststreptococcal glomerulonephritis

41
Q

Symptomatic microscopic or gross hematuria in children

Evaluation

New incontinence, dysuria, frequency, urgency

A

UTI

42
Q

Nephrolithiasis

When to use immediate expulsion therapy

A

Pts with sepsis, acute renal failure, anuria, relentless pain and nausea

43
Q

Struvite stones

Characteristics

A

“Staghorn Calculus”

Infxn induced

usually don’t cause pain

F>M (UTI?)

Should be removed

44
Q

Nephrolithiasis

Risk Factors

A

Urine composition

Prior nephrolithiasis

Family Hx

Gastric bypass/bariatric surgery

Acyclovir

Low fluid intake

Acidic urine

Upper tract UTI

45
Q

Cystoscopy

When to use

A

ALL adults with unexplained hematuria

Video-assisted flexible cystoscopy under local anesthesia

46
Q

Macroscopic hematuria (gross hematuria)

Characteristics

A

Red or brown urine

If clots, lower tract source

Color change doesn’t reflect large degree of blood loss

Centrifuge to see if truly blood

47
Q

Renal biopsy and cystoscopy in children

A

Rarely needed

Consider biopsy if progressive disease

48
Q

Nephrolithiasis

Confirmatory Tests

US

A

PROCEDURE OF CHOICE for those needing to avoid radiation (pregnancy)

May miss small stones and urethral stones

49
Q

Nephrolithiasis

Hematuria

A

Usually gross hematuria

Present in most pts but absence doesn’t rule out

Present in 95% day one and 65% day four

50
Q

Urinalysis

Extraglomerular bleeding

A

Not common

BLOOD CLOTS. Clots never come from glomerular disease

51
Q

Nephrolithiasis

When do you have dysuria and urgency?

A

When stone in distal ureter

52
Q

Extraglomerular Disease

If absence of symptoms or signs…

A

No cause of low level hematuria that requires immediate diagnosis

Repeat in a few days to determine transient or persistent

53
Q

Persistent Hematuria in Children

IgA nephropathy

A

Renal biopsy diagnosis

Usually gross hematuria, previous GI or Resp illness, (-) FHx

54
Q

Microscopic hematuria

Define

A

Visible with microscopic examination of urine

55
Q

Asymptomatic microscopic hematuria with proteinuria in children

Evaluation

A

Check serum creatinine and 24 hr urine for protein

If elevated, significant renal disease very likely and further w/u indicated (serum C3, C4, albumin, CBC, ASO tiger, ANA, imaging, renal biopsy)

56
Q

Uric Acid shape

A

Rhomboid

57
Q

Urine cytology

A

90% sensitivity for bladder cancer; not good for upper tract cancers

58
Q

Glomerular disease

Characteristic findings

A

Proteinuria, RBC casts, renal insufficiency

Do kidney biopsy

59
Q

Nephrolithiasis

Confirmatory Tests (gold standard)

A

Non-contrast helical CT scan (GOLD STANDARD!)

100% specific

Picks up stones missed by KUB or IVP

Can find alternative dx if not stones

Faster than IVP

60
Q

Nephrolithiasis

Confirmatory Tests

Intravenous pyelogram (IVP)

A

Previous best (not anymore)

Lower sensitivity, higher radiation than CT

61
Q

Hematuria in Children

Causes of Persistent Hematuria

A

IgA nephropathy

Thin basement membrane disease (benign familial hematuria, AD)

Alport syndrome (hereditary nephritis)

Postinfectious glomerulonephritis

Hypercalcuria

Nutcracker syndrome

D&T3 Exam 1 (19 decks)

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