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CRRAB II > Hematuria (Russ) - W4 > Flashcards

Hematuria (Russ) - W4 Flashcards

1
Q

How does the urine dipstick identify blood?

A

strip for blood utilizies hydroen peroxide that catalyzes a chemical rxn between hemologin (or myoglobin) and the chromogen tetramethylbenzidine

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2
Q

What can cause false negatives or positives on the urine dipstick?

A
  • positive = alkaline urine or contaminuation w/oxidizing agents
  • negative = occurs in presence of formalin and high urinary concentration of ascorbic acid
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3
Q

What characterizes hematuria in adults and children?

A
  • children = 5 red blooc cells/HPF
  • adults = 2 RBC/HPF
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4
Q

What are some causes of hematuria?

A
  • transient unexplained
  • UTI
  • Stones
  • Cancer: bladder, kidney, prostate
  • less frequent
    • exercise
    • trauma
    • endometriosis
    • sickle cell disease
    • polycystic kidney disease
    • glomerular disease
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5
Q

What does it mean if the urine sediment is red?

urine supernatant red?

A
  • urine sediment red = hematuria
  • urine supernatant red = not hematuria, need dipstick for heme
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6
Q

What can cause a red supernatant dipstick that is NEGATIVE for heme

A
  • porphyria
  • phenazopyridine
  • beets
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7
Q

What if the red supernatant is POSITIVE FOR HEME?

A
  • myogloinuria - clear plasma
  • hemoglobinuria- plasma red
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8
Q

What causes the red color when eating beets?

A

betalaine pigment

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9
Q

What are 4 good indicators of glomerular bleeding?

A
  1. red cell casts
  2. proteinuria
  3. dysmorphic appearing red cells
  4. smokey brown or cola color
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10
Q

What is a good indicator of extraglomerular bleeding?

A

CLOTS

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11
Q

What test should you do if it’s the first incidence of hematuria?

A

CT scan of abdomen and pelvis

ultrasound if recurrenty

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12
Q

What are unusual causes of hematuria?

A
  1. AV malformations
  2. fistulas
  3. loin pain - hematuria syndrome
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13
Q

What are some causes of persistent microscopic hematuria in children?

A
  • glomerulopathies: IgA nephropathy, Alport’s syndrome, thin basement membrane disease, post infectious glomerulonephritis
  • Hypercalciuria
  • Nutcracker syndrome - left renal vein compressed by aorat and superior mesenteric
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14
Q

What are causes of symptomatic hematuria in children?

A
  • glomerular disease
  • interstitial tubular diseases
  • lower UTI
  • nephrolithiasis
  • tumor
  • vascular disease
  • gross hematuria - UTI, trauma
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15
Q

Who are stones (urolithiasis) more common in?

What are the symptoms?

A
  • Men> women
  • Whites > blacks
  • risk increases w/age
  • Symptoms
    • flank pain
    • abdominal pain
    • testicle/labial pain
    • wax and wane pain
    • gross/microscopic hematuria
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16
Q

What are the most common types of stones?

How do we diagnose?

A
  • 80% are calcium
  • oxalate > phosphate
  • diagnose = CT scan of abdomen and pelvis
17
Q

What are risks for calcium stone formation?

A
  • increased CALCIUM excretion
  • increased URIC ACID excretion
  • REDUCED CITRATE excretion
  • low urine volume
  • INCREASED OXALATE excretion
18
Q

What is the most common cause of idiopathic hypercalciuria?

A
  • absorptive hypercalciuria - autosomal dominant
  • leads to elevated Calcitriol levels
19
Q

What is shown in the image?

A

Calcium oxalate crystals

“dumbell and envelope shaped”

20
Q

What can cause decreased citrate? Hypocitraturia

A
  • chronic diarrhea
  • renal tubular acidosis
  • ureteral diversion
  • high protein diet
  • topiramate
21
Q

How do calcium and oxalate work together?

A

Calcium binds to oxalate to prevent absorption.

If you’re not getting calcium, there is more oxalate exposed.

22
Q

What are some metabolic problems seen with calcium stone formation?

A
  • primary hyperparathyroidism - excessive calcium in urine
  • medullary sponge kidney - abnormal papilla
  • distal renal tubular acidosis - citrate issue
23
Q

What is a good METABOLIC WORK UP for calcium stones

A
  • plasma calcium concentration
  • parathyroid hormone
  • electrolytes
  • serum uric acid
  • 24 hour urine - volume, ca, pH, citrate, oxalate, creatinine, pH, sodium, phosphorus
24
Q

Should you restrict calcium when treating calcium stones?

A

NO cuz oxalate would be unopposed

25
Q

Medications for calcium stones

A
  • thiazide diuretics - block calcium excretion
  • potassium citrate or bicarb
  • orthophosphate
  • allopurinol/febuxostat - block uric acid
  • calcium carbonate - high oxalate loads
26
Q

Uric Acid Urolithiasis

Common?

Pathogenesis?

Treatment

A
  • non-opaque on exam (radiolucent) - hot, arid climates
  • see high concentration of uric acid in urine + ACID urine pH
  • Treatment
    • increase urine output > 2 L day
    • alkalinize the urine
    • allopurinol/febuxostat
27
Q

Struvite Stones “magnesium ammonium phosphate”

Presentation

Causes

Treatment

A
  • coffin lid appearance
  • occur often when you can’t empty bladder - related to infection.
  • increased AMMONIA production + increased urine pH
  • TREATMENT
    • antibiotics
    • acetohexemic acid - urease inhibitor
    • ESWL
28
Q

Cystine Stones

presentation

cause

Clinical manifestations

treatment

A
  • Hexagonal crystals - RADIO-OPAQUE
  • Autosomal recessive - impaired cystine transport that leads to decreased reabsorption + increased secretion.
  • Treatment
    • high fluid > 3L
    • alkalinization of urine
    • restrict Na+
    • penicillamine
    • tiopronin
    • captopril
    • resistant to ESWL
  • there are other invasive measures availalbe
  • renal transplant cures
29
Q

With the first kidney stone, when is medical treatment indicated?

A
  • formation of NEW Stones
  • enlargment of OLD Stones
  • PASSAGE OF GRAVEL w/urine
  • multiple stones at presentation
30
Q

What is the risk of a symptomatic second stone?

A

15% at one year

35-40% at five years

50% at 10 years

men> women

31
Q

What are some complications w/ESWL

A
  • treating <2cm can lead to obstruction
  • damages blood vessels and tubules
  • new hypertension
  • impaired renal function due to scar formation
  • high incidence of struvite stones after if they had residual calciuli after ESWL

CRRAB II (26 decks)

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