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CPR Exam 3 > Hematuria - Tyler > Flashcards

Hematuria - Tyler Flashcards

1
Q

macroscopic (gross) hematuria specific laboratory parameters

A

red sediment with red blood cells on microscopy (>3500 red blood cells per high-power field)

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2
Q

microscopic hematuria specific laboratory parameters

A

2-3 red blood cells per high-power field on urine microscopy

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3
Q

glomerular cases of hematuria

A

primary glomerulonephritis, secondary nephritis, or familial

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4
Q

non-glomerular cases of hematuria

A

lower urinary tract source, or upper urinary tract source

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5
Q

what are the clinical manifestations of renal cell carcinoma?

A
  • *alarm symptoms** (age >40, weight loss, chronic malaise, appetite loss, fever)
  • gross hematuria
  • flank pain
  • solid renal mass on imaging
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6
Q

what are the demographics of renal cell carcinoma?

A
  • male:female 2:1
  • cigarette smoker
  • familial: von Hippel-Lindau syndrome, hereditary papillary RCC, hereditary leiomyoma-RCC, Birt-Hogg-Dube syndrome
  • dialysis-related acquired cystic disease
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7
Q

what are the differential diagnoses of renal cell carcinoma?

A
  • angiomyolipomas (fat density visible by CT)
  • renal pelvis urothelial cancers (more central location)
  • renal oncocytomas (indistinguishable pre-op)
  • renal abscesses
  • adrenal tumors
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8
Q

what are the laboratory tests should be run with suspected RCC?

A
  • hematuria (in 60% of cases)
  • paraneoplastic syndromes
  • erythrocytosis from increased erythropoietin production in 5% (but anemia far more common)
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9
Q

what imaging studies should be preforms with suspected RCC?

A
  • solid renal mass on abdominal US or CT
  • CT and MRI scan most valuable (they confirm character of mass, stage the lesion)
  • chest radiographs for pulm metastasis
  • bone scans for large tumors, bone pain, elevated alkaline phosphatase
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10
Q

what is the expected prognosis of RCC of tumors confined to the renal capsule (T1-2)?

A

5 year disease-free survivals of 90-100% after radial nephrectomy

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11
Q

what is the prognosis of RCC tumors that extending beyond the renal capsule (T3-4), and node-positive tumors?

A

50-60% and 0-15% 5 year disease free survival, respectively

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12
Q

what is the prognosis of RCC with solitary resectable metastases?

A

radical nephrectomy with resection of the metastasis has resulted in 5-year disease-free survival rates of 15-30%

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13
Q

when to refer patients?

  • solid renal mass or complex cysts
  • RCC
  • metastatic disease
A
  • urologist for further evaluation
  • urologic surgeon for surgical excision
  • oncologist
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14
Q

what are the examples of primary glomerulonephritis that cause hematuria? (3)

A
  • IgA nephropathy
  • postinfection glomerulonephritis
  • idiopathic glomerulosclerosis
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15
Q

what are the examples of secondary glomerulonephritis? (3)

A
  • SLE
  • Wegener’s granulomatosis
  • other vasculidities
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16
Q

what are the examples of familial glomerulonephritis?

A
  • thin basement membrane disease

- hereditary nephritis (Alport synd)

17
Q

What are the clinical manifestation of IgA nephropathy?

A
  • episodic gross hematuria that occurs during upper respiratory infection
18
Q

What are the clinical manifestation of IgA nephropathy?

A
  • episodic gross hematuria that occurs during upper respiratory infection
  • RBC casts with negative serologies for other glomerulonephridities
19
Q

how is a diagnosis of IgA nephropathy confirmed?

A

kidney biopsy showing iGa deposits in the mesangium

20
Q

what does the Oxford IgA nephropathy MEST classification

A

Messangial hypercellularity
Endocapillary hypercellularity
Segmental glomerulosclerosis
Tubular atrophy/interstitial fibrosis

21
Q

what is the prognosis of IgA nephropathy?

A

excellent with normal function and low proteinuria

NOTE: kidney biopsy is restricted to patients with sustained proteinuria .1g/day or worsening kidney function

22
Q

what lab tests should be run with suspected IgA nephropathy?

A
  • UA (demonstrating protein, RBC, and RBC casts
  • serum creatinine may be elevated
  • urine protein-tocreatinine ration (reveals mild increases in proteinuria)
  • serum IgA (elevated in only 50% of patients, has little clinical utility)
23
Q

What are the clinical manifestations of medullary sponge kidney?

A
  • present at birht, not diagnosed until fourth or fifth decade
  • kidneys have marked irregular enlargement of medullary and interpapillary collecting ducts
  • gross or microscopic hematuria
  • recurrent UTI’s
  • nephrolithiasis (calcium phosphate and calcium oxalate stones)
  • decreased urinary concentrating ability and nephrocalcinosis
24
Q

What are the clinical manifestations of medullary sponge kidney?

A
  • present at birth, not diagnosed until fourth or fifth decade
  • kidneys have marked irregular enlargement of medullary and inter-papillary collecting ducts
  • gross or microscopic hematuria
  • recurrent UTI’s
  • nephrolithiasis (calcium phosphate and calcium oxalate stones)
  • decreased urinary concentrating ability and nephrocalcinosis

CPR Exam 3 (6 decks)

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