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Nephrology > Kidney stones, UTI, pyelonephritis > Flashcards

Kidney stones, UTI, pyelonephritis Flashcards

1
Q

Unilateral flank tenderness, colicky radiating pain to the groin/inner thigh, and hematuria are classic signs of _

A

Unilateral flank tenderness, colicky radiating pain to the groin/inner thigh, and hematuria are classic signs of nephrolithiasis

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2
Q

The best initial imaging for nephrolithiasis is a _

A

The best initial imaging for nephrolithiasis is a non-contrast CT scan
* In pregnancy we use ultrasound

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3
Q

Individuals prone to kidney stones should avoid excessive vitamin C, why?

A

Individuals prone to kidney stones should avoid excessive vitamin C, because it makes oxalate

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4
Q

Why is a low sodium diet recommended to individuals prone to kidney stones?

A

High salt shuts off RAAS –>
Decreases reabsorption of Na+ –>
Decreases Ca2+ reabsorption –>
Increases calcium in the urine

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5
Q

Treatment of nephrolithiasis

A

Treatment of nephrolithiasis:
* Pain management (NSAIDs)
* Antispasmodics (Tamsulosin, nifedipine)

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6
Q
A

Staghorn calculi- struvite stone

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7
Q

Struvite stones are also called _

A

Struvite stones are also called ammonium magnesium phosphate stones

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8
Q

Ammonium magnesium phosphate stones are caused by bacteria that are _ positive

A

Ammonium magnesium phosphate stones are caused by bacteria that are urease (+)
* Proteus mirabilis
* Staphylococcus saprophyticus
* Klebsiella

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9
Q

Struvite stones are caused by bacteria that are capable of turning urea into _

A

Struvite stones are caused by bacteria that are capable of turning urea –> ammonia

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10
Q

Struvite stones favor (acidic/basic) urine

A

Struvite stones favor basic/alkaline urine
* Bacteria that convert urea –> ammonia make these stones

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11
Q

The characteristic xray sign associate with struvite stones is called _

A

The characteristic xray sign associate with struvite stones is called staghorn calculi

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12
Q

Struvite stones appear _ on Xray and _ on CT

A

Struvite stones appear radiopaque on Xray and radiopaque on CT

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13
Q

Struvite stones produce urine cyrstals that look like _

A

Struvite stones produce urine cyrstals that look like rectangular prisms (coffin lids)

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14
Q

How do we manage struvite stones?

A

Struvite stones are almost always too big and require surgical removal
* Also use antibiotics for UTI

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15
Q

Calcium stones are associated with increased calcium + _ or _

A

Calcium stones are associated with increased calcium + oxalate or phosphate
1. Calcium oxalate (most common)
2. Calcium phosphate

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16
Q

Ethylene glycol increases the risk of calcium stones due to the production of _

A

Ethylene glycol increases the risk of calcium stones due to the production of oxalate

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17
Q

(Low/high) levels of citrate increase the risk of calcium stones

A

Low citrate increases the risk of calcium stones
* Citrate likes to bind calcium
* Low citrate means more free calcium

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18
Q

Increased vitamin C intake increases _ levels

A

Increased vitamin C intake increases oxalate levels

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19
Q

Pathophysiology of calcium stones in Crohn’s disease patients

A

Pathophysiology of calcium stones in Crohn’s disease patients:
1. Fat malabsorption
2. Increased fatty acids in the GI system
3. Fat binds to calcium
4. Increases the free oxalate
5. Calcium oxalate stones can form

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20
Q

Calcium stones (oxalate and phosphate) will appear _ on Xray and _ on CT

A

Calcium stones (oxalate and phosphate) will appear radiopaque on Xray and radiopaque on CT

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21
Q

Calcium oxalate stones create a urine crystal that looks like _

A

Calcium oxalate stones create a urine crystal that looks like dumbbells, envelopes

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22
Q

Calcium phosphate stones create a urine crystal that looks like _

A

Calcium phosphate stones create a urine crystal that looks like wedge

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23
Q

Calcium phosphate stones are often formed due to _

A

Calcium phosphate stones are often formed due to hyperparathyroidism

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24
Q

Treatment for calcium stones (oxalate or phosphate) includes _ drug and _ diet

A

Treatment for calcium stones (oxalate or phosphate) includes thiazides and low sodium diet

25
Q

Calcium phosphate stones favor (acidic/basic) urine

A

Calcium phosphate stones favor basic urine

26
Q

We would want to alkalinize the urine to treat calcium (oxalate/phosphate) stones

A

We would want to alkalinize the urine to treat calcium oxalate stones
* ie give citrate

27
Q

(True/False) Patients with calcium stones should restrict calcium

A

False; restricting calcium increases the amount of free oxalate

28
Q

Cystine stones are caused by a defect in _

A

Cystine stones are caused by a defect in absorption of amino acids
* Autosomal recessive defect in the PCT reabsorption of amino acids

29
Q

A defect in the reabsorption of cystine, ornithine, lysine, and arginine at the PCT is inherited in _ pattern

A

A defect in the reabsorption of cystine, ornithine, lysine, and arginine at the PCT is inherited in autosomal recessive pattern
* Causes cystine stones

30
Q

Positive sodium cyanide nitroprusside indicates _ stones

A

Positive sodium cyanide nitroprusside indicates cystine stones

31
Q

Cystine stones precipitate in (basic/acidic) urine

A

Cystine stones precipitate in acidic urine

32
Q

Cystine stones appear _ on Xray and _ on CT

A

Cystine stones appear weakly radiopaque on Xray and moderately radiopaque on CT

33
Q

Cystine stones create _ urine crystals

A

Cystine stones create hexagonal urine crystals

34
Q

Treatments for cystine stones include:

A

Treatments for cystine stones include:
* Alkalinizing urine
* Low sodium diet
* Chelating agents

35
Q

_ stones may be associated with urine that smells like rotten eggs

A

Cystine stones may be associated with urine that smells like rotten eggs

36
Q

Uric acid stones precipitate in (acidic/basic) urine environments

A

Uric acid stones precipitate in acidic urine environments
* Urate + H+ = Uric acid

37
Q

Risk factors for uric acid stones

A

Risk factors for uric acid stones:
* Gout
* Increased cell turnover (tumor lysis, leukemia)
* Desert climates (low urine volume)

38
Q

Uric acid stones show up _ on Xray and _ on CT scan

A

Uric acid stones show up radiolucent (cannot be seen) on Xray and visible on CT scan

39
Q

The urine crystals of uric acid stones have _ shape

A

The urine crystals of uric acid stones have rhomboid, rosette shape

40
Q

Managment for uric acid stones includes _ drug and reducing the intake of _

A

Managment for uric acid stones includes allopurinol and reducing the intake of purines (like meat)

41
Q

Calcium oxalate stones precipitate in (acidic/basic) urine

A

Calcium oxalate stones precipitate in acidic urine

42
Q

Acute cystitis involves a bacterial ascension from the _ to the _

A

Acute cystitis involves a bacterial ascension from the urethra to the bladder
* Cystitis means “inflammation of the bladder”

43
Q

Most common causes of UTI:

A

Most common causes of UTI:
* E.coli
* Staphylococcus saprophyticus
* Klebsiella
* Proteus mirabilis

44
Q

_ is a structural abnormality in which urine moves upward in the urinary tract and predisposes an individual to cystitis

A

vesiculo-urethral relux is a structural abnormality in which urine moves upward in the urinary tract and predisposes an individual to cystitis

45
Q

Only (cystitis/pyelonephritis) will present with fever

A

Only pyelonephritis will present with fever
* Cystitis will not present with systemic symptoms

46
Q

Cystitis can present with _ pain and pain with urination

A

Cystitis can present with suprapubic pain and pain with urination
* Other sx include increased urinary frequency, urgency, and dysuria

47
Q

Diabetes is a risk factor for UTI due the inhibition of _

A

Diabetes is a risk factor for UTI due the inhibition of diapedesis and phagocytosis of neutrophils

48
Q

Cystitis may present with _ signs on urinalysis

A

Cystitis may present with (+) leukocyte esterase, (+) nitrites, pyuria, bacteriuria

49
Q

Cystitis is associated with _ serum WBCs and pyelonephritis is associated with _ serum WBCs

A

Cystitis is associated with normal serum WBCs and pyelonephritis is associated with elevated serum WBCs

50
Q

A bacterial ascension from the urethra to the kidney is known as _

A

A bacterial ascension from the urethra to the kidney is known as pyelonephritis
* Involves an interstitital neutrophil infiltration

51
Q

Acute pyelonephritis will commonly present with _ sx

A

Acute pyelonephritis will commonly present with CVA tenderness, dysuria, flank pain, fever
* We see systemic sx unlike in cystitis

52
Q

A complication of pyelonephritis is _ necrosis

A

A complication of pyelonephritis is renal papillary necrosis

53
Q

Pyelonephritis will present with the same signs as a UTI on a urinalysis; however _ and _ may also be present

A

Pyelonephritis will present with the same signs as a UTI on a urinalysis; however WBC casts and hematuria may also be present

54
Q

_ is the most common antibiotic used for simple UTI; _ is the antibiotic of choice for pyelonephritis

A

TMP-SMX is the most common antibiotic used for simple UTI; ciprofloxacin is the antibiotic of choice for pyelonephritis

55
Q

Recurrent pyelonephritis can be caused by _ subtype

A

Recurrent pyelonephritis can be caused by xanthogranulomatous pyelonephritis
* Typically unilateral

56
Q

Risk factors of chronic pyelonephritis include _ and _

A

Risk factors of chronic pyelonephritis include vesiculourethral reflux and chronic obstruction (kidney stones)

57
Q

CT scan of chronic pyelonephritis will show _

A

CT scan of chronic pyelonephritis will show corticomedullary scarring and blunted calyces

58
Q

Xanthogranulomatous pyelonephritis (chronic) is diagnosed by _ sign on CT scan

A

Xanthogranulomatous pyelonephritis (chronic) is diagnosed by bear paw sign on CT scan

59
Q

Chronic pyelonephritis will show _ on light microscopy

A

Chronic pyelonephritis will show thryoidization on light microscopy
* Renal tubules containing eosinophilic proteinaceous material

Nephrology (16 decks)

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