Lecture Renal/GI (Quiz 4)

Question 1

What are the 4 symptoms of Urinary Obstruction?

Answer 1

• Anuria
• Polyuria
• Bladder distention
• Sometimes asymptomatic

Question 2

What are the 4 symptoms of Renal/Ureter Stones?

Answer 2

• Renal colic
• Hematuria
• Pyelonephritis
• Sometimes asymptomatic

Question 3

What is inflammation of the kidney due to a bacterial infection and may include Flank pain, Fever, 10-20% chronic renal failure, and Kidney scarring? What three things cause this?

Answer 3

• Pyelonephritis
• Retrograde spread from cystitis
  Common with urinary obstruction (stenosis)
  Diabetes.

Question 4

What is 80-90% of renal malignancies, More common in males >40 yrs, and smokers, and have an increased occurrence in Analgesic users (NSAIDS) and individuals with Obesity? What are the usual 5 symptoms? Where does it metastasize most often?

Answer 4

• Renal cell carcinoma
• Often asymptomatic, Hematuria, Dull flank pain, Fever and Fatigue.
• Lungs and Bones

Question 5

What is the most common congenital Renal tumor? When is it most common?

Answer 5

• Wilm’s Tumor (Nephroblastoma)

- Most common in the first 3 years of life.

Question 6

What is caused by Stones, Catheters, Short female urethras and Obstructions?

Answer 6

• Bacterial cystitis

Question 7

What is Most often in males >50 years old, Associated with smoking, carcinogens (e.g., dyes, paint etc.) and is the Most common Urothelial (bladder) Malignancy?

Answer 7

• Urothelial carcinomas

Question 8

What is Often caused by bacteria such as cystitis, Causes enlarged and tender prostate can cause obstruction and Most common in older men?

Answer 8

• Prostatitis

Question 9

What is Very common in older men; 95% > 75 years old, Serious Sequelae less common, the Cause is not well known; perhaps has to do with Androgens or even Estrogens, Urinary obstruction is common and 10% require surgery to relieve?

Answer 9

• Benign Prostatic Hyperplasia

Question 10

What is the is most common malignancy (except for skin cancers) in older men? How are most detected? For this a PSA (Prostate Specific Antigen) test is done. What is an abnormal amount? What 2 things in a PSA test means a higher risk for cancer?

Answer 10

• Prostatic adenocarcinoma (60% of men >80 years old)
• Rectal Exams
• > 4-6 mg/ml is abnormal
• Rapid increase in PSA amount and an increased amount of PSA bound to Alpha-1-Antichymotrypsin.

Question 11

____ million American adults have chronic kidney (renal) disease.____ million of these are on dialysis?

Answer 11

• 26 million

- 1/2 million

Question 12

What has Platelet dysfunctions (bleeding), Gingival hyperplasia, Bone abnormalities (slow bone healing after oral surgery), Premature bone loss (osteoporosis) and Infectious complications (due to immunosuppression)?
What are the three main causes of Chronic Renal Disease?
What is the most common Primary Glomerulonephritis? What are 4 common symptoms of Chronic Renal Disease?

Answer 12

• Chronic Renal Disease
• Diabetes, Hypertension, and Chronic Glomerulonephritis.
• IgA Nephropathy that is triggered by a viral infection.
• Heavy proteinuria (excessive protein in urine indicates renal cell death), Hematuria, Inflammatory injury to kidneys (e.g., immune deposits in glomeruli block normal blood filtration and reabsorption), and Glomeruli scarring and damaged functioning-could be sclerotic types.

Question 13

What is treatment for small Kidney stones (smaller than 1 cm)? Large stones? What are the three medications used for these?

Answer 13

• Small Kidney Stone Treatment: Drink considerable water, Dietary changes, OTC analgesics (ibuprofen, Naprosyn), and Tamusolin drug (Flomax)—relaxes ureter muscle (often have spasm due to irritation of the stone).
• Large Kidney Stone Treatment: Lithotripsy (shock wave treatment)-break up stones, Surgical removal, and Opioid analgesics for pain.
• Medications:
  a. Hydrochlorothiazide: Reduces calcium in urine
  b. Sodium bicarbonate: ALKALINIZE urine
  c. Allopurinol: Reduces uric acid excretion—also used for gout

Question 14

What are the 4 major types of Kidney stones?

Answer 14

a. Calcium/oxylate excess in urine (~80% of stones)
b. Struvite (~10% of stones): Magnesium ammonium phosphate crystals-often associated with urinary infections-only type where treatment is to Acidify urine.
c. Uric acid-often associated with gout
d. Cysteine

Question 15

Urinary Tract Infections (UTIs) include what two entities? What bacteria causes this? What 3 medications are used to treat UTIs?

Answer 15

• Cystitis and Urethritis
• E. Coli
• Medications:
  • Trimethoprim-sulfamethoxazole
  • Amoxicillin + clavulanic acid (resistant bacteria a problem)
  • Ciprofloxacin (expensive)

Question 16

What are the 4 drugs to treat Hemodialysis (Kidney dialysis)? What are the dental concerns associated with Hemodialysis?

Answer 16

• Medications:
  • Atenolol and/or Captopril: Hypertension
  • Heparin: Prevent clotting in blood passed through dialysis machine.
  • Furosemide: Potent diuretic-reduces fluid retention and the amount of fluid that needs to be removed by the dialysis.
  • Prophylactic Antibiotics: Have a high rate of infection in these patients.
• Dental Concerns:
  • Higher incidence of periodontal disease, more likely to have oral infections due to weakened immune system
  • Prophylactic antibiotics prior to surgical dental procedures.

Question 17

When treating a kidney stone the majority of the stones are cleared by making the urine more Alkaline (basic), which one is the exception?

Answer 17

• Struvite: Acidify urine to clear.