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ABIM > Nephro-UA and Hematuria > Flashcards

Nephro-UA and Hematuria Flashcards

1
Q

What are acanthocytes?

A

Acanthocytes or erythrocytes of different sizes and shapes, particularly with vesicle shaped protrusions

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2
Q

What do acanthocytes suggest about the pathology?

A

Glomerulonephritis, especially with RBC casts

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3
Q

What do leukocyte casts suggest?

A

Pyelo or another nephritis

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4
Q

Eosinophils in the urine?

A 
Allergic reaction
atheroembolic disease
rapidly progress glomerulonephritis
small vessel vasculitis
parasite infection
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5
Q

Muddy brown casts?

A

ATN

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6
Q

Urine crystals: Morphology/shape? Associated conditions?

CALCIUM OXALATE

A

shape: envelope, dumbbell, needle

associated conditions: hypercalciuria, calcium oxalate stones, ethylene glycol poisoning

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7
Q

Urine crystals: Morphology/shape? Associated conditions?

CALCIUM PHOSPHATE

A

Shape/morph: prism, needle, star-like clumps

Associated conditions: Distal renal tubular acidosis, tumor lysis syndrome

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8
Q

Urine crystals: Morphology/shape? Associated conditions?

URIC ACID

A

Rhomboid; needle; rosette

Associated conditions: diabetes mellitus, obesity, gout, hyperuricemia, tumor lysis syndrome, urine pH<6

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9
Q

Urine crystals: Morphology/shape? Associated conditions?

MAGNESIUM AMMONIUM (struvite)

A

Coffin-lid

chronic UTI with urease producing organisms

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10
Q

Urine crystals: Morphology/shape? Associated conditions?

CYSTINE

A

Hexagonal

Associated conditions: Cystinuria

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11
Q

What pathology is suggested by isomorphic erythrocytes?

A

tumor, stone, infection

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12
Q

What are life-threatening and clinically urgent causes of hematuria?

A

Rapidly progressive glomerulonephritis, urinary tract malignancy

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13
Q

How should asymptomatic microhematuria be evaluated?

A

CT urography, except in patients with chronic kidney disease, pregnant patients, or patients allergic to contrast

Cystoscopy should be performed in patients over 35 years old or those with risk factors for a urologic malignancy

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14
Q

What is glomerular hematuria and what does it suggest?

A

Glomerular hematuria shows brown or tea colored urine with dysmorphic erythrocytes (or acanthocytes) and or erythrocyte casts on urine sediment exam. May suggest a vasculitis

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15
Q

In asymptomatic patients, should a UA be used to screen for bladder cancer?

A

No

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16
Q

Page 8, review the clinical evaluation of hematuria. What is the first step for evaluating hematuria

A

Retest to confirm the hematuria

17
Q

What are causes of transient hematuria

A

exercise, trauma, menstruation

18
Q

What is the evidence for glomerular hematuria?

A

Acanthocytes or erythrocyte casts, reduced kidney function, evidence of systemic illness (fever, rash, joint pain), proteinuria >+1

19
Q

What is the evidence for nonglomerular hematuria?

A

isomorphic erythrocytes, passage of pure blood clots

20
Q

If nonglomerular hematuria is expected, what do you test for first?

A

A UTI

21
Q

If someone has glomerular bleeding what do you do?

A

Nephro evaluation and possible kidney biopsy, kidney ultrasound

22
Q

If you have nonglomerular bleeding and a UTI has been ruled out.. then what?

A

1-you assess risk factors for malignancy

  • no risk: follow-up evaluation and repeat UA
  • low risk: upper tract imaging==US vs helical CT followed by cytology or cystoscopy depending on how aggressive you want to be
  • high risk: perform complete evaluation with upper tract imaging, cytology, cystoscopy
23
Q

What is usually the first imaging test of choice for evaluation of kidneys?

A

US

It is cheap, safe and gives info

24
Q

When should a kidney biopsy be considered?

A

When a patient has glomerular hematuria, severely increased albuminuria, acute or chronic CKD of unclear cause, and kidney transplant dysfunction monitoring

ABIM (58 decks)

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