Nephrolithiasis, bladder cancer, renal cell carcinoma Flashcards
1
Q
What is Kidney stone Etiology?
A
- Stone formation occurs when normally soluble material (Ca, PO4, uric acid) supersaturates the urine and begins the process of crystal formation.
- It is not clear how crystals formed in the tubules become a stone, rather than being washed away by the high rate of urine flow.
- It is presumed that crystal aggregates become large enough to be anchored ( usually at the end of the collecting ducts), and then slowly increase in size over time.
2
Q
What are types of Nephrolithiasis?
A
-60-80% calcium stones (Ca oxalate > Ca phosphate) -15% struvite (magnesium ammonium phosphate) -5% uric acid (radiolucent stones) -1-3% cystine -The same patient may have more than one type of stone concurrently (e.g.. calcium and uric acid).
3
Q
What is the Epidemiology of Nephrolithiasis?
A
- Prevalence 2-3% in general population
- Estimated lifetime risk about 12% for men 5% for women
- Approximately 50% of patient with previous urinary calculi have recurrence within 10 years.
- The rate of urolithiasis increases with age, is higher in men compared to women, and caucasians compared to other races
- It has been estimated that 7-10 of every 1,000 hospital admission are due to stones.
4
Q
What are the Risk Factors of calcium stones?
A
- History of prior calcium urolithiasis
- Family history of urolithiasis
- Diet
- Medications
- Hyperparathyroidism
- Hypercalcemia of malignancy
- Sarcoidosis
- Medullary sponge kidney
5
Q
What are the Risk Factors of Nephrolithiasis?
A
- Uric acid lithiasis = radiolucent
- Struvite stones
- Cystine stones
6
Q
Clinical presentation of Nephrolithiasis?
A
- Renal colic begins suddenly
- Severe unilateral flank pain– radiating to groin/testicle/labia (T10-S4 dermatome)
- Pacing, Rocking, Writhing, Constant movement unable to find position of comfort (contrast to peritonitis)
- Frequently with nausea, vomiting, diaphoresis
- Tachycardia, Hypertension
- Gross hematuria and dysuria/frequency/urgency
- May have CVAT but abdomen is unremarkable
- Testicles are not tender or swollen
7
Q
What is the diagnosis of Ureteral colic?
A
-Focused history with RF assessment (family history of calculi, duration and evaluation of symptoms)
-Clinical presentation w/ Physical Exam
-Urinalysis
-CBC
-BMP
-Radiologic tests
(KUB, IVP, US, NCCT scan)
8
Q
What is an ultrasound?
A
- Sensitivity19%, specificity 97%
- Accessible
- Good for diagnosis of hydronephrosis and renal stones
- Poor visualization of ureteral stone unless at UPJ or UVJ
- Detects indirect signs of obstruction: collecting system dilatation (hydroureter), a loss of a ureteric jet
- Difficulty in measuring the size of a stone
- Procedure of choice for patients who should avoid radiation, including children, pregnant women and woman in childbearing age.
9
Q
What is KUB?
A
- Sensitivity 45-59% Specificity 71-77%
- Accessible and inexpensive.
- May be sufficient to document the size and location of radiopaque (59%) urinary calculi ( Ca oxalate, Ca phosphate), but radiolucent stones such as pure Uric acid, pure Cystine, Indinavir, pure matrix
- Unfortunately stones are frequently obscured by stool or bowel gas, ureteral stones overlying the bony pelvis or transverse processes of vertebrae .
- Furthermore, non-urologic radio-opacities, such as calcified mesenteric lymph nodes, gallstones, stool and phleboliths may be misinterpreted as stones.
10
Q
What is Ivp study?
A
- Sensitivity 64-87% Specificity 92-94%
- Relatively safe despite the need for contrast (If CT is unavailable)
- Provides information about the stone (size, location, radiodensity) and degree of obstruction.
- Serum Cr must be measured before the test
- Nephrotoxic effect is minimized by adequate hydration, minimum amount of contrast material used.
- Poor visualization of non-genitourinary structures
11
Q
What is Noncontrast helical ct?
A
- Fast, accurate, and readily identifies all stone types in all location (pure matrix stones and Indinavir stones not seen)
- Sensitivity 95-100% , Specificity 94-96%
- Expensive
- CT should not be used as a first line test with pregnant/child/suspicion of gynecologic etiology
- Findings consistent with calculi on CT
12
Q
What is >5mm management?
A
- Open nephrostomy
- Percutaneous nephrostolithotomy
- Ureteroscopy
- Extracorporeal shock wave lithotripsy
13
Q
What is Staghorn calculi?
A
Upper urinary tract stones involve the renal pelvis and extend into at least 2 calyces
14
Q
What is the Work up for recurrent stones?
A
- calcium stones
- Uric acid
- Cystine
- Struvite
15
Q
What is the Pathology of Bladder cancer?
A
Transitional cell carcinoma
