Painless and Occult Hematuria Flashcards
Heavy exercise induces hematuria (+/- proteinuria) in ___________ of athletes. What type of athletes might you see this in?
50-80%
due to temporary decreases in RBF leading to nephron ischemia
occurs most commonly in:
- Swimmers
- Track athletes
- Lacrosse players
What tests should always be performed with hematuria?
- Microscopy
- Culture w/ sensitivity
What are the effects of Ibuprofen on the kidney?
decrease in GFR
ibuprofen is more toxic to the kidneys then acetaminophen
What are the effects of indomethacin and celecoxib on the kidney?
decrease in free water clearance
How do NSAIDs contribute to kidney damage?
inhibition of cyclooxygenase within the kidney
Which results in a net effect of renal ischemia by activating the RAAS system and increases systemic vasoconstriction
Cyclooxygenase is the rate-limiting enzyme for prostaglandins. Prostaglandins have a protective effect on the kidney, what is this?
PGE2 and PGI2 protect kidney by modulating renal vasoconstriction
How many days before and after do you need to be aware that a menstruating patient will show blood in a UA around their period
Up to 24 hours prior
several days after
UA dipsticks have up to a ________ false-positive rate
35%
Patient presents with UA symptoms and a very alkaline urine of pH > 9
Proteus infection
What is the lab definition of hematuria?
greater than 3 RBC/hpf (high powered field)
A patient experiences a significant trauma and you consider whether imaging may be a good move to check on the status of the kidneys. What indicates to you whether or not imaging should be performed?
Hemodynamically stable patients do not require radiographic evaluation
What is a concern of infants who are diagnosed with sickle cell trait (SCT, HbAS) but then are forgotten because babies healthy.
patients can develop renal papillary necrosis —> FSGN —> RCC (Renal Medullary Carcinoma)
A 55-year-old male presents for refill of blood pressure medications. He reports that he walks 30 minutes, five times/week and is following a low fat diet (because his wife won’t fry anything). He is a former smoker having quit one year ago when he was diagnosed with HTN. A UA dipstick reveals 1+ blood.
At the tie of diagnosis of HTN, the urinalysis was negative for both blood and protein
Bladder cancer
What are the major risk factors for bladder cancer?
- Male
- >35 years old
- current or former tobacco use
- Analgesic abuse
- exposure to chemicals or dyes (benzenes or aromatic amines)
- Exposure to carcinogenic agents or chemotherapy (alkylating agents)
Once blood is identified in the urine microscopy plays a crucial role in ruling out false positives. What are the false positives?
- 35% of UA dipsticks give false-positives
- myoglobinuria (Rhabdo), hemoglobinuria
- high alkaline urine (pH > 9) - think Proteus
- Ascrobic Acid (vitamin C)
Are the pros and cons of US in abdominal exam
Pros
- low cost
- no radiation
- good for tumors > 3cm, cysts, and hydronephrosis
Cons, misses:
- Small stones
- bladder masses < 3 cm (this is big)
- urothelial transitional cell carcinoma
What is CTU (Computed Tomography Urography) highly sensitive for?
renal liathiasis (calculi)
Also…:
- small renal parenchymal masses
- aneurysms
- renal/perirenal abscesses
Two phases, with and w/o contrast
Cystoscopy is highly effective for lower GU complaints. What are the benefits of this method?
- Visualization of microstructural changes
- Removal of stones
- Cauterization of bleeds
- Biopsy of tissue
American Urological Association: all patients _______ w/ _______ ___________ should be evaluated with cystoscopy
> 35 y/o; asymptomatic microhematuria
What types of injury make a patient more at risk for developing chronic Glomerulonephritis?
- Glomerular scarring
- Cortical tubular atrophy
- Interstitial inflammation
- Interstitial fibrosis
- Atherosclerosis
Describe the vascular/hemodynamic and inflammatory effects of activation of the RAAS system
Vascular/hemodynamic:
- vasoconstriction of afferent/efferent arterioles (Also systemic)
- Increases glomerular pressure —> hyperfiltration —> inflicts direct glomerular damage
Inflammatory:
- RAAS system activates inflammatory system —> interstitial and tubular fibrosis
Smoker (must have quit > 6 mos)
Obese & HTN
sedentary job
high carb/high protein diet
2+ pitting edema to LE bilaterally
carotids have soft systolic bruits (bilaterally)
UA: 1+ blood, 1+ protein
What do you want to order on this patient?
EKG: left ventricular hypertrophy —> enlarged heart
Bruits: Atherosclerosis
UA w/ microscopic evaluation:
- check BUN, Cr, Na
24 hour urine:
- albumin & microalbumin/Cr ratio
How will a Glomerulonephritis patient present?
- microscopic or gross hematuria
- RBC casts or Dysmorphic RBCs
- always some level of proteinuria
How might renal ultrasound allow you to determine whether a patient has acute or chronic Glomerulonephritis?
renal ultrasound can be used to assess size of kidneys as these are generally reduced in chronic disease
