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Renal II Quiz II > Painless and Occult Hematuria > Flashcards

Painless and Occult Hematuria Flashcards

1
Q

Heavy exercise induces hematuria (+/- proteinuria) in ___________ of athletes. What type of athletes might you see this in?

A

50-80%

due to temporary decreases in RBF leading to nephron ischemia

occurs most commonly in:

  • Swimmers
  • Track athletes
  • Lacrosse players
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2
Q

What tests should always be performed with hematuria?

A
  • Microscopy
  • Culture w/ sensitivity
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3
Q

What are the effects of Ibuprofen on the kidney?

A

decrease in GFR

ibuprofen is more toxic to the kidneys then acetaminophen

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4
Q

What are the effects of indomethacin and celecoxib on the kidney?

A

decrease in free water clearance

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5
Q

How do NSAIDs contribute to kidney damage?

A

inhibition of cyclooxygenase within the kidney

Which results in a net effect of renal ischemia by activating the RAAS system and increases systemic vasoconstriction

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6
Q

Cyclooxygenase is the rate-limiting enzyme for prostaglandins. Prostaglandins have a protective effect on the kidney, what is this?

A

PGE2 and PGI2 protect kidney by modulating renal vasoconstriction

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7
Q

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

A

Up to 24 hours prior

several days after

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8
Q

UA dipsticks have up to a ________ false-positive rate

A

35%

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9
Q

Patient presents with UA symptoms and a very alkaline urine of pH > 9

A

Proteus infection

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10
Q

What is the lab definition of hematuria?

A

greater than 3 RBC/hpf (high powered field)

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11
Q

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?

A

Hemodynamically stable patients do not require radiographic evaluation

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12
Q

What is a concern of infants who are diagnosed with sickle cell trait (SCT, HbAS) but then are forgotten because babies healthy.

A

patients can develop renal papillary necrosis —> FSGN —> RCC (Renal Medullary Carcinoma)

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13
Q

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

A

Bladder cancer

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14
Q

What are the major risk factors for bladder cancer?

A
  1. Male
  2. >35 years old
  3. current or former tobacco use
  4. Analgesic abuse
  5. exposure to chemicals or dyes (benzenes or aromatic amines)
  6. Exposure to carcinogenic agents or chemotherapy (alkylating agents)
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15
Q

Once blood is identified in the urine microscopy plays a crucial role in ruling out false positives. What are the false positives?

A
  1. 35% of UA dipsticks give false-positives
  2. myoglobinuria (Rhabdo), hemoglobinuria
  3. high alkaline urine (pH > 9) - think Proteus
  4. Ascrobic Acid (vitamin C)
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16
Q

Are the pros and cons of US in abdominal exam

A

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
17
Q

What is CTU (Computed Tomography Urography) highly sensitive for?

A

renal liathiasis (calculi)

Also…:

  • small renal parenchymal masses
  • aneurysms
  • renal/perirenal abscesses

Two phases, with and w/o contrast

18
Q

Cystoscopy is highly effective for lower GU complaints. What are the benefits of this method?

A
  • Visualization of microstructural changes
  • Removal of stones
  • Cauterization of bleeds
  • Biopsy of tissue
19
Q

American Urological Association: all patients _______ w/ _______ ___________ should be evaluated with cystoscopy

A

> 35 y/o; asymptomatic microhematuria

20
Q

What types of injury make a patient more at risk for developing chronic Glomerulonephritis?

A
  1. Glomerular scarring
  2. Cortical tubular atrophy
  3. Interstitial inflammation
  4. Interstitial fibrosis
  5. Atherosclerosis
21
Q

Describe the vascular/hemodynamic and inflammatory effects of activation of the RAAS system

A

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
22
Q

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?

A

EKG: left ventricular hypertrophy —> enlarged heart

Bruits: Atherosclerosis

UA w/ microscopic evaluation:

  • check BUN, Cr, Na

24 hour urine:

  • albumin & microalbumin/Cr ratio
23
Q

How will a Glomerulonephritis patient present?

A
  • microscopic or gross hematuria
  • RBC casts or Dysmorphic RBCs
  • always some level of proteinuria
24
Q

How might renal ultrasound allow you to determine whether a patient has acute or chronic Glomerulonephritis?

A

renal ultrasound can be used to assess size of kidneys as these are generally reduced in chronic disease

25
Q

What is the mechanism of damage in hypertensive nephropathy?

A

RAAS activation —> hyperfiltraiton

26
Q

What gene accounts for an increased risk of hypertensive nephrosclerosis in young African Americans?

A

APOL1 (Apolipoprotein L1)

expressed in podocytes

27
Q

What is the key to controlling hypertensive glomerulopathy?

A

control of blood pressure (bring down HTN)

28
Q

In diabetic nephropathy of a patient with type 1 diabetes how would damage to glomerular, tubular, interstitial, and vascular lesions progress?

A

In parallel and independent of albuminuria

29
Q

In diabetic nephropathy of a patient with type 2 diabetes how would damage to glomerular, tubular, interstitial, and vascular lesions progress?

A

Variable in progression

can develop albuminuria w/ little change to the nephron

30
Q

For diabetic patients (type 1 & 2) how do they present clinically with diabetic nephropathy?

A

early - clinically stable

late - edema and HTN

damage is more related to the nephron than to the actual glomerulus itself

Renal II Quiz II (12 decks)

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