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Professional Development > Part 31 > Flashcards

Part 31 Flashcards

1
Q

Presence of an initial kidney stone attack after age ___ is very rare

A

50

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2
Q

Up to 1 in ___ people will be affected by a kidney stone in their lifetime

A

11

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3
Q

All kidney stones are more common in men except for ____

A

struvite stones

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4
Q

Risk factors for nephrolithiasis (6)

A
  • DM
  • PKD
  • dehydration
  • cystinuria
  • hyperparathyroidism
  • drugs
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5
Q

Recurrence rate for a kidney stone is __%

A

52

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6
Q

4 types of kidney stones and a unique fact about each

A

1) calcium oxolate (most common)
2) struvite (more common in women and causes staghorn calculi)
3) uric acid (seen in gout)
4) cystine (related to cystinuria, autosomal recessive disease)

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7
Q

Staghorn calculi definition

A

Upper urinary tract stones that involve the renal pelvis and extend into at least 2 calyces, most often struvite type and seen in females

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8
Q

What is the most common metabolic abnormality seen in formation of calcium oxylate kidney stones? How does low diet calcium cause increased stone formation?

A

Hypercalciuria

A lack of Ca2+ in diet to bind oxalate and neutralize it means that it is absorbed into the blood stream and urine increasing new stone formation

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9
Q

Clinical presentation of nephrolithiasis

A

Sudden onset of severe pain that starts in flank and moves inferior and anterior, often with associated nausea, vomiting, occasionally fever and chills if coexisting infections, and restlessness

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10
Q

Even large calculi can be ___ in patients until they are triggered to begin moving

A

asymptomatic

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11
Q

Pain from nephrolithiasis may suddenly stop for a period when…

A

….the stone reaches the bladder

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12
Q

Stranguria definition

A

Painful frequent urination of small volumes with associated urgency, urine expelled slow drop by drop with straining and patient is left with incomplete sense of emptying

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13
Q

Gold standard diagnostic choice for nephrolithiasis, what about children or pregnant patients?

A

Non contrast CT of abdomen and pelvis, in children or pregnant patients recommended to use renal ultrasound

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14
Q

supportive care for nephrolithiasis (2)

A
  • IV hydration
  • pain relief (acetaminophen)
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15
Q

Expulsive therapy for nephrolithiasis (1)

A

-alpha blockers

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16
Q

Indications for interventional therapy for nephrolithiasis (5)

A
  • solitary kidney
  • failure to respond to conservative management
  • stones >10mm
  • UTI or sepsis
  • struvite stones
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17
Q

Ureteroscopy for management of nephrolithiasis

A

-Can visualize and and dilate ureter, sometimes by placing stent

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18
Q

Extracorporal shockwave lithotripsy definition

A

Use of shockwaves to break up the kidney stone and allow it to pass in smaller pieces

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19
Q

Percutaneous nephrolithotomy indications (2)

A
  • in stones greater than 2 cm
  • in staghorn calculi
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20
Q

Alkalining agents can help dissolve these 2 types of stones

A
  • uric acid
  • cystine
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21
Q

Primary age group to see kidney stones

A

35-45

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22
Q

Acute Kidney injury is characterized by its ___

A

fast onset (days to weeks)

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23
Q

Metabolic acidosis is brought on when the kidney is no longer doing what?

A

Excreting H+ ions and reabsorbing HCO3-

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24
Q

2 values that confirm AKI

A
  • increase in creatinine level
  • decrease in urine output
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25
Q

1 risk factor for developing AKI is having…

A

Chronic kidney disease

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26
Q

Mortality rate for severe AKI is up to ___%

A

60

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27
Q

If AKI requires dialysis, there is a ___ risk of progression to CKD stage IV or V

A

Increased

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28
Q

When treating AKI, important to avoid ____agents such as NSAIDS, aminoglycosides, ACE inhibitors/ARB’s, and cyclosporines

A

Nephrotoxic

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29
Q

1 cause of prerenal AKI

A

Decreased renal perfusion

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30
Q

1 cause of post renal AKI

A

Obstruction

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31
Q

Prognosis of prerenal AKI

A

Good, typically does not cause permanent damage if treated

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32
Q

Most common acute tubular necroses are in ____ patients

A

Hospitalized

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33
Q

Acute Interstitial nephritis treatment (1)

A

-Corticosteroids

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34
Q

Some common causes of Intrinsic AKI (4)

A
  • glomerulonephritis
  • acute tubular necrosis
  • acute interstitial nephritis
  • renal artery stenosis
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35
Q

Common physical exam findings of AKI (5)

A
  • edema
  • confusion
  • asterixis
  • coke colored urine
  • cva tenderness
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36
Q

In assessing AKI you want to determine if it is prerenal or intrinsic renal, how can you do this?

A

FENa test <1% indicates prerenal cause and >2% indicates intrinsic renal cause

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37
Q

Any patient having kidney issues needs to be on a ___ and ____restricted diet

A

protein, sodium

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38
Q

Protective IV therapy against hyperkalemia for heart arrhythmia

A

Calcium gluconate

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39
Q

Treatment for hyperkalemia to increase cellular uptake of potassium is…

A

….insulin with glucosee IV

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40
Q

IV sodium bicarbonate can be used to treat….

A

….metabolic acidosis

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41
Q

Indications that AKI warrants dialysis (3)

A
  • metabolic acidosis
  • hyperkalemia
  • signs of uremia such as asterixis and mental decline
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42
Q

1 cause of acute tubular necrosis is….

A

…renal hypoperfusion

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43
Q

3 big hormones of the kidney

A
  • calcitriol
  • erythropoietin
  • renin
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44
Q

Chronic renal failure definition

A

Process of significant irreversible reduction in number of functioning nephrons characterized by at least 3 months of reduced GFR

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45
Q

2 most common causes of chronic renal failure

A
  • hypertension
  • uncontrolled diabetes
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46
Q

2 elements needed to diagnose chronic renal failure

A
  • Albuminuria
  • GFR
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47
Q

Chronic kidney failure in stage G1-G3B are usually ____

A

asymptomatic

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48
Q

Chronic renal failure involves every organ system, including 2 endocrine ones…

A

…osteoperososis due to calcitriol lack and anemia due to erythropoietin

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49
Q

Uremic scratching is a finding seen in ___ and define it

A

Chronic kidney failure, hyper phosphatemia causing itching and scratching on excoriated skin

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50
Q

Treatment for chronic kidney failure includes these 4 classes of meds

A
  • ACE or ARB’s
  • diuretics
  • Ereythropoietin stimulating agent
  • iron supplements
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51
Q

Nongenetic causes of renal cyst formation (1)

A

-Acquired with end stage renal disease after several years of dialysis typically

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52
Q

Genetic causes of renal cyst formation (5)

A
  • Autosomal dominant PKD
  • Medullary sponge kidney
  • autosomal recessive PKD
  • Nephronophithisis
  • Medullary cystic kidney disease
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53
Q

Mechanism of polycystic kidney disease

A

-malformation of proteins important to the structure of the primary cilium (polycystin 1 and 2)

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54
Q

3 criteria for a simple kidney cyst to be evaluated on ultrasonography that if present allow it to be differentiated from a carcinoma or abscess

A
  • mass is round and sharply demarcated with smooth walls
  • no echoes in mass
  • good transmission of cyst and enhanced transmission byond the cyst (fluid filled)
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55
Q

Imaging study of choice for renal cyst if ultrasonography proves inconclusive and one good alternative

A

CT scan
MRI

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56
Q

Bosniak classification of renal cysts

A 
1 - not malignant
2 - not malignant
2F
3 - 50/50
4 - always malignant
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57
Q

Most common renal masses that typically produce no signs or symptoms

A

Simple renal cysts

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58
Q

Risks associated with simple cysts (3)

A
  • infection
  • hypertension
  • hemorrhage
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59
Q

A negative side effect in 50% of patients on dialysis for >3 years is development of…

A

PKD

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60
Q

Acquired PKD clinicla features (3)

A
  • flank pain
  • hematuria
  • predispsoal to nephrolithiasis
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61
Q

Autosomal dominant PKD characteristics (4)

A
  • most common
  • ultimately fatal
  • no specific therapy
  • cysts often show up in other areas as well
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62
Q

Autosomal dominant PKD affected genes, what chromosomes do they occupy?

A

-PKD1 (faster progressoin) and 2 (less common and slower), 16 and 4 respectively

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63
Q

Those with audosomal dominant PKD most often die of what cause?

A

-cardiac diseases

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64
Q

Diagnosis of a renal cyst below the age of 18 is strongly suggestive of…

A

…Autosomal dominant PKD

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65
Q

Test of choice to detect autosomal dominant PKD

A

Ultrasound

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66
Q

Absence of cysts on ultrasound cannot exclude possibility of subsequent expression of ____phenotype

A

Autosomal dominant PKD

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67
Q

2 major goals of treatment of Autosomal dominant PKD

A

-control diabetes
- control hypertension

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68
Q

Autosomal dominant PKD prognosis

A

-Variable and hard to predict, about 50% reach age 73 without being at end stage renal failure

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69
Q

Autosomal recessive pkd presents at ____

A

infancy

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70
Q

Complications of infants with autosomal recessive PKD (3, which one kills?)

A
  • portal hypertension
  • pulmonary hypoplasia (death)
  • hepatomegaly
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71
Q

___% of children with autosomal recessive pkd progress to end stage renal disease in the first decade of life

A

50

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72
Q

Autosomal recessive pkd treatment and prognsosi

A
  • none, sometimes transplant
  • 15 year survival rate about 67%
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73
Q

Medullary sponge kidney is malformation of the ___ and ____ opposed to in pkd where the ____ is affected

A

collecting ducts, renal pyramids. cortex

74
Q

Medullary sponge kidney diagnostic study

A

Intravenous pyelogram

75
Q

Medullary sponge kidney treatment and prognosis

A
  • preventing recurrent infections and stones
  • very good, rarely leads to end stage renal disaese
76
Q

Nephronophthisis definition

A

A disease characterized by fibrosis impairing kidney function in younger patients often times stunting growth and resulting in fluid filled cysts in the cortocomedullary region of kidneys

77
Q

Most common genetic cause of ESRD in children and young adults is…

A

….Nephronophthisis

78
Q

Medullary cystic kidney disease definition and 3 symptoms

A

A disease characterized by fibrosis impairing function of kidneys in adult age patients that ultimately leads to kidney failure, often times lacks cyst development but has skin darkening, hiccups, and nocturia

79
Q

Medullary cystic kidney disease specific gravity will be….

A

….very low

80
Q

Medullary cystic kidney disease treaetment

A

no cure, control symptoms

81
Q

Stage V chronic renal disease is also known as…

A

…end stage renal disease

82
Q

Uremia definition

A

Raised level of urea in the blood stream that can eventually reach toxic levels in the blood causing different effects to different organs (pericarditis, encephalopathy, pleural effusion)

83
Q

2 leading pathologies that cause end stage renal disease

A

Diabetes
Hypertension

84
Q

Stage V chronic renal disease has a GFR of below…

85
Q

End stage renal disease prognosis without treatment, with dialysis, and with transplant

A
  • Mortality rate of 25% a year
  • 10 years with dialysis
  • up to 21 years after transplant close to normal life expectancy
86
Q

What causes death in end stage renal disease

A

Cardiac arrhythmia due to hyperkalemia

87
Q

Symptoms of end stage renal disease (4)

A
  • decreased urine output
  • generalized pruritus
  • pitting edema
  • skin pigmentation
88
Q

3 evaluations almost universal in patients with end stage renal disease

A
  • elevated BUN
  • elevated creatinine
  • normocytic normochromatic anemia
89
Q

Treatment for anemia of end stage renal disease

A
  • Erythropoietin replacement
  • iron replacement as necessary
90
Q

Acute vs chronic Hemodialysis

A

Can be acute in the case of acute kidney injury for a short period of time or chronic therapy

91
Q

Benefits of renal transplant

A

Liberated from fluid restrictions, free to travel and work, can achieve correction of metabolic abnormalities and anemia with restoration of normal renal function

92
Q

Absolute contraindicatioin to hemodialysis

A

Hyperkalemia refractory to conservative measures such as diuretics or dietary restriction

93
Q

Clearance and ultrafiltration in hemodialysis

A

Clearance is elimination of solute from blood via diffusion (moving from high conc. to low)

Ultrafiltration is removal of excess liquid while retaining particles useful to the body

94
Q

Dialysate definition

A

Fluid used to remove or deliver compounds that a failing kidney cannot secret or retain in proper concentration, contains balanced solution of sodium, potassium, calcium, etc.

95
Q

Hemodialysis can treat the ___ function of the kidney but not the ___ function

A

filtering, endocrine

96
Q

Dialysis washout syndrome

A

Hypotension, cramps, nausea, etc from rapid loss of plasma solute conc during filtration from hemodialysis

97
Q

2 compartments of a dialysis machine and what separates them?

A
  • Blood compartment
  • dialysate compartment
  • Hemodialysis filte
98
Q

Heparin’s role in hemodialysis

A

A heparin pump is required to keep the blood moving so patients on hemodialysis are consistently exposed to blood thinners

99
Q

AV fistula definition

A

The gold standard or best means of vascular access for hemodialysis, often formed from sowing the cephalic vein and radial artery to allow for high blood flow rate in the vein while maintaining easy puncture access

100
Q

AV graft definition

A

An alternative means of hemodialysis access chosen for those with poor vasculature, involves insertion of a graft tube between arterial and venous circulation, not preferred due to increased risk of infection and thrombosis compared to AV fistula

101
Q

Tunnel catheter/permacath definition

A

A tunnel catheter thru the internal jugular to the vena cava used for chronic hemodialysis sessions but not preferred due to high rate of infection and clotting

102
Q

Home hemodialysis definition

A

A growing popular alternative to dialysis centers where a trained caregiver can give dialysis and gain access to av fistula or graft and run machine

103
Q

Peritoneal dialysis

A

A form of dialysis that uses the peritoneal membrane as a filter following injection of 2-3 L of dialysate to be filled and drained periodically opposed to the machine to deliver continuous dialysis

104
Q

Benefits of peritoneal dialysis (5)

A
  • no need for vascular access
  • no anticoagulants involved
  • slow continuous process avoiding hemodynamic shifts
  • greater independence as patients can self amdinister
  • less need to restrict salt, protein and fluid in diet
105
Q

Complications of peritoneal dialysis

A

-Infection in peritoneal cavity or at site of catheter

106
Q

Peritoneal dialysis dialysate solution contains…

A

…electrolytes in physiologic concentrations and varying amounts of glucose to promote osmotic pressure

107
Q

Contraindications for peritoneal dialysis

A
  • large body
  • elderly
  • severe lung disease
  • abdominal surgery
108
Q

Peritoneal dialysis allows for preservation of….

A

…vasculature in case of needing to shift to hemodialysis in future

109
Q

In the case of congestive heart failure what type of dialysis should a patient undergo?

A

Peritoneal because it prevents fluid buildup between sessions

110
Q

In case of coagulopathy what type of dialysis should a patient undergo?

A

Peritoneal because it doesn’t involve anticoagulants

111
Q

Peritoneal dialysis sees decreased function after…

A

…10 years

112
Q

Prior to beginning dialysis a patient must follow a ____ diet that is ___ protein, potassium sodium and fluids

A

renal, low

113
Q

During dialysis a patient must follow a ___ diet involving ___ protein and ___ potassium and sodium, as well as daily supplements of….

A

dialysis, high, low, B complex vitamins

114
Q

Cyclosporine, a ___ class of drug has been used extensivley to improve success rate of ____

A

immunosupprssant, renal transplant

115
Q

Average wait for a kidney transplant

116
Q

Extra points are given to ___ awaiting a renal transplant, etiology or severity of disease are ____

A

children, not considered

117
Q

Kidney recipient contraindications (3)

A

very few including

  • active or recent malignancy
  • active infection
  • active substance abuse
118
Q

Kidney donation complications

A

-very few issues and almost no death, complications might include hemothorax or pneumothorax

119
Q

Kidney replacement procedure

A
  • recipients kidneys are not removed (to preserve any endocrine or filtration function left)
  • new kidney placed in iliac fossa
  • renal artery/vein of donated kidney is connected to external iliac artery/vein of recipient
  • donated ureter attached to recipient bladder
120
Q

Due to close proximity to the vasculature, cancer of the kidney…

A

…metastasizes quickly

121
Q

Gross or microscopic hematuria is….

A

…cancer until proven otherwise, it occurs in up to 85% of bladder cancers and 40% of renal cancers

122
Q

(T/F) color does not reflect amount of blood in urine specimen

123
Q

Microscopic hematuria marker under sediment microscopic evaluation

A

> 3 indicates hematuria

124
Q

Hematuria occuring primarily at the beginning of urination is usually from…

A

…urethra

125
Q

Blood that is noticed as dicharge between voiding or as a stain on undergarments while voiding itself is clear indicates…

A

….origin of blood at urethral meatus or anterior urethra

126
Q

Hematuria appearing toward the end of voiding is usually from…

A

….bladder neck of prostatic urethra

127
Q

Hematuria occuring throughout voiding can originate from…

A

…anywhere in the urinary tract

128
Q

Imaging study of choice in adults to detect urological cancer

129
Q

Imaging study of choice in children and pregnant women to detect urologicl cancer

A

Ultrasonography

130
Q

Cystoscopy is performed in what situations to detect urological cancer?

A

-all patients older than 35 with asymptomatic hematuria or suspicion of cancer

131
Q

Cytology is performed in what situations to detect urological cancer?

A

-all patients with asymptomatic hematuria or suspicion of cancer because a cystoscope can only reach the bladder to visualize cancer

132
Q

1 Risk factor for urological malignancy

A

smoking history

133
Q

Loin pain hematuria syndrome definition

A

Idiopathic hematuria that occurs with flank pain despite absence of discernible cause

134
Q

Most common type of kidney cancer

A

Renal cell carcinoma

135
Q

Renal cell carcinoma prognosis

A

Doubled 5 year survival rate caus eof higher detection

136
Q

Renal cell carcinoma definition and 6 subtypes

A

Cancer that originates in the renal cortex and is very common, includes clear cell carcinoma, papillary carcinoma, chromophobe, oncocytic, collecting duct, and translocation

137
Q

Renal cell carcinoma treatment

A

Resection of tumor to analyze via biopsy

138
Q

Clear cell carcinoma definition

A

A benign highly vascular subtype of renal cell carcinoma predominantly found, associated with von hippel lindau disease

139
Q

Papillary carcinoma definition

A

A subtype of renal cell carcinoma that originates in the proximal tubule and is associated with painful cutaneous leiomyomas

140
Q

Chromophobe carcinoma definitiion

A

A subtype of renal cell carcinoma that is uncommon and slower progressing that originates in collecting duct

141
Q

Oncocytomas definition

A

A subtype of renal cell carcinoma that is slow growing and typically benign

142
Q

Collecting duct tumor (bellini’s duct) definition

A

A subtype of renal cell carcinoma that is rare and aggressive and has poor prognosis

143
Q

Triad for renal cell carcinoma in 9% of patients

A
  • flank pain
  • hematuria
  • palpable abdominal renal mass
144
Q

Most common sites for renal cell carcinoma metastasis(5)

A

-lung
-lymph nodes
-bone
brain
-liver

145
Q

If renal cancer has metastasized to the bone might see measurable increase in blood ___ levels

146
Q

1st order for patient with suspected renal cell carcinoma

A

CT of abdomen

147
Q

TNM classification of tumors

A
  • T is tumor size and how far its invaded past fascia (0-4)
  • N is nodes checking for regional metastasis (0-1)
  • M is for metastasis either close or distant (0-1)
148
Q

Renal cell carcinoma treatment

A

-surgery is only long term care available

149
Q

Wilm’s tumor definition

A

A childhood cancer that is the most common renal malignancy in children and causes palpable nontender abdominal mass to grow extensively, must be ultrasound and CT’d to stage it from there

150
Q

Wilm’s tumor staging

A

Stage I - tumor is limited to kidney with intact capsule
II
III
IV - hematogenous metastases present
V - bilateral renal involvement at time of initial diagnsois

151
Q

Wilm’s tumor prognosis

A

Very good, 85-100%

152
Q

Staging of bladder cancer

A
  • non muscle invasive
  • muscle invasive
  • metastatic
153
Q

Bladder cancer definition

A

Tumor arising in bladder, ureters, or urethra, 6th most common cancer in US

154
Q

Urothelial carcinoma

A

Common location of bladder cancer due to changing of cells in the ureters and bladder to transitional cells

155
Q

Bladder cancer 2 greatest predisposing factors

A
  • occupational
  • tobacco smoking
156
Q

Bladder cancer clinical presentation

A
  • painless hematuria
  • decrease in voiding capacity, straining, or feeling of incomplete voiding
157
Q

gold standard for initial diagnosis and staging of bladder cancer

A

Cystoscopy followed by urine cytology

158
Q

Transurethral resection of bladder tumor definition

A

Removal of all visible lesions to determine tumor depth and presence of invasion during cystoscopy to then confirm diagnosis and classify tumor

159
Q

Imaging study for bladder cancer

160
Q

Treatment for non muscle invasive bladder cancer

A

-Resection followed by BCG therapy 4-6 weeks post op

161
Q

Treatment for muscle invasive bladder cancer (2)

A
  • stoma formation
  • neobladder used from small piece of bowel
162
Q

3 things high osmolality iodinated IV constarast is associated with

A
  • hypervolemia
  • CHF exacerbation
  • Acute kidney injury
163
Q

A cystoscope uses ___ to distend the bladder, is inserted ___ and may contain instruments for ___ and ____

A

fluid, retrograde,biopsy, stone removal

164
Q

Best imaging study to demonstrate a renal calculus

A

Helical CT scan

165
Q

An intravenous pyelogram would be least effective for imaging….

A

…urethral stricture due to BPH

166
Q

A ureteroscope is beneficial to visualize…

A

….a constricture in the ureter

167
Q

An older male can be more difficult to perform cystoscopy on because of…

A

BPH curvature

168
Q

Hydronephrosis

A

Fluid distension of the kidney due to backing up of ureter blockage causing swelling

169
Q

IV radiographic contrast media used for IVP and CT scans

A

Iodinated derivatives utilized for opacification of the urinary tract by blocking x rays, injected via IV and filtered out thru kidneys, excreted by glomerular filtration and concentrated in urinary system

170
Q

High vs low osmolality contrast media (who is at risk?)

A

High osmolality contrast media causes fluid shifts in the body into the vasculature from the periphery (hypervolemia) putting certain patients at risk
Low osmolality is less concentrated and is more expensive but good for those with risk factors

171
Q

Contrast related renal dysfunction definition, what specific drug should you avoid giving a patient with this

A

-Iatrogenic acute renal insufficiency that causes AKI in hospitalized patients with underlying disease causing an increase in creatinine

Metformin because it can build up in blood

172
Q

Abdominal series plain films (3)

A
  • Chest xray in case of referred pain from chest
  • Flat plate (supine KUB)
  • Upright film KUB
173
Q

CT scan definition and how to orient

A

Multiple plain films that form a computer cross section of 2D view thru the body, viewed as if from feet looking up to head where patients left side is on right side of image and patients right is on left side of image (bone is light and tissue is dark)

174
Q

MRI definition

A

A useful imaging study that does not involve radiation used to visualize soft tissue (tissue is light and bone is dark)

175
Q

Ultrasound definition

A

Painless, noninvasive, bedside, relatively inexpensive (bone appears white tissue appears dark)

176
Q

TRUS abbreviation

A

Transrectal ultrasound

177
Q

IVP procedure (4)

A
  • First take a scout film KUB
  • Inject IV contrast
  • 1st scout film shows bones, soft tissue, and kidney stone if present
  • 2nd film nephrogram phase shows contrast in renal parenchyma
  • 3rd film excretion film shows contrast in ureters and bladder, no voiding cystogram!!!
178
Q

Retrograde Pyelography definition

A

Opposite of IVP, does not use IV contrast but uses water contrast introduced directly into ureters using cystoscope followed by KUB of abdomen, can be used to image the lower urinary system or if allergic to iv contrast or having renal failure

179
Q

Radionuclide imaging of kidney definition

A

Place a small amount of radioactive tracer into body via IV, then kidneys filtering blood flow filter it out, image with a gamma camera to see how well kidney filterrs out the tracer

180
Q

Renal arteriogram/angiogram definition

A

X ray image of arteries of kidneys using catheter introduced to renal artery and ocntrast injected, x ray then used to visualize renal vasculature

181
Q

Acute tubular necrosis is a __renal disease

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