Path 4 Obstructive Renal Disease & Nephrolithiasis

Question 1

Sudden complete obstruction

Answer 1

Mild dilation of pelvis and calyces and atrophy

Question 2

Intermittent obstruction

Answer 2

Progressive dilation because glomerular filtration not suppressed

Question 3

Obstruction labs

Answer 3

• Increased urea and creatinine
• Hyponatremia
• Hyperchloremic metabolic acidosis

Question 4

Obstruction urinalysis

Answer 4

-Elevated pH due to nephron destruction

Question 5

Urolithiasis predisposing factors (3)

Answer 5

• Gout
• Cystinuria
• Hyperoxaluria

Question 6

Calcium oxalate stone etiology (4)

Answer 6

• Hyperparathyroidism
• Diffuse bone disease
• Sarcoidosis
• Vit D toxicity

Question 7

Calcium oxalate stone mechanism

Answer 7

Nucleation by uric acid crystals

Question 8

Magnesium ammonium phosphate (struvite) stone etiology (2)

Answer 8

• Proteus infection

- Staph infeciton

Question 9

Magnesium ammonium phosphate mechanism

Answer 9

Ammonium raises pH, struvite precipitates

-Staghorn calculi

Question 10

Only radiolucent stones

Answer 10

Uric acid stones

Question 11

Uric acid stone etiology (2)

Answer 11

• Gout

- Leukemia

Question 12

Cystine stone etiology

Answer 12

Genetic defect in cystine reabsorption -> cystinuria

Question 13

Small v Large stones

Answer 13

large stones usually asymptomatic, small stones get lodged in ureters

Question 14

Stone clinical

Answer 14

Severe flank pain radiating to groin

• Costovertebral tenderness
• Nausea, vomiting, hematuria

Question 15

Acute pyelonephritis etiology

Answer 15

E. coli (90%)

Question 16

Acute pyelonephritis clinical

Answer 16

Fever, flank pain, dysuria, urgency

Question 17

Acute pyelonephritis findings

Answer 17

WBC casts in urine, WBC in blood, cystitis

Question 18

Increased risk of pyelonephritis

Answer 18

• Vesico-ureteral reflux
• Diabetes
• Obstruction
• Females
• Immunosuppression
• Trauma

Question 19

Acute pyelonephritis histology

Answer 19

Tubule inflammation

Glomeruli spared

Question 20

Papillary necrosis of renal papillae

Answer 20

Ischemia due to marginal blood supply

Question 21

Papillary necrosis of renal papillae etiology

Answer 21

• Diabetes
• Phenacetin (analgesic)
• Sickle cell disease

Question 22

Papillary necrosis of renal papillae clinical

Answer 22

Same as acute pyelonephritis

-Can be insidious progressive renal failure

Question 23

Papillary necrosis of renal papillae histo

Answer 23

Coagulative necrosis rimmed by acute inflammation

Question 24

Xanthogranulomatous pyelonephritis

Answer 24

Chronic foamy histiocytic inflammation forming pseudotumerous lesion, must be excised

Question 25

Xanthogranulomatous pyelonephritis etiology

Answer 25

• Gram negative bacteria

- Staghorn calculus

Question 26

Chronic pyelonephritis

Answer 26

Interstitial fibrosis and tubular atrophy

-Cortical scarring, distortion with blunted calyces

Question 27

Chronic pyelonephritis histology

Answer 27

Thyroidization of kidney (atrophic tubules)

Question 28

Chronic pyelonephritis etiology

Answer 28

Vesico-ureteral reflux

Question 29

Cystitis clinical

Answer 29

Dysuria, suprapubic pain, increased frequency, urgency

Question 30

Cystitis etiology

Answer 30

E. coli

Question 31

Cystitis urine test

Answer 31

Cloudy (WBCs)

• Pyuria (positive leukocyte esterase test)
• Nitrite test positive
• Culture positive is diagnostic

Question 32

Urethritis etiology

Answer 32

• E.coli
• Chlamydia trachomatis (sterile pyuria)
• Neisseria gonorrhoeae (sterile pyuria)

Question 33

Urethritis clinical

Answer 33

Dysuria, urgency of urination