Quiz 1 Flashcards
Optimal daily urine volume should be?
~2500 ml
How much water intake is required to make the optimal amount of daily urine?
~250+ ml qh
Burning pain with voiding felt in suprapubic area may be a sign of what?
Acute cystitis
Painful suprapubic area may be a sign of what?
Acute urinary retention
Is chronic retention painful in the bladder area (suprapubic)?
No - little or no pain
Urethritis s/sxs (ddx common features of dysuria)
20-40 M or F
Pain throughout urination that is burning in quality
Freq, urethral d/c, inflamed urethra (m), local LA
UA: Pyuria, bacteriuria, hematuria
suprapubic palpation is painless
CVA tenderness (-)
Cystitis s/sxs (ddx common features of dysuria)
F: 15+ yrs, M: infant, elderly
Timing of pain is midstream/late that is burning in quality
No radiating pain, but chronic may cause dull abd or perineal pn
Freq, gross hematuria, fatigue
Mildly positive CVA tenderness
UA: Pyuria, bacteriuria, hematuria
Pyelonephritis s/sxs (ddx common features of dysuria)
F: 15+ yrs, M: infant, elderly
Timing of pain is variable and may be burning
Pain referral: Flank, abdominal pain
Fever is usually present, may be high
Freq, myalgia, fatigue, weakness, N&V
suprapubic palpation is Painless unless concurrent cystitis
CVA tenderness is strongly positive
UA: Pyuria, bacteriuria, hematuria
Chronic prostatitis s/sxs (ddx common features of dysuria)
M 30+ yrs
Timing of the pain is variable with the quality being pelvic dullness
Pain radiation: Testicular pain, general pelvic pain
Freq, altered libido, pn on ejaculation
suprapubic palpation is painless
CVA tenderness is mildly + or -
UA: pyuria, often negative
Oliguria and anuria causes?
May be caused by acute renal failure (due to shock or dehydration), fluid-ion imbalance, OR bilateral ureteral obstruction. REFER for immediate tx!
Oliguria definition?
<500 ml urine output daily
Anuria definition?
<100 ml urine output daily
Does the degree of hematuria relate to the seriousness of the cause?
NO! The degree of hematuria does not relate the seriousness of cause; thus, the presence of any RBCs >1 occasion should be investigated to R/O serious condition
Gross hematuria in adults considered sign of cancer until ruled out!
Asymptomatic microscopic hematuria is commonly from what source?
Renal
Gross hematuria is commonly from what source?
Uroepithelial.
Gross, painless hematuria often the first manifestation of an urothelial tumor.
What is the most common cause of hematuria in children without UTI or GN?
Hypercalciuria with microcalculi (metabolic cause of hematuria)
If there is a history of hematuria and the first UA is clear, when do you do a repeat?
1 week
If there is a history of trauma or exercise induced hematuria, when do you do a repeat urine?
in 24- 48 hrs
Adult bladder capacity?
350 to 450 ml.
A random S.G. of greater than _________ is a good indication that there is no intrinsic Ki dz?
1.020
Normal Specific Gravity - 1.003 - 1.030
Dip-strips pick up what types of protein?
Albumin but not globulin, thus abN globulins such as Bence-Jones proteins are missed.
What type of test picks up both albumin and globulin?
3% sulfosalycilic acid (SSA)
If a Dip-strip = pos. & SSA = pos what does this mean?
Protein is albumin or globulin and further testing is
needed.
If a Dip-strip = neg. & SSA = pos what does this mean?
Protein is globulin and a further workup is essential.
If a Dip-strip = pos. & SSA =neg what does this mean?
False positive, probably due to high pH.
What should be done if protein is >1+?
Do a 24 hour urine collection if protein is greater than 1+
150 mg/24 h
What is the level of plasma glucose needed to see positive glucose in the urine?
Positive results seen when plasma glucose levels reach 170 mg/dl (nephron thresholds vary).
What should you do if you find urine glucose?
Run a serum glucose– if normal consider renal tubular dz.
When will urine nitrites be positive?
Picks up conversion of nitrate to nitrite by coagulase- splitting bacteria (E. coli, enterobacter, pseudomonas)
Seen with >100,000 organisms/mL.
Why is urine nitrites such a useful test?
Useful to detect asymptomatic urinary tract infections - a positive test may be the only sign of PN in women (especially those pregnant), children & elderly.
What test will often be the first indication of viral hepatitis?
Urine urobilinogen.
It elevates before the serum enzymes and urinary bilirubin.
What type of cast is pathognomonic of acute GN or vasculitis?
RBC casts.
What is endogenous creatinine clearance (24 hr urine and serum samples) used for?
Accurate and reliable measure of renal function without need for infusion.
What is the gold standard for measuring GFR?
Inulin infusion.
Nephritic syndrome definition?
Glomerular inflammatory process causing renal dysfunction.
Nephritic syndrome s/sxs?
PHAROH: Proteinuria, Hematuria (cola colored urine), Azotemia, RBC casts, Oliguria, HTN
MC cause of (post) infectious nephritic syndrome?
Most common: group A beta-hemolytic strep ⇒PSGN: “Nephrotoxic Strep”
Glomerular bleeding characteristics?
Dark red, brown, cola-colored urine Proteinuria Dysmorphic RBCs (acanthocytes) HTN Edema Back/flank pain Reduced renal function (+) URI/fever/rash hx
Urologic bleeding characteristics?
Bright red urine Clots may be present RBC morphology: Isomorphic Urinary voiding sxs Back/flank pain Normal renal function (+) trauma hx
What type of hypersensitivity is Post-infectious glomerulonephritis (eg. PSGN)?
Type III
S/sxs of PSGN?
Prior group A beta-hemolytic strep (GAS) infx: strep pharyngitis or rash (impetigo). Latent period 1-3 weeks post pharyngitis 3-6 weeks after skin infx
Fever, confusion, HTN, periorbital edema, hematuria, HA, N&V, malaise.
UA of PSGN?
Cola-colored urine, oliguria, RBCs, RBC casts (pathognomonic, but not always present), Proteinuria <3.5.
What UA finding is pathognomonic for PSGN?
RBC casts
What serology is used to dx PSGN?
Streptozyme test for 5 antibodies
PSGN tx?
1) Treat infection if present (penicillin, erythromycin)
2) Treat any edema or HTN (conventional: loop diuretics)
3) Limit protein (about 1g/kg per day) and sodium
4) Bed rest
5) Botanicals: Curcuma, Echinacea
6) Quercitin, bromelain
7) Vit C to bowel tolerance Vit E 800 IU
8) Constitutional hydrotherapy, skin brushing
What is a serious DDX variant of PSGN?
Same etiologies of acute GN can cause Rapidly Progressing Glomerulonephritis (RPGN). Drugs (penicillin, hydralazine, allopurinol and rifampaim), sometimes idiopathic. Can see anti-ANCA.
Can lead to acute renal failure.
What are 3 categories of cause of nephritic syndrome?
- Post-infectious (PSGN mc)
- Autoimmune (Goodpasture, Wegeners, H-S purpura)
- Primary kidney dz: IgA nephropathy
MC cause of primary nephritic syndrome?
What is the cause?
IgA nephropathy AKA Berger Dz.
Idiopathic.
IgA nephropathy s/sxs?
Episodic gross hematuria <5 days after viral or bacterial URI (flu-like sx) or gastroenteritis; persistent microscopic hematuria, mild persistent proteinuria, HTN; rarely– acute or chronic renal failure.
Asymptomatic in 30-40%.
General treatment approach to Nephritic syndromes:
1) Avoid sodium, avoid high-potassium foods, low protein diet, low antigen diet (gluten, meat, dairy)
2) Grifola, Withania, Tinospora
3) Diuretics (use with caution)
4) Fish oil (12 g/d)
5) Treat HTN: goal BP is <125/75 mmHg in presence of proteinuria >1g/d.
6) Remove other allergens (environmental, etc)
7) Conventional approach: corticosteroids, alkyating agents (cyclophosphamide), calcineurin inhibitors, rituximab and ocrelizumab
Nephrotic syndrome definition?
The end result of a variety of diseases that damage (immunological or other assaults) the GBM ⇒ protein wasting (from alteration of the negative charge), and increased permeability of glomerular capillaries.
Nephrotic syndrome s/sxs?
Massive prOteinuria, peripheral edema, hyperlipidemia, hypoalbuminemia, foamy urine, cough, exertional dyspnea
