Renal Pathology and Pharmacology

Question 1

What are the 4 symptoms of Urinary Obstruction?

Answer 1

1. Anuria
2. Polyuria
3. Bladder distention
4. Sometimes asymptomatic

Question 2

What are the 4 symptoms of Renal/ureter stones?

Answer 2

1. Renal colic
2. Hematuria
3. Pyelonephritis
4. Sometimes asymptomatic

Question 3

What is Pyelonephritis?

Answer 3

Kidney infection

Question 4

What are 4 consequences of Pyelonephritis?

Answer 4

1. Flank pain
2. Fever
3. 10-20% chronic renal failure
4. Kidney scarring

Question 5

What are 4 groups of people are at risk for Renal cell carcinomas?

Answer 5

1. More common in males >40 yrs
2. Smokers
3. Analgesic users (NSAIDS)
4. Obesity

Question 6

What are 5 symptoms of Renal cell carcinomas?

Answer 6

1. Hematuria
2. Dull flank pain
3. Fever
4. Fatigue
5. Often asymptomatic

Question 7

Renal cell carcinomas most likely metastize to what two parts of the body?

Answer 7

Lungs or bones

Question 8

What age are Wilms tumors most common?

Answer 8

First 3 years

Question 9

What is the most common congenital renal tumor?

Answer 9

Wilms tumor

Question 10

What are 4 contributing factors to bacterial cystitis in the bladder?

Answer 10

1. Stones
2. Catheters
3. Short female urethras
4. Obstructions

Question 11

What are 3 features of urothelial carcinomas?

Answer 11

1. Most often in males >50 years old
2. Most common urothelial malignancy
3. Associated with smoking, carcinogens (e.g., dyes, paint etc.)

Question 12

What are 3 features of prostatitis?

Answer 12

1. Most common in older men
2. Often caused by bacteria responsible for cystitis
3. Causes enlarged and tender prostate can cause obstruction

Question 13

95% of cases of benign prostatic hyperplasia happen in men over what age?

Answer 13

75

Question 14

What percent of benign prostatic hyperplasia cases must be relieved with surgery?

Answer 14

10%

Question 15

What is the cause of benign prostatic hyperplasia?

Answer 15

Not well known; perhaps has to do with androgens or even estrogens

Question 16

(T/F) Urinary obstruction is uncommon in benign prostatic hyperplasia patients.

Answer 16

False

Question 17

Prostatic adenocarcinoma is most common malignancy (except skin cancers) in what demographic?

Answer 17

Older men; 60% of men >80 years old

Question 18

How is prostatic adenocarcinoma most often detected?

Answer 18

Rectal exams

Question 19

What does a rapidly increasing PSA (prostate specific antigen) mean?

Answer 19

High risk for cancer

Question 20

How much PSA (prostate specific antigen) is abnormal?

Answer 20

> 4-6 mg/ml

Question 21

(T/F) PSA (prostate specific antigen) is higher with age

Answer 21

True

Question 22

The more PSA bound to ______________, the higher the risk of cancer.

Answer 22

alpha-1-antichymotrypsin (inflammatory protein)

Question 23

How many American adults have chronic kidney disease?

Answer 23

26 Million

Question 24

How many American adults are on dialysis?

Answer 24

½ million

Question 25

What are 3 main causes of Chronic Renal disease?

Answer 25

1. Diabetes 2. Hypertension 3. Chronic glomerulonephritis

Question 26

What is the most common primary glomerulonephritis?

Answer 26

IgA nephropathy—triggered by a viral infection

Question 27

5 things CRD patients can have:

Answer 27

1. Platelet dysfunctions (bleeding) 2. Gingival hyperplasia 3. bone abnormalities (slow bone healing after oral surgery) 4. Premature bone loss (osteoporosis) 5. Infectious complications (due to immunosuppression)

Question 28

4 common symptoms of CRD

Answer 28

1. Heavy proteinuria (excessive protein in urine indicates renal cell death) 2. Hematuria 3. Inflammatory injury to kidneys (e.g., immune deposits in glomeruli block normal blood filtration and reabsorption) 4. Glomeruli scarring and damaged functioning-could be sclerotic types

Question 29

What are 4 common treatments (and analgesic) for small (<1 cm) kidney stones?

Answer 29

1. Drink considerable water 2. Dietary changes 3. OTC analgesics (ibuprofen, Naprosyn) 4. Tamusolin (Flomax)—relaxes ureter muscle (often have spasm due to irritation of the stone)

Question 30

What are 3 treatments (and analgesic) for larger kidney stones?

Answer 30

1. Lithotripsy (shock wave treatment)-break up stones 2. Surgical removal 3. Opioid analgesics for pain

Question 31

What is the most common type of kidney stone? What percentage?

Answer 31

Calcium/oxylate excess in urine (~80% of stones)

Question 32

What type of kidney stone is often associated with urinary infections? What Percentage?

Answer 32

Struvite (~10% of stones)-magnesium ammonium phosphate crystals

Question 33

What is the only treatment for struvite kidney stones?

Answer 33

Acidify urine

Question 34

Which type of kidney stone is often associated with gout?

Answer 34

Uric acid

Question 35

In treatment of kidney stones, what is Hydrochlorothiazide for?

Answer 35

Thiazide diuretic—reduces calcium in urine

Question 36

In treatment of kidney stones, what is Sodium bicarbonate for?

Answer 36

Alkalinizes urine

Question 37

In treatment of kidney stones, what is Allopurinol for?

Answer 37

Reduces uric acid excretion—also used for gout

Question 38

What bacteria are UTI's often caused by?

Answer 38

E. Coli

Question 39

What are 3 common treatments for UTIs?

Answer 39

1. Trimethoprim-sulfamethoxazole 2. Amoxicillin + clavulanic acid (resistant bacteria a problem) 3. Ciprofloxacin (expensive)

Question 40

What drug is used for hypertension in hemodialysis patients?

Answer 40

Atenolol and/or captopril

Question 41

What drug is used to prevent clotting in blood passed through dialysis machine?

Answer 41

Heparin

Question 42

What potent diuretic reduces fluid retention and the amount of fluid that needs to be removed by dialysis?

Answer 42

Furosemide

Question 43

What drug has a high rate of infection in hemodialysis patients?

Answer 43

Prophylactic antibiotics

Question 44

Renal cell carcinomas account for what percentage of total renal malignancies?

Answer 44

80-90% of renal malignancies