Renal - UTIs; Nephrolithiasis; Chronic Renal Failure Flashcards
True/False.
UTIs can be infections of the urethra, bladder, or kidney.
True.
UTIs are more common in which gender?
Females
Name a few risk factors for UTIs.
Sexual intercourse;
urinary stasis;
catheters
True/False.
UTIs are most commonly ascending infections.
True.
Infections of the bladder are known as _____itis.
Infections of the bladder are known as cystitis.
True/False.
Cystitis typically presents as dysuria, oliguria, urgency, suprapubic pain, and fever.
False.
Cystitis typically presents as dysuria, urinary frequency, urgency, and suprapubic pain (and no systemic symptoms like fevers).
True/False.
Cases of cystitis are not typically associated with systematic symptoms such as fever.
True.
Laboratory findings in cystitis
Urinalysis — ___________________________
Dipstick — Positive leukocyte esterase and nitrites
Culture — > 100,000 colony-forming units (gold standard)
Laboratory findings in cystitis
Urinalysis — Cloudy urine with > 10 WBCs/high-power-field
Dipstick — Positive leukocyte esterase and nitrites
Culture — > 100,000 colony-forming units (gold standard)
Laboratory findings in cystitis
Urinalysis — Cloudy urine with > 10 WBCs/high-power-field
Dipstick — ______________________________
Culture — > 100,000 colony-forming units (gold standard)
Laboratory findings in cystitis
Urinalysis — Cloudy urine with > 10 WBCs/high-power-field
Dipstick — Positive leukocyte esterase and nitrites
Culture — > 100,000 colony-forming units (gold standard)
Laboratory findings in cystitis
Urinalysis — Cloudy urine with > 10 WBCs/high-power-field
Dipstick — Positive leukocyte esterase and nitrites
Culture — ______________________________
Laboratory findings in cystitis
Urinalysis — Cloudy urine with > 10 WBCs/high-power-field
Dipstick — Positive leukocyte esterase and nitrites
Culture — > 100,000 colony-forming units (gold standard)
What is the gold standard for cystitis diagnosis by laboratory findings?
Cultures
(> 100,000 colony-forming units)
What percentage of cases of cystitis are caused by E. coli?
80%
Name five common etiologies of cystitis.
(1) E. coli
(2) S. saprophyticus
(3) Klebsiella pneumoniae
(4) Proteus mirabilis
(5) Enterococcus faecalis
Alkaline urine with an ammonia scent would indicate what etiology of cystitis?
Proteus mirabilis
Staphylococcus saprophyticus as an etiology of cystitis has a higher incidence in what population?
Young, sexually active women
What is sterile pyuria?
Pyuria (> 10 WBCs/hpf + leukocyte esterase) with a negative culture
Dysuria with sterile pyuria suggests urethritis due to one of what two causes?
(1) Chlamydia trachomatis
OR
(2) Neisseria gonorrhoeae
Infections of the kidney are known as __________itis.
Infections of the kidney are known as pyelonephritis.
Name three common causes of pyelonephritis.
(1) Escherichia coli (90%)
(2) Enterococcus faecalis
(3) Klebsiella species
____% of cases of pyelonephritis are due to E. coli.
90% of cases of pyelonephritis are due to E. coli.
Patients with ____________ reflex have an increased risk of pyelonephritis.
Patients with vesicoureteral reflex have an increased risk of pyelonephritis.
In addition to the symptoms of cystitis (dysuria, urinary frequency, urgency, suprapubic pain), patients with pyelonephritis will have what additional symptoms?
Fever;
flank pain
In addition to the symptoms of cystitis (dysuria, urinary frequency, urgency, suprapubic pain), patients with pyelonephritis will often present with fever and flank pain.
What laboratory findings will be present?
WBC casts in urine;
leukocytosis
Repeated bouts of acute pyelonephritis (chronic pyelonephritis) can lead to what effects on the kidneys?
Interstitial fibrosis
+
tubular atrophy
Chronic pyelonephritis often results due to repeated bouts of acute pyelonephritis because of what two causes?
(1) Vesicoureteral reflex (in children)
(2) Obstruction (e.g. BPH; cervical carcinoma)
Chronic pyelonephritis is characterized by _________ scarring with _________ calyces.
Chronic pyelonephritis is characterized by cortical scarring with blunted calyces.
Vesicoureteral reflex results in scarring at which pole(s) of the kidney?
Both the upper and lower
What type of casts may be seen in the urine as a result of chronic pyelonephritis?
‘Waxy’ casts
Chronic pyelonephritis is characterized by ______ic tubules containing ___________ic _______eous material.
Chronic pyelonephritis is characterized by atrophic tubules containing eosinophilic proteinaceous material.
The proteinaceous material filling the atrophic tubules found in chronic pyelonephritis resembles that found in what other organ?
The thyroid
(‘thyroidization’ of the kidney)
The technical term for renal stone formation is ___________sis.
The technical term for renal stone formation is nephrolithiasis.
Name two simple risk factors for nephrolithiasis?
(High something; low something else)
(1) High solute concentration in urinary filtrate
(2) Low urine volume
How does nephrolithiasis typically present?
Colicky pain
+
hematuria
+
unilateral flank tenderness
Renal stones are typically passed within hours. If not, ________ intervention may be required.
Renal stones are typically passed within hours. If not, surgical intervention may be required.
What is the most common type of renal stone?
Calcium oxalate;
and/or calcium phosphate
What is the second most common type of renal stone?
Ammonium magnesium phosphate (struvite)
(after calcium oxalate/phosphate)
What is the third most common type of renal stone?
Uric acid
(after calcium oxalate/phosphate; then struvite)
________ stones are a rare cause of nephrolithiasis (kidney stones) that are most often seen in children.
Cystine stones are a rare cause of nephrolithiasis (kidney stones) that are most often seen in children.
Cystine stones are a rare form of nephrolithiasis (kidney stone) that most commonly occurs in what patient population?
Children
What are the most common causes of calcium oxalate and/or calcium phosphate nephrolithiasis?
(1) Idiopathic (MC)
(2) Hypercalcemia
(3) Crohn’s disease
What is the most common cause of ammonium magnesium phosphate (struvite) nephrolithiasis?
Infections
(with urease-positive organisms that alkalinize the urine — e.g. P. mirabilis or Klebsiella species)
Staghorn calculi that fill the renal pelvis are most commonly made of what substance?
Ammonium magnesium phosphate (struvite)
Name some factors that increase the risk of uric acid nephrolithiasis.
- Hot, arid climates
- Low urine volume
- Acidic pH
- Hyperuricemia
What is the most common cause of cystine nephrolithiasis (a rare form of nephrolithiasis seen in children)?
Cystinuria
(genetic defect in tubular reabsorption of cysteine)
With what medication can recurrent nephrolithiasis due to calcium oxalate and/or calcium phosphate be treated?
Hydrochlorothiazide
(a calcium-sparing diuretic)
How is ammonium magnesium phosphate (struvite) nephrolithiasis typically treated?
(1) surgical removal
(2) Infection treatment
How is uric acid nephrolithiasis typically treated?
(1) Hydration
(2) Urine alkalinization
(also, allopurinol for patients with gout)
How is cystine nephrolithiasis typically treated?
(1) Hydration
(2) Urine alkalinization
True/False.
Chronic renal failure may result from glomerular, tubular, inflammatory, or vascular insults.
True.
What are the most common causes of chronic renal failure?
Diabetes mellitus;
hypertension;
glomerular disease
What are the main treatment options for chronic renal failure?
Dialysis
+
renal transplant
Chronic renal failure causes _____emia.
Chronic renal failure causes uremia.
Describe the effects of chronic renal failure on the following:
Serum nitrogen
Serum calcium
Serum sodium
Uremia (azotemia)
Hypocalcemia
Salt and water retention
Describe the effects of chronic renal failure on the following:
Serum potassium
Blood pressure
Hematocrit
Hyperkalemia
Hypertension (salt and water retention)
Anemia
Why is chronic renal disease characterized by anemia?
Decreased erythropoietin
(produced by renal peritubular interstitial cells)
Are salt and water retained or lost in chronic renal disease?
Retained
(resulting in secondary hypertension)
True/False.
Chronic renal disease presents with hypokalemia and metabolic alkalosis.
False.
Chronic renal disease presents with hyperkalemia and metabolic acidosis.
Why does chronic renal disease result in hypocalcemia?
Decreased 1-alpha-hydroxylation of vitamin D
(and resulting hyperphosphatemia as well)
What bone pathologies are associated with chronic renal disease?
Renal osteodystrophy
(also, osteomalacia and osteoporosis)
How does chronic renal disease result in renal osteodystrophy?
Secondary hyperparathyroidism
Describe the various uremic effects of chronic renal failure on appetite.
Nausea;
anorexia
Describe the various uremic effects of chronic renal failure on the cardiovascular system.
Pericarditis;
platelet dysfunction
Describe the various uremic effects of chronic renal failure on the nervous system.
Encephalopathy
+
asterixis
Describe the cutaneous effects of chronic renal failure uremia.
Urea crystal deposition
True/False.
A patient asks how he can lower his risk of calcium oxalate stones. The correct answer would be to remain hydrated and avoid food high in calcium only as calcium is the main driver of these types of nephrolithiasis.
False.
A patient asks how he can lower his risk of calcium oxalate stones. The correct answer would be to remain hydrated and avoid food high in oxalate as oxalate is the main driver of these types of nephrolithiasis (although lowering calcium levels is also beneficial).
Urine microscopy shows dumbell-shaped crystals. This is most consistent with what form of nephrolithiasis?
Calcium oxalate monohydrate
Urine microscopy shows crystals that look like little envelopes (a square with an x through the middle). This is most consistent with what form of nephrolithiasis?
Calcium oxalate dihydrate
Urine microscopy shows wedge-shaped, prism-like crystals. This is most consistent with what form of nephrolithiasis?
Calcium phosphate
Urine microscopy shows rectangular, ‘coffin-lid’ crystals. This is most consistent with what form of nephrolithiasis?
Struvite
Urine microscopy shows yellow-brown, rhomboid-shaped crystals. This is most consistent with what form of nephrolithiasis?
Uric acid
Urine microscopy shows hexagonal crystals. This is most consistent with what form of nephrolithiasis?
Cystine
_________ are a complication of acute pyelonephritis and can be either renal or perinephric.
Abcesses are a complication of acute pyelonephritis and can be either renal or perinephric.
What disorder is here described?
- Gangrenous infection of kidneys by gram-negative organisms*
- (very aggressive, life-threatening emergency)*
Emphysematous pyelonephritis
What disorder is here described?
A variant of chronic pyelonephritis characterized by xanthogranulomas (granulomas made of foamy histiocytes/macrophages)
Xanthogranulomatous pyelonephritis
What disorder is here described?
A chronic granulomatous disorder that mainly affects the bladder (Histology: sheet of large histiocytes with abundant granular cytoplasm, may see cytoplasmic inclusions called Michaelis-Gutman bodies; stain positive for calcium (von Kossa positive) and iron)
Malakoplakia
