Renal - UTIs; Nephrolithiasis; Chronic Renal Failure Flashcards by Jason Worley

True/False.

UTIs can be infections of the urethra, bladder, or kidney.

True.

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UTIs are more common in which gender?

Females

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Name a few risk factors for UTIs.

Sexual intercourse;

urinary stasis;

catheters

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True/False.

UTIs are most commonly ascending infections.

True.

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Infections of the bladder are known as _____itis.

Infections of the bladder are known as cystitis.

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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).

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True/False.

Cases of cystitis are not typically associated with systematic symptoms such as fever.

True.

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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)

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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)

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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)

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What is the gold standard for cystitis diagnosis by laboratory findings?

Cultures

(> 100,000 colony-forming units)

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What percentage of cases of cystitis are caused by E. coli?

80%

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Name five common etiologies of cystitis.

(1) E. coli
(2) S. saprophyticus
(3) Klebsiella pneumoniae
(4) Proteus mirabilis
(5) Enterococcus faecalis

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Alkaline urine with an ammonia scent would indicate what etiology of cystitis?

Proteus mirabilis

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Staphylococcus saprophyticus as an etiology of cystitis has a higher incidence in what population?

Young, sexually active women

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What is sterile pyuria?

Pyuria (> 10 WBCs/hpf + leukocyte esterase) with a negative culture

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Dysuria with sterile pyuria suggests urethritis due to one of what two causes?

(1) Chlamydia trachomatis

(2) Neisseria gonorrhoeae

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Infections of the kidney are known as __________itis.

Infections of the kidney are known as pyelonephritis.

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Name three common causes of pyelonephritis.

(1) Escherichia coli (90%)
(2) Enterococcus faecalis
(3) Klebsiella species

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____% of cases of pyelonephritis are due to E. coli.

90% of cases of pyelonephritis are due to E. coli.

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Patients with ____________ reflex have an increased risk of pyelonephritis.

Patients with vesicoureteral reflex have an increased risk of pyelonephritis.

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In addition to the symptoms of cystitis (dysuria, urinary frequency, urgency, suprapubic pain), patients with pyelonephritis will have what additional symptoms?

Fever;

flank pain

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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

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Repeated bouts of acute pyelonephritis (chronic pyelonephritis) can lead to what effects on the kidneys?

Interstitial fibrosis

tubular atrophy

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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 **_atroph_**ic tubules containing **_eosinophil_**ic **_proteinac_**eous 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 **_nephrolithia_**sis.

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.

1. **Hot**, arid climates 2. **Low** urine volume 3. **Acidic** pH 4. **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 **_ur_**emia.

Describe the effects of chronic renal failure on the following: ## Footnote **Serum nitrogen** **Serum calcium** **Serum sodium**

**Uremia** (azotemia) **Hypo**calcemia **Salt** and water **retention**

Describe the effects of chronic renal failure on the following: ## Footnote **Serum potassium** **Blood pressure** **Hematocrit**

**Hyper**kalemia **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 ***hyper***kalemia 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? ## Footnote * Gangrenous infection of kidneys by gram-negative organisms* * (very aggressive, life-threatening emergency)*

Emphysematous pyelonephritis

What disorder is here described? ## Footnote *A variant of chronic pyelonephritis characterized by xanthogranulomas (granulomas made of foamy histiocytes/macrophages)*

Xanthogranulomatous pyelonephritis

What disorder is here described? ## Footnote *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