Renal - UTIs; Nephrolithiasis; Chronic Renal Failure

Question 1

True/False.

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

Answer 1

True.

Question 2

UTIs are more common in which gender?

Answer 2

Females

Question 3

Name a few risk factors for UTIs.

Answer 3

Sexual intercourse;

urinary stasis;

catheters

Question 4

True/False.

UTIs are most commonly ascending infections.

Answer 4

True.

Question 5

Infections of the bladder are known as _____itis.

Answer 5

Infections of the bladder are known as cystitis.

Question 6

True/False.

Cystitis typically presents as dysuria, oliguria, urgency, suprapubic pain, and fever.

Answer 6

False.

Cystitis typically presents as dysuria, urinary frequency, urgency, and suprapubic pain (and no systemic symptoms like fevers).

Question 7

True/False.

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

Answer 7

True.

Question 8

Laboratory findings in cystitis

Urinalysis — ___________________________

Dipstick — Positive leukocyte esterase and nitrites

Culture — > 100,000 colony-forming units (gold standard)

Answer 8

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)

Question 9

Laboratory findings in cystitis

Urinalysis — Cloudy urine with > 10 WBCs/high-power-field

Dipstick — ______________________________

Culture — > 100,000 colony-forming units (gold standard)

Answer 9

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)

Question 10

Laboratory findings in cystitis

Urinalysis — Cloudy urine with > 10 WBCs/high-power-field

Dipstick — Positive leukocyte esterase and nitrites

Culture — ______________________________

Answer 10

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)

Question 11

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

Answer 11

Cultures

(> 100,000 colony-forming units)

Question 12

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

Answer 12

80%

Question 13

Name five common etiologies of cystitis.

Answer 13

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

Question 14

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

Answer 14

Proteus mirabilis

Question 15

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

Answer 15

Young, sexually active women

Question 16

What is sterile pyuria?

Answer 16

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

Question 17

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

Answer 17

(1) Chlamydia trachomatis

OR

(2) Neisseria gonorrhoeae

Question 18

Infections of the kidney are known as __________itis.

Answer 18

Infections of the kidney are known as pyelonephritis.

Question 19

Name three common causes of pyelonephritis.

Answer 19

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

Question 20

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

Answer 20

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

Question 21

Patients with ____________ reflex have an increased risk of pyelonephritis.

Answer 21

Patients with vesicoureteral reflex have an increased risk of pyelonephritis.

Question 22

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

Answer 22

Fever;

flank pain

Question 23

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?

Answer 23

WBC casts in urine;

leukocytosis

Question 24

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

Answer 24

Interstitial fibrosis

+

tubular atrophy

Question 25

Chronic pyelonephritis often results due to repeated bouts of acute pyelonephritis because of what two causes?

Answer 25

(1) Vesicoureteral reflex (in children)
(2) Obstruction (e.g. BPH; cervical carcinoma)

Question 26

Chronic pyelonephritis is characterized by _________ scarring with _________ calyces.

Answer 26

Chronic pyelonephritis is characterized by cortical scarring with blunted calyces.

Question 27

Vesicoureteral reflex results in scarring at which pole(s) of the kidney?

Answer 27

Both the upper and lower

Question 28

What type of casts may be seen in the urine as a result of chronic pyelonephritis?

Answer 28

‘Waxy’ casts

Question 29

Chronic pyelonephritis is characterized by ______ic tubules containing ___________ic _______eous material.

Answer 29

Chronic pyelonephritis is characterized by atrophic tubules containing eosinophilic proteinaceous material.

Question 30

The proteinaceous material filling the atrophic tubules found in chronic pyelonephritis resembles that found in what other organ?

Answer 30

The thyroid

(‘thyroidization’ of the kidney)

Question 31

The technical term for renal stone formation is ___________sis.

Answer 31

The technical term for renal stone formation is nephrolithiasis.

Question 32

Name two simple risk factors for nephrolithiasis?

(High something; low something else)

Answer 32

(1) High solute concentration in urinary filtrate
(2) Low urine volume

Question 33

How does nephrolithiasis typically present?

Answer 33

Colicky pain

+

hematuria

+

unilateral flank tenderness

Question 34

Renal stones are typically passed within hours. If not, ________ intervention may be required.

Answer 34

Renal stones are typically passed within hours. If not, surgical intervention may be required.

Question 35

What is the most common type of renal stone?

Answer 35

Calcium oxalate;

and/or calcium phosphate

Question 36

What is the second most common type of renal stone?

Answer 36

Ammonium magnesium phosphate (struvite)

(after calcium oxalate/phosphate)

Question 37

What is the third most common type of renal stone?

Answer 37

Uric acid

(after calcium oxalate/phosphate; then struvite)

Question 38

________ stones are a rare cause of nephrolithiasis (kidney stones) that are most often seen in children.

Answer 38

Cystine stones are a rare cause of nephrolithiasis (kidney stones) that are most often seen in children.

Question 39

Cystine stones are a rare form of nephrolithiasis (kidney stone) that most commonly occurs in what patient population?

Answer 39

Children

Question 40

What are the most common causes of calcium oxalate and/or calcium phosphate nephrolithiasis?

Answer 40

(1) Idiopathic (MC)
(2) Hypercalcemia
(3) Crohn’s disease

Question 41

What is the most common cause of ammonium magnesium phosphate (struvite) nephrolithiasis?

Answer 41

Infections

(with urease-positive organisms that alkalinize the urine — e.g. P. mirabilis or Klebsiella species)

Question 42

Staghorn calculi that fill the renal pelvis are most commonly made of what substance?

Answer 42

Ammonium magnesium phosphate (struvite)

Question 43

Name some factors that increase the risk of uric acid nephrolithiasis.

Answer 43

1. Hot, arid climates
2. Low urine volume
3. Acidic pH
4. Hyperuricemia

Question 44

What is the most common cause of cystine nephrolithiasis (a rare form of nephrolithiasis seen in children)?

Answer 44

Cystinuria

(genetic defect in tubular reabsorption of cysteine)

Question 45

With what medication can recurrent nephrolithiasis due to calcium oxalate and/or calcium phosphate be treated?

Answer 45

Hydrochlorothiazide

(a calcium-sparing diuretic)

Question 46

How is ammonium magnesium phosphate (struvite) nephrolithiasis typically treated?

Answer 46

(1) surgical removal
(2) Infection treatment

Question 47

How is uric acid nephrolithiasis typically treated?

Answer 47

(1) Hydration
(2) Urine alkalinization

(also, allopurinol for patients with gout)

Question 48

How is cystine nephrolithiasis typically treated?

Answer 48

(1) Hydration
(2) Urine alkalinization

Question 49

True/False.

Chronic renal failure may result from glomerular, tubular, inflammatory, or vascular insults.

Answer 49

True.

Question 50

What are the most common causes of chronic renal failure?

Answer 50

Diabetes mellitus;

hypertension;

glomerular disease

Question 51

What are the main treatment options for chronic renal failure?

Answer 51

Dialysis

+

renal transplant

Question 52

Chronic renal failure causes _____emia.

Answer 52

Chronic renal failure causes uremia.

Question 53

Describe the effects of chronic renal failure on the following:

Serum nitrogen

Serum calcium

Serum sodium

Answer 53

Uremia (azotemia)

Hypocalcemia

Salt and water retention

Question 54

Describe the effects of chronic renal failure on the following:

Serum potassium

Blood pressure

Hematocrit

Answer 54

Hyperkalemia

Hypertension (salt and water retention)

Anemia

Question 55

Why is chronic renal disease characterized by anemia?

Answer 55

Decreased erythropoietin

(produced by renal peritubular interstitial cells)

Question 56

Are salt and water retained or lost in chronic renal disease?

Answer 56

Retained

(resulting in secondary hypertension)

Question 57

True/False.

Chronic renal disease presents with hypokalemia and metabolic alkalosis.

Answer 57

False.

Chronic renal disease presents with hyperkalemia and metabolic acidosis.

Question 58

Why does chronic renal disease result in hypocalcemia?

Answer 58

Decreased 1-alpha-hydroxylation of vitamin D

(and resulting hyperphosphatemia as well)

Question 59

What bone pathologies are associated with chronic renal disease?

Answer 59

Renal osteodystrophy

(also, osteomalacia and osteoporosis)

Question 60

How does chronic renal disease result in renal osteodystrophy?

Answer 60

Secondary hyperparathyroidism

Question 61

Describe the various uremic effects of chronic renal failure on appetite.

Answer 61

Nausea;

anorexia

Question 62

Describe the various uremic effects of chronic renal failure on the cardiovascular system.

Answer 62

Pericarditis;

platelet dysfunction

Question 63

Describe the various uremic effects of chronic renal failure on the nervous system.

Answer 63

Encephalopathy

+

asterixis

Question 64

Describe the cutaneous effects of chronic renal failure uremia.

Answer 64

Urea crystal deposition

Question 65

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.

Answer 65

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).

Question 66

Urine microscopy shows dumbell-shaped crystals. This is most consistent with what form of nephrolithiasis?

Answer 66

Calcium oxalate monohydrate

Question 67

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?

Answer 67

Calcium oxalate dihydrate

Question 68

Urine microscopy shows wedge-shaped, prism-like crystals. This is most consistent with what form of nephrolithiasis?

Answer 68

Calcium phosphate

Question 69

Urine microscopy shows rectangular, ‘coffin-lid’ crystals. This is most consistent with what form of nephrolithiasis?

Answer 69

Struvite

Question 70

Urine microscopy shows yellow-brown, rhomboid-shaped crystals. This is most consistent with what form of nephrolithiasis?

Answer 70

Uric acid

Question 71

Urine microscopy shows hexagonal crystals. This is most consistent with what form of nephrolithiasis?

Answer 71

Cystine

Question 72

_________ are a complication of acute pyelonephritis and can be either renal or perinephric.

Answer 72

Abcesses are a complication of acute pyelonephritis and can be either renal or perinephric.

Question 73

What disorder is here described?

• Gangrenous infection of kidneys by gram-negative organisms*
• (very aggressive, life-threatening emergency)*

Answer 73

Emphysematous pyelonephritis

Question 74

What disorder is here described?

A variant of chronic pyelonephritis characterized by xanthogranulomas (granulomas made of foamy histiocytes/macrophages)

Answer 74

Xanthogranulomatous pyelonephritis

Question 75

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)

Answer 75

Malakoplakia