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Urinary System > Session 7 > Flashcards

Session 7 Flashcards

1
Q

What are calcium renal stones composed of?

A

Most are calcium oxalate and calcium phosphate but may just be calcium phosphate, or uric acid.

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2
Q

Why do struvite renal stones form?

A

Due to presence of bacteria with urease enzymes, cause formation of stones containing urease or triple-phosphate.

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3
Q

When do cysteine renal stones form?

A

In cysteinuria.

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4
Q

What drugs can cause renal stones to form?

A

Indinavir, trimterene or sulphadiazine.

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5
Q

Why do renal stones form?

A

Urine becomes supersaturated with minerals; seed crystals form via nucleation; mineral deposits form around the seed crystal and the stone grows.

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6
Q

What are Randall’s plaques?

A

Calcium plaques present on the membranes in the urinary tract; very easy for renal stones to form around these plaques.

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7
Q

What factors increase the likelihood of renal stone formation?

A

Urine stasis, drug use, genetic/congenital disorders.

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8
Q

What conditions are calcium oxalate stones associated with?

A

Conditions causing hypercalcaemia, hyperoxaluria and hypercalciuria, e.g. Hyperparathyroidism , diffuse bone disease, sarcoidosis, Crohn’s disease, etc.

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9
Q

What effect does PTH have on calcium homeostasis?

A

Increases serum calcium by increasing osteoclastic bone resorption; increasing intestinal calcium absorption; increasing calcitrol synthesis; increasing phosphate secretion.

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10
Q

What effect does vitamin D have on calcium homeostasis?

A

Increases serum calcium by increasing calcium gut resorption; increasing calcification and resorption of bone.

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11
Q

What effect does calcitonin have on calcium homeostasis?

A

Decreases serum calcium by inhibiting osteoclastic bone resorption; increasing renal excretion of calcium and phosphate.

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12
Q

What commonly causes hypercalciuria?

A

Idiopathic, hypercalcaemia, excessive dietary calcium intake, excessive resorption of calcium from the skeleton due to weightlessness or immobilisation.

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13
Q

How is hypercalcaemia commonly caused?

A

Hypersecretion of PTH; destruction of bone tissue; other mechanisms such as sarcoidosis, thiazide diuretics, excessive vit D ingestion, milk-alkali syndrome.

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14
Q

What are the common symptoms of hypercalcaemia?

A

Bones, stones, grooms and moans: painful and easily fractured bones, renal stones, abdominal groans, psychic moans.

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15
Q

How is hyperoxaluria usually caused?

A

Autosomal recessive disorder in oxalate synthesis (primary hyperoxaluria); increased intestinal oxalate absorption secondary to GI disease (Crohn’s disease, etc.); high dietary oxalate intake; low calcium intake.

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16
Q

What is hyperuricaemia?

A

Excess uric acid in the blood.

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17
Q

What does hyperuricaemia predispose patients to?

A

Uric acid stones.

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18
Q

What usually causes hyperuricaemia?

A

Increased cell turnover: due to lympho- or myelo-proliferation disorders or after chemotherapy due to tumour lysis syndrome.

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19
Q

How do renal stones usually present?

A

Usually asymptomatic but may have colic, dull loin aches, recurrent UTIs, haematuria, renal failure or UT obstruction.

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20
Q

How does colicy pain usually present?

A

Very painful bouts lasting 20-60 minutes caused by peristaltic contractions or spasm of the ureter radiating from the flank to iliac fossa and testes/labium/inner thigh in the L1 nerve root. May be accompanied by nausea, vomiting, pallor, sweating and restlessness.

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21
Q

How are renal stones investigated?

A

MSU, RBCs, urinary casts, urinary crystals, urine cultures, serum levels (urea, creatinine, electrolytes and calcium), CT best investigation as sees most stones.

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22
Q

What are common complications of renal stones?

A

Acute pyelonephritis, gram-negative sepsis, necrosis of the renal parenchyma, urinary obstruction, hydronephrosis, ulceration through the collecting system walls.

23
Q

How are renal stones treated?

A

Analgaesia and warmth to site of pain; bed rest; ureteroscopy; pericutaneous nephrolithotomy; ESWL therapy.

24
Q

How can renal stones be prevented?

A

Drink more to decrease urine supersaturation; alkalinity urine with potassium citrate.

25
Q

What types of bacteria usually cause UTIs?

A

Coliforms and gram-negative rods.

26
Q

What host factors can increase likelihood of a UTI?

A

Shorter urethra (women); urethral obstruction due to enlarged prostate, pregnancy, stones and tumours; neurological problems causing incomplete emptying of the bladder and residual urine; ureteric reflux causing ascending infection of the bladder.

27
Q

Why does UTI typically occur in the pelvic-ureteric junction?

A

Due to stones.

28
Q

Why does UTI typically occur in the ureter?

A

Due to calculus, cancers or retroperitoneal fibrosis.

29
Q

Why does UTI typically occur in the bladder?

A

Due to nephrogenic bladder.

30
Q

Why does UTI typically occur in the vesicoureteric junction of the bladder?

A

Due to stones.

31
Q

Why does UTI typically occur at the bladder neck?

A

Due to hypertrophy.

32
Q

Why does UTI typically occur in the prostatic urethra?

A

Due to cancer or benign prostate enlargement.

33
Q

Why does UTI typically occur in the urethra?

A

Due to stones.

34
Q

What bacterial factors increase likelihood of UTI?

A

Fimbrae, haemolysin secretion, K antigen, urease secretion.

35
Q

How does cystitis usually present?

A

Lower UTI: pain and burning on urination, high frequency and urgency to urinate, dysuria, low grade fever.

36
Q

How does acute pyelonephritis usually present?

A

Fever, loin pain (often one sided and localised to kidney), dysuria, increased frequency of urination.

37
Q

What is an uncomplicated UTI?

A

Infection by a usual organism in a patient with a normal urinary tract and normal urinary function.

38
Q

What is a complicated UTI?

A

UTI when one or more factors are present to predispose the person to persistent infection, recurrent infection or treatment failure.

39
Q

In which patient groups is a UTI usually complicated?

A

Men, children, pregnant women, pyelonephritis sufferers, recurrent infection sufferers, patients with failure of treatment, patients with other complications.

40
Q

When should and shouldn’t a urine culture be performed when investigating a UTI?

A

Perform if complicated UTI is suspected, don’t perform if uncomplicated.

41
Q

How are urine specimens taken when screening for UTI?

A

Usually MSU, can also take catheter sample or suprapubic aspiration. Transported to lab at 4 degrees in boric acid.

42
Q

What does turbid urine suggest?

A

Presence of UTI.

43
Q

When is dipstick testing useful in UTI screening?

A

To exclude UTI in children, men and elderly women.

44
Q

When is dipstick testing not useful in UTI screening?

A

Acute uncomplicated UTIs in women; men with typical/severe symptoms; catheterised patients; older patients without features of infection.

45
Q

What is microscopy likely to show in patients suffering from UTIs?

A

Presence of WBCs and RBCs as well as squame cells.

46
Q

When should imaging be used in investigating a suspected UTI>

A

Always in children, also useful in septic patients to establish renal involvement.

47
Q

How should asymptomatic bacteriuria be treated?

A

Shouldn’t be treated usually as doesn’t increase mortality, treat like UTI in pregnancy or urological surgery.

48
Q

How are UTIs treated?

A

Increase fluid intake; address underlying cause; give antibiotic course: 3 days for uncomplicated, 5-7 days for lower complicated UTI; only treat catheter patients if systemically unwell; give prophylaxis if recurrent UTIs.

49
Q

What antibiotics are prescribed in simple cystitis infections?

A

Trimethoprim or nitrofurantoin.

50
Q

Why is a short course of antibiotics given in simple cystitis?

A

5-7 day course is no more effective and shorter course reduces selection pressure for resistance.

51
Q

What antibiotics are given in complicated lower UTIs?

A

Trimethoprim, nitrofurantoin or cephalexin.

52
Q

How is pyelonephritis treated?

A

14 day course of coamoxiclav, ciprofloxacin or gentamicin.

53
Q

Why isn’t nitrofurantoin used in pyelonephritis?

A

Has systemic activity.

54
Q

Should all symptomatic adult women be given treatment for UTI?

A

No. Most infections are self limiting so don’t need antibiotic treatment.

Urinary System (11 decks)

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