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Repro / GU > SM_243: Hydronephrosis / Nephrolithiasis > Flashcards

SM_243: Hydronephrosis / Nephrolithiasis Flashcards

1
Q

Hydronephrosis is ___

A

Hydronephrosis is a descriptive term referring to the dilation of the renal pelvis and calyces

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2
Q

Obstructive uropathy is ___

A

Obstructive uropathy is structural impedance to the flow of urine anywhere along the urinary tract

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3
Q

Obstructive nephropathy is ____

A

Obstructive nephropathy is damage to the renal parenchyma resulting from obstruction of urine flow anywhere along the urinary tract

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4
Q

Describe presentation of acute obstruction

A

Acute obstruction

  • Flank pain
  • Lower abdominal pain
  • Groin pain
  • Penile, testicular, clitoral pain
  • Inner thigh pain
  • Nausea / vomiting
  • Fever and chills (infection)
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5
Q

Describe laboratory tests for obstruction

A

Obstruction laboratory tests

  • Serum: azotemia, hyperkalemia
  • Urine: hematuria, proteinuria, pyuria, urinary casts, crystalluria, elevated urinary sodium, decreased osmolality, decreased urine to plasma creatinine ratio
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6
Q

Anuria results from ____ obstruction

A

Anuria results from bilateral obstruction

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7
Q

Describe acute obstruction

A

Acute obstruction

  1. Phase I: RBF and ureteral pressure rise (1-1.5 hours)
  2. Phase II: decreased RBF, increased ureteral pressure (1.5-5 hours)
  3. Phase III: decreased RBF, decreased ureteral pressure (> 5 hours)
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8
Q

Describe gross changes in kidney due to obstruction

A

Gross changes in kidney due to obstruction

  • Hydronephrosis variable: extrarenal vs intrarenal collecting system
  • Compression of papillae: calyceal blunting
  • Thinning of parenchyma
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9
Q

Describe histological changes in kidney due to obstruction

A

Histological changes in kidney due to obstruction

  • Dilation of tubules and flattening of epithelium
  • Glomeruli eventually enlarge, Bowman’s capsule thickens, hyalization
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10
Q

Describe presentation of chronic obstruction

A

Chronic obstruction

  • Intermittent flank pain
    Weight gain, edema, malaise, anorexia, headaches, fatigue, dysuria
  • Uremia: m.s. changes, tremors, bleeding
  • Obstructive symptoms: weak intermittent stream, overflow, incontinence
  • Irritative symptoms: frequency, urgency nocturia
  • Polyuria: poor concentrating ability
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11
Q

Describe diangosis of obstruction

A

Obstruction diagnosis

  • Intravenous urogram: delayed nephrogram, delayed pyelogram, hydronephrosis, columning, forniceal rupture
  • Ultrasonography: dilated collecting system continuity of calcyes and pelvis, anechoic central areas in normally echogenic renal sinus, chronic obstruction with parenchyma thinning
  • Diuretic renography: Technetium 99m mercaptoacetyltriglycine, > 20 min
  • Whitaker test: percutaneous renal pelvis pressure transducer, bladder pressure transducer, saline / contrast infued, > 22 cm H20
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12
Q

___ is gold standard for diagnosing obstruction and occurs when ___ cm H20

A

Whitaker test is gold standard for diagnosing obstruction and occurs when > 22 cm H20

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13
Q

Describe postobstructive diuresis

A

Postobstructive diuresis

  • Polyuria after release of bilateral obstruction
  • Physiologic release of urea, sodium, water
  • Pathologic impaired concentrating ability and sodium resorption
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14
Q

Describe symptoms of infection in obstruction

A

Infection in obstruction

  • Fever, chills, rigors
  • Tachycardia
  • Hypotension = sepsis
  • Leukocytosis, pyuria, bacteriuria
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15
Q

Bactermia in obstruction involves ____, ____, and ____

A

Bactermia in obstruction involves pyelolymphatic urine backflow, pyelovenous urine backflow, and forniceal rupture (extravasation)

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16
Q

Treatment for obstruction and infection includes ____, ____, and ____

A

Treatment for obstruction and infection includes antibiotics, IV fluids, and drainage via percutaneous nephrostomy or ureteral stenting

17
Q

Urolithiasis formation involves ____, ____, and ____

A

Urolithiasis formation involves supersaturation, crystallization, and aggregation

18
Q

Describe physical chemistry of urolithiasis

A

Urolithiasis physical chemistry

  • Solubility product (Ksp): point at which saturation is reached and crystallization occurs
  • Formation product: urine metastable with respect to CaOx, inhibitors / matrix / nucleation /; etc
  • Inhibitors: Mg, citrate, etc
  • Complexors: citrate, Mg
  • Promoters: glycosaminoglycans, Tamm-Horsfall protein
19
Q

Describe types of kidney stones

A

Kidney stones

  • Calcium oxalate (most common)
  • Uric acid
  • Struvite (infection stones)
  • Calcium phosphate
  • Cystine
20
Q

Initial evaluation of nephrolithiasis includes ____, ____, and ____

A

Initial evaluation of nephrolithiasis includes urinalysis, urine culture, and serum studies

21
Q

Hypercalciuria is ___

A

Hypercalciuria is increased urinary excretion of Ca

  • Present in 50-70% of kidney stone patients
22
Q

Describe treatment for hypercalciuria

A

Hypercalciuria treatment

  • Idiopathic hypercalciuria (HCTZ, chlorthalidone, moduretic): fluids, low salt diet, thiazide diuretics
  • Secondary hypercalciuria: parathyroidectomy, correct underlying disease
23
Q

Describe treatment for hyperoxaluria

A

Hyperoxaluria treatment

  • Low oxalate diet
  • Increased Ca intake
  • Calcium citrate
  • Pyridoxine
  • Magnesium oxide
24
Q

Describe causes of hyperuricosuria

A

Hyperuricosuria causes

  • Gout
  • Increased purine intake

Increased turnover of nucleic acids: hematologic malginancies, hemolytic anemia, rhabdomyolysis, psoriasis

Increased uric acid synthesis: alcohol consumption

Inborn errors of metabolism

Uricosuric agents

25
Q

Hyperuricosuria treatment involves ____, ____, and ____

A

Hyperuricosuria treatment involves low purine diet, alkaline urine, and allopurinol (if gout)

26
Q

Describe struvite stones

A

Struvite stones

  • Urease producing bacteria use urease to supply their demand for nitrogen
  • Urea represents principal excretory nitrogenous product in urine
  • Bacteria split urea with urease to NH3
  • NH3 used to form glutamate and glutamine
27
Q

____, ____, ____, and ____ are urease-producing bacteria

A

Proteus, Klebsiella, Pseudomonas, and Staphylococcus are urease-producing bacteria

28
Q

Struvite stone treatment involves ___ and ___

A

Struvite stone treatment involves stone free and antibiotics

29
Q

Cystinuria is caused by ____ and leads to____

A

Cystinuria is caused by inborn error of transport of dibasic amino acids and results in supersaturation and stone formation

  • Dibasic amino acids: cystine, ornathine, lysine, arginine
30
Q

Describe treatment of cystinuria

A

Cystinuria treatment

  • Potassium citrate: alkalinize to 6.5 - 7
  • Low salt diet
  • Thiola: mixed disulfide
  • 3L of urine: dilution
31
Q

Three points in the ureter that a stone will most likely not pass are ___, ___, and ___

A

Three points in the ureter that a stone will most likely not pass are ureteral pelvic junction, iliac vessels, and ureteral vesical junction

32
Q

Patient may die from post-obstructive diuresis if not recognized or managed correctly due to ___

A

Patient may die from post-obstructive diuresis if not recognized or managed correctly due to hyponatremia

33
Q

Septic patient with hydronephrosis and obstructing stone in proximal ureter should be managed with ____ or ____

A

Septic patient with hydronephrosis and obstructing stone in proximal ureter should be managed with ureteral stent or percutaneous nephrostomy tube

34
Q

It is important to relieve obstruction because obstruction causes ___ and ___

A

It is important to relieve obstruction because obstruction causes AKI and CKD

35
Q

Hypercalciuria is ___, ___, or ___

A

Hypercalciuria is absorptive (from GI tract), renal leak, or primary hyperparathyroidism

Repro / GU (46 decks)

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