Urine disorders Flashcards
Polyuria
> 3L/day
250mosmol/L –> osmotic diuresis
water diuresis (cant concentrate urine)
DDx of hematuria
Benign mass: oncocytoma, angiomyolipoma, BPH
Malignant mass: RCC, transitional CC, squamous CC, prostate adenocarcinoma
Stones: staghorn calculi, calcium stones, uric acid stones
infective: pyelonephritis, cystitis, urethritis
Trauma
Renal: IgA nephropathy, thin basement membrane disease, hereditary nephritis
Iatrogenic: traumatic catheterization, radiation, renal biopsies, ESWL
Upper tract hematuria
total time during urination
nausea, vomiting, stones, renal colic
Bladder hematuria
total time during urination
voiding symptoms - cystitis, bladder stone, carcinoma in situ
Prostate hematuria
Initial/terminal, most urine is not bloody
BPH - painless, voiding sx
Urethral hematuria
initial/terminal blood
GU-specific hematuria causes
Glomerulonephritis: reddish-brown, tea-coloured
- dysmorphic RBC
- RBC/granular casts
- proteinuria
- RTI
Calculi
RCC: hematuria, flank pain, abdominal mass palpable
TCC: hematuria, dysuria, frequency
UTI
Systemic hematuria causes
Miliary TB - pulmonary sx
Clots: more severe bleeding
CT disease
Coagulopathy - anticoagulant therapy
Approach to hematuria - general
image everyone with any kind of hematuria
- except women <40, female, non-smoker, no exposures) with UTI, stones
Retrograde pyelogram: allergy to contrast, poor renal fxn
Cystoscopy
gold standard for urinary bladder neoplasm
Approach to symptomatic hematuria
renal colic: CT KUB Trauma: CT IVP flank pain with fever or hematuria: US -if shows mass: CT renal mass - obs but no visible stone: CT IVP or cystoscopy + retrograde pyelogram
Approach to painless hematuria
US - rule out stones, hydronephrosis, mass
if mass - CT renal mass
if no mass - CT IVP or C&P
urinanalysis shows casts - renal biopsy
DDx for flank pain
AAA abdominal aortic dissection appendicitis ectopic pregnancy - FOUR EMERGENCIES
Pathogenesis of ureteric calculi
Supersaturation
Nucleation
Lack of stone inhibitors - mucoproteins, citrate, Mg, RNA peptides
Crystal aggregation
Stasis
Urine pH changes: uric acid in low pH, struvite in high pH
Types of stones
Calcium - 75% - oxalate, phosphate
Infection - 15% - Mg-ammonium-phosphate, staghorn calculi
Uric acid 10-15%
Cystine stones 1%
S&S of renal calculi
renal colic pain upper ureter and kidney --> flank pain, may radiate to thigh lower ureter, bladder, urethra --> suprapubic pain, may radiate to genitals hematuria nausea & vomiting voiding symptoms diuresis, chills oliguria/anuria writhing fever staghorn calculi - renal failure infection
Approach to renal calculi
CT KUB gold standard
if contraindicated use US
serial KUB to follow stone
Management of renal calculi
Fluids, pain management
passive: 8mm 20%
alpha-blockers may help
Indications for acute intevention of renal calculi
high fever
unremitting pain or nausea
renal failure
Extracorporeal shockwave lithotripsy (ESWL)
shockwaves
upper ureter and kidney stones <1.5cm
CI in pregnancy
Retrograde ureteroscopy, lithoscopy, basket extraction, stent
Ureteroscope to visualize stone, fragment with laser, collect with basket extraction, stent ureter for healing
<2cm along entire kidney and ureter
used in pregnancy
Anterograde pc nephrolithotomy
pc access to kidney to break up stone
>2cm in kidney
Open nephrolithotomy /ureterolithotomy
used when less invasive measures failed
Nephrectemy
poor/nonfunctioning kidney with large stone
