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USMLE Renal > Urine Pathologies - Stones, Bladder > Flashcards

Urine Pathologies - Stones, Bladder Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the different types of renal stones you can get?

A
  • Calcium oxalate and phosphate
  • Ammonium magnesium phosphate (struvite)
  • Uric acid
  • Cystine
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2
Q

What stones may not be visible?

A
  • Uric acid stones are radiolucent on X-ray (visible on CT)

- Cystine stones are faintly radiopaque on X-ray and moderately on CT

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3
Q

What urine pH is associated with Uric acid and Cystine?

A

Low pH

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4
Q

What urine pH is associated with Calcium PHOSPHATE, Ammonium magnesium phosphate (STRUVITE) stones?

A

Increased pH

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5
Q

What are more common calcium oxalate or calcium phosphate stones?

A

Calcium oxalate

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6
Q

What percentage of stones are Calcium?

A

80%

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7
Q

What are causes of Calcium oxalate stones?

A
  • Ethylene glycol (antifreeze)
  • Vit C overuse
  • Hypocitraturia (associated with decreased urine pH)
  • Malabsorption (Crohn’s disease)
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8
Q

What kind of stones are associated with hypocitraturia?

A

Calcium oxalate

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9
Q

How are Calcium oxalate stones treated?

A
  • Thiazides
  • Citrate
  • Low-Na+ diet
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10
Q

How are calcium phosphate stones treated?

A
  • Thiazides

- Low Na+ diet

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11
Q

What do calcium oxalate crystals look like?

A

Envelope or dumbbell

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12
Q

What do calcium phosphate crystals look like?

A

Wedge-shaped prism

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13
Q

What do struvite (ammonium magnesium phosphate) look like?

A

Coffin lid

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14
Q

What percentage of stones are struvite (ammonium magnesium phosphate)?

A

15%

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15
Q

What are struvite (ammonium magnesium phosphate) stones caused by?

A

Infection with urease +ve bug

  • Proteus mirabilis
  • Staph saprophyticus
  • Klebsiella
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16
Q

How do urease positive bugs work?

A

Hydrolyse urea to ammnia -> urine alkalisation

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17
Q

How are struvite (ammonium magnesium phosphate) stones treated?

A
  • Eradication of underlying infection

- Surgical removal of stone

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18
Q

What percentage of stones are uric acid?

A

~ 5%

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19
Q

How are uric acid stones treated?

A
  • Alkalization of urine (CA inhibitor -acetazolamide)

- Alopurinol

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20
Q

What are uric acid stones associated with?

A
  • Decreased urine volume
  • Arid climates
  • Acidic pH
  • Gout
  • Leukemia (high cell turnover)
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21
Q

What do uric acid stones look like?

A

Rhomboid or rosettes

22
Q

What do cystine stones look like?

A

Hexagonal

-May form staghorn calculi

23
Q

What condition are cystine stones associated with?

A

Aut recessive condition

- Cystine reabsorbing PCT transporter loses function -> cystinuria

24
Q

What other amino acids are poorly reabsorbed in Cystinuria (aut recessive disorder)?

A

COLA

  • Cystine
  • Orthinine
  • Lysine
  • Arginine
25
Q

What test can confirm the presence of cystine stones?

A

+ve Sodium cyanide nitroprusside test

26
Q

What are cystine stones treated with?

A
  • Low Na+ diet
  • Alkalinazation of urine
  • Chelating agents (tiopronin, penicillamine) if refractory
27
Q

What are the causes of hydronephrosis?

A
  • Urinary tract obstruction (e.g. renal stones, BPH, congenital obstructions, cervical cancer, injury to ureter)
  • Retroperitoneal fibrosis
  • Vesicoureteral reflux
28
Q

What are the different classes of urinary incontinence?

A
  • Stress incontinence
  • Urgency incontinence
  • Overflow incontinence
29
Q

What is stress incontinence due to?

A
  • Urethral hypermobility or intrinsic sphincter deficiency
  • leak w. increased intra-abdo pressure
  • Associated w. obesity, pregnancy, vaginal delivery, prostate surgery
30
Q

How may stress incontinance be treated?

A
  • Pelvic floor muscle strengthening (Kegel) exercises
  • Weight loss
  • Pessaries
31
Q

How can stress incontinence be diagnosed?

A

+ve bladder stress test

- Directly observed leakage from urethra upon coughing or Valsalva maneuver

32
Q

What is the mechanism behind urgency incontinence?

A

Detrusor overactivity

-> Leak w. urge to void immediately

33
Q

What is urgency incontinence associated with?

A

UTI

34
Q

How can Urgency incontinence be treated?

A
  • Kegel exercises
  • Bladder training (timed voiding, distractionor relaxation techniques)
  • Antimuscarinics (e.g. oxybutynin for overactive bladder)
  • Mirabegron
35
Q

What is the mechanism of action behind overflow incontinence?

A
  • Incomplete emptying (detrusor underactivity or outlet obstruction)
  • > Leak w. overfilling
  • > Increased postvoid residual on catherization or US
36
Q

What are the causes of overflow incontinence?

A
  • Polyuria (e.g. diabetes)
  • Bladder outlet obstruction (eg BPH)
  • Spinal cord injury (eg MS)
37
Q

How can overflow incontinence be treated?

A
  • Catherization

- Relieve obstruction (eg alpha-blockers for BPH)

38
Q

What does acute cystitis present with?

A
  • Suprapubic pain
  • Dysuria
  • Urinary frequency
  • Urgency
39
Q

What are the common bugs to cause acute cystitis?

A
  • E coli (most common always)
  • Staph saprophyticus - sexually active young women
  • Klebsiella
  • Proteus mirabilis - urine has ammonia scent
40
Q

What will labs show in acute cystitis?

A
  • +ve leukocyte esterase
  • +ve nitrites (indicates presence of enterobacteriaceae)
  • Sterile pyuria (pyuria with -ve urine cultures) could suggest urethritis from STI
41
Q

What may UTI symptoms with negative urine cultures be suggestive of?

A

STI

42
Q

How are UTIs treated?

A

Antibiotics

  • TMP-SMX
  • Nitrofurantoin
43
Q

What will be seen on histology in acute pyelonephritis?

A

Neutrophils infiltrating renal interstitium

- Affects cortex with relative sparing of glomeruli/vessels

44
Q

What does acute pyelonephritis present with?

A
  • Fevers
  • Flank pain (costovertebral angle tenderness)
  • N/V
  • Chills
45
Q

What will the urine contain in acute pyelonephritis?

A

WBCs in urine +/- WBC casts

46
Q

What will CT show in acute pyelonephritis?

A

Striated parenchymal enhancement

47
Q

What are risk factors for developing acute pyelonephrtitis?

A
  • Indwelling urinary catheter
  • Urinary tract obstruction
  • Vesicouretral reflux
  • DM
  • Pregnancy
48
Q

What are complications of acute pyelonephritis?

A
  • Chronic pyelonephritis
  • Renal papillary necrosis
  • Perinephric abscess
  • Urosepsis
49
Q

What is chronic pyelonephritis a result of?

A

Recurrent or inadequetly treated episodes of acute pyelonephrtitis
- Typically requires predisposition to infection such as vesicouretral reflux or chronically obstructing kidney stones

50
Q

What will chronic pyelonephritis have in the kidney?

A
  • Coarse asymmetric corticomedullary scarring, blunted calyces
  • Tubules can contain eosinophilic casts resembling thyroid tissue (thyroidisation of kidney)
51
Q

What is xanthogranulomatous pyelonephritis?

A

Rare

  • Grossly orange nodules that can mimic tumour nodules
  • Characterised by widespread kidney damage due to granulomatous tissue containing foamy macrophages
  • Associated with Proteus infection

USMLE Renal (11 decks)

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