URO - UTOB Flashcards
Refers to the dilation of the renal pelvis or calyces
Hydronephrosis
Refers to the functional or anatomic obstruction of urinary flow at any level of the urinary tract
Obstructive uropathy
Present when the obstruction causes functional or anatomic renal damage
Obstructive nephropathy
True about symptom of upper urinary tract obstruction EXCEPT
a. Pain secondary to stretching of the urinary collecting system
b. The pain produced by ureteral obstruction is sharp and persistent
c. Hematuria in adults should be regarded as asa symptom of urologic malignancy
d. AOTA
e. NOTA
B. pain is colicky
What is the hallmark of partial or complete upper urinary tract obstruction is
hydroureteronephrosis
True about clinical implications of upper urinary tract obstruction EXCEPT
a. Hydroureteronephrosis with the ureteral dilation extending to the level of the obstruction
b. Hydroureteronephrosis directly correlated with the degree of obstruction
c. Serum creatinine may be elevated in the contralateral kidney will compensate so serum chemistries may not indicate renal impairment.
d. Partial obstruction may result in permanent loss of function on the affected side if not alleviated within several weeks.
B. does not correlate, it may take some time for hydronephrosis to develop
Complete occlusion of the upper ureteral tract can cause permanent dysfunction within _____
2 weeks
What are the most common stones in the urinary tract?
Calcium oxalate
Arrange the following in order of frequency
A. Calcium oxalate
B. Struvite
C. Cystine
D. Calcium Phosphate
A>D>B>C
CT scans will demonstrate all calculi EXCEPT those composed of
crystalline-excreted indinavir
What is the study of choice to evaluate for urolithiasis
Non contrast CT scan
True about Upper urinary tract obstruction EXCEPT
a. Stones are usually asymptomatic in the renal pelvis or bladder but are very common cause of symptomatic ureteral obstruction.
b. Smaller stones up to 5mm may cause severe symptoms but typically pass without intervention
c. alpha blockers wihch relax the distal ureter may be given to reduce renal colic.
d. calculi >=7mm are more likely to become impacted or have a prolonged passage through the ureter
B. 6mm not 5mm
True about urolithiasis
a. obstructing stones are temporized with stent placement, which allows proximal collecting system decompression.
b. urinary infection coexists with an obstructing stone, a stent can be placed but a PCN is preferable if the patient demonstrates any instability
c. definitive treatment for renal or ureteral calculi iinclude extracorporeal shockwave lithotripsy.
d. Patients with recurrent stones will benefit from examination of stone composition and 24 hr urine collection
ATOA
Definitive treatment of renal or ureteral calculi (5)
Ureteroscopy
Percutaneous Nephrostolithotomy
Extracorporeal Shock wave lithotripsy
T/F better hydration is useful for all etiologies
T
most patients will benefit from alkalinization of the urine. What is used to do this?
Potassium citrate
The noncrystalline component of stones composed of mucoproteins, proteins, carbohydrates, urinary inhibitors
Matrix
Indications for a metabolic stone evaluation
Recurrent stone formers Strong family history of stones Intestinal disease Pathologic skeletal fractrues Osteopoosis History of urinary tract infection with calculi Personal history of gout Infirm health Solitary kidney Anatomic abnormalities Renal insufficiency
urine pH <5.5 what is the most likely etiology of stone
a. infection lithiasis
b. calcium oxalate
c. uric acid
d. cysteine
C
urine pH > 7.5 which lithiasis more likely?
Infection lithiasis
Stone is radioopaque on radiography. This is true in the following EXCEPT
a. calcium oxalate
b. calcium phosphate
c. xanthine
d. struvite
C; Struvite is radioluscent. same as uric acid, xanthene, triamterene
True about abbreviated protocol for low-risk single stone formers EXCEPT
a. complete medical history is necessary only in certain cases
b. calcium fast/ load tests can discriminate between various forms of hypercalciuria
c. Routine performance of calcium fast/load tests is required to complete a metabolic evaluation
C
Hyperuricosuria may be associated with these types of calculi
Pure uric acid
calcium oxalate
What should be suspected in patients who are hyperuricosuric
dietary indiscretion/purine gluttony
Usual urine pH in infection calculi
greater than 6.5 and 7.0
Typical appearance stones produced with infection.
staghorn calculi
How much fluids should be consumed?
enough to produce 2-3L urine per day
True about fluid recommendations
a. we are required to drink 8-10 glasses of water a day
b. water hardness is unlikely to play a significant role in recurrence risk.
c. carbonated water increases risk of stone formation
d. Soda-flavored with phosphoric acid may decrease stone risk.
e. soda flavored with citric acid increase stone risk
B
A. Drink enough to make 2L of urine
C. carbonated drink decreases risk of stone formation
D. phosphoric acid: increase stone risk
E. citric acid: decrease stone risk
True about dietary recommendations
a. citrus juices may be useful adjunct to stone prevention
b. animal diet reduce stone risk
c. diet high in fruits increase stone formation
d. no benefit for dietary sodium restriction
A
b. increase risk
C. decrease risk
D. with benefit
True about dietary recommendations
a. Dietary calcium restriction reduces risk for stone recurrence
b. Calcium supplementation s likely safest when waken with meals
c. avoidance of excess dietary oxalate is unnecessary
d. Vitamin C in large doses may decrease the risk of stone recurrence
B
A. dietary calcium increases risk of stone recurrence
C. avoidance of excess dietary oxalate is reasonable and intuitive
D. Vitamine C in large doses may increase the risk of stone recurrences
Dose limit of Vitamin C/ day
2g/day
Give 5 examples of oxalate food
Tea cocoa spinach mustard greens pokeweed swiss chard beets rhubarb okra berries chocolate nuts wheat germ soy crackers pepper
What are the first-line therapy for renal hypercalciuria
Thiazides
True about hyperuricosuric calcium oxalate nephrolithiasis
a. patients with hyperuricosuria should be instructed to decrease dietary purine intake
b. allopurinol can decrease uric acid
c. potassium citrate can effectively alter the urinary milieu in patients with hyperuricosuria
c. Allopurinol decrease the supersaturation of uric acid and calcium oxalate
AOTA
Struvite calculi are best managed with
surgical removal rather than chemical dissolution
Recurrent infections and therefore recurrent calculi may be avoided with the use of
antibiotic prophylaxis
What is the preferred intervention for normal kidney with small stone burden
Shock wave lithotripsy
Patients with lower pole calculi larger than ____ will experience significantly better stone-free rates after PNL than after SWL
10mm
The procedure of choice for patients with staghorn calculi is
PNL
This is a good treatment option for the morbidly obese with a large stone burden.
PNL
what treatment should be done for morbidly obese patient with renal calculi, small stone border
utereoscopy
Process resulting in encasement of the ureters along with the great vessels, in a dense fibrotic mass.
Retroperitoneal fibrosis
What are the imaging findings for retroperitoneal fibrosis?
medially displaced ureters with a homogeneous, plaque-like mass in the retroperitoneum.
This medication may be given to reverse the inflammatory process in retroperitoneal fibrosis
corticosteroid
True about retroperitoneal fibrosis except
a. underlying malignancy should always be considered.
b. fibrotic and inflammatory mass envelopes and potentially obstructs retroperitoneal structures including either or both ureters
c. fibrous whitish plaque that encase the aorta, inferior vena cavaa, and their major brances and also the ureters.
d. common
D, rare
Symptoms of retroperitoneal fibrosis
nonspecific symptoms:
- back, abdominal, or flank pain
- weight loss
- anorexia
- malaise
What percentage of patients with retroperitoneal fibrosis will have hypertension
50%
Classic radiologic findings in retroperitoneal fibrosis
medial deviation of extrinsically compressed ureters with hydronephrosis
What is the management for retroperitoneal fibrosis if medical tx fails or if the patient is not a candidate for medical tx?
Ureterolysis
When should ureteral stents be removed?
6-8 weeks after ureterolysis.
