Urologic Cases Flashcards
What will the pain of a kidney stone be like
Sharp, stabbing
Constant pain but severity waxes and wanes (3-8/10)
Flank pain that radiates to groin***
What symptoms other than pain will a pt with a. Kidney stone have
Dysuria
Dark urine
Hematuria
Nausea
What are the 5 types of stones?
Calcium oxalate
Calcium phosphate
Struvite
Uric acid
Cystine
What is the most common type of stone
Calcium oxalate
Calcium phosphate second most
Which type of kidney stones are radiolucent
Uric acid
What are the risk factors for kidney stones
Hx of prior stone
Family hx
Decreased fluid intake
Malabsorption that causes increased oxalate excretion in urine (ex, bariatric surg)
Hyperparathyroidism, HTN, DM, obesity, gout, excessive running (marathon)
What is the preferred imaging technique for kidney stones
Non-contrast low radiation CT
Contrast decreases the sensitivity for small stones.
What is the 2nd best imaging technique for kidney stone
Ultrasound.
Less sensitive than CT. Might need to get a CT anyways if the US is negative
Who needs a referral to urology for kidney stones?
Referral:
Stone >10mm
Failure to pass stone
Significant obstruction
URGENT referral:
Infection
AKI
Anuria
Unyielding pain, N/V
What is the surgical treatment of choice for kidney stones
Shock Wave Lithotripsy
Do all stones need surgical removal
Only 10-20%
What are the 3 options for surgical removal of stones
Lithotripsy
Ureteroscopy
Percutaneous nephrolithotomy
After a stone is removed/passed, do you need to do anything with it
Send for analysis
Patient may need to pee through a strainer to collect stones
How could a patient prevent stones
Increase hydration
Decrease Na intake
Allopurinol if gout
HCTZ to reduce calcium in urine
If you get a non-contrast CT for a kidney stone what would it mean if you saw “perinephritic stranding”
Inflammation/obstruction
What medication will facilitate passage of kidney stones
α-blocker
What is the classic triad of renal cell carcinoma
Hematuria
Flank pain
Palpable abdominal mass
(Present in 9% of patients)
Does cigarette smoking increase risk for renal cell carcinoma
Yes
Also being an old guy
How will a patient present if they have Polycystic Kidney disease
Mild urine discoloration/blood
History of stones and UTIs
Mild abdominal pain/feeling of “fullness”
Elevated BP*
Palpitations
Mid systolic click*
Large palpable kidneys
What are some complications of PKD
Infection of cyst
Cyst hemorrhage
Kidney stones
What are some of the extrarenal manifestaions of PKD
Hepatic/splenic/pancreatic cysts
Heart valve abnormalities (mitral valve prolapse)
Intracranial aneurysm (worst headache of my life)
Which casts are in pyelonephritis
WBC casts
Which casts are in glomerulonephritis
RBC casts
Which casts are in acute tubular necrosis (intrinsic kidney injury)
Muddy brown/renal tubular casts
What do hyaline casts signify
Benign and found in normal urine (also present in concentrated urine…exercise/diuretics)
___________is the HALLMARK of progressive kidney disease
Declining GFR
Name that stage of CKD:
Kidney damage with normal or increased GFR
GFR 90+
Stage 1
Name that stage of CKD:
Kidney damage with mildly decreased GFR
GFR 60-89
Stage 2
Name that stage of CKD:
Mild-moderate decreased GFR
GFR 45-59
Stage 3a
Name that stage of CKD:
Moderate-severe decrease GFR
GFR 30-44
3b
Name that stage of CKD:
Severely decreased GFR
GFR 15-29
Stage 4
Name that stage of CKD:
Kidney failure
GFR <15 or dialysis
Stage 5 (add D if on dialysis)
