UT obstructions and congenital disorders

Question 1

Symptoms and signs:
Asymptomatic (detected in imaging)
Symptomatic: renal colic, pain localized in the back, intensive increasing with no alleviating factors.

Answer 1

Urolithiasis

Question 2

Extrinsic causes in upper urinary tract obstruction?

Answer 2

Cervix: carcinoma
Uterus: pregnancy or tumor
Prostate: invasive carcinoma

Question 3

Pain or burning sensation during urination

Answer 3

Dysuria

Question 4

Detects opaque calcareous or cystine stones. Wide availability and minimal radiation and low cost. But it has limited sensitivity and specificity

Answer 4

KUB (kidneys, ureters, and bladder) x-ray

Question 5

Affects 5%-10% of the US people, nephrolithiasis, men are more affected, the age of predisposition is 20-30 years, heredity and errors in metabolism ((cystinuria (Ýconcentrations of cystine in urine) and primary hyperoxalurias)

Answer 5

Urolithiasis

Question 6

Laboratory findings:

• increased serum creatine: bilateral & unilateral obstruction
• hematuria and pyuria: few RBC, but depending on obstruction hematuria will be present

Answer 6

Ureteral colic

Question 7

70% most common stones in the US are composed of?

Answer 7

Calcium oxalate or calcium phosphate

Question 8

Decreased pH urinalysis most likely describes what type of stones?

Answer 8

Uric acid stones or calcium oxalate stones

Question 9

Obstruction below the vesicoureteral junction

Answer 9

Lower urinary tract obstruction

Question 10

Highest sensitivity and specificity for kidney diagnosis, but the disadvantage: radiation exposure and high cost.

Answer 10

CT scan

Question 11

patients with hyperuricemia, gout and leukemias has increased?

Answer 11

Uric acid

Question 12

refers to dilation of the urinary tract, renal pelvis, and calyces with kidney atrophy

Answer 12

Hydronephrosis

Question 13

Ureteral functional causes of lower UT obstruction?

Answer 13

Prostate: benign prostatic hypertrophy

Bladder: cancer

Question 14

strong need to urinate.

Answer 14

Urinary urgency

Question 15

Low grade obstruction is also known as?

Answer 15

Partial or incomplete obstruction

Question 16

Answer 16

Agenesis of the kidney

Question 17

Risk factors:

dietary: (animal protein, oxalate, Sodium, sucrose and fructose)

Non dietary: (age, race, obesity, lack access of water and medication table in pp, exercise)

urinary: increased urine vol.

Clinical presentation:
• Present or absence of pain, depends on site of obstruction and degrees.
• Pain, change in urine output, hypertension, hematuria and Ý serum creatine.

Answer 17

Urolithiasis

Question 18

Bilateral agenesis is incompatible with life.
• The solitary kidney enlarges as a compensatory hypertrophy.
• Some develop glomerular sclerosis in the remaining kidney as a result of the adaptive changes in hypertrophied nephrons.

Answer 18

Agenesis of the kidney

Question 19

Pathogenesis:
Stones occurs in urine that is supersaturated, this affects:
• Crystal components concentrations • Inhibitors(citrate)
• Urine pH

Answer 19

Urolithiasis

Question 20

Ureteral anatomic causes of lower urinary tract obstruction?

Answer 20

Post-instrumentation such as catheter

Question 21

Answer 21

Hypoplasia

Question 22

refers to the renal disease cause by impaired flow of urine or tubular fluid.

Answer 22

Obstructive nephropathy

Question 23

Pain is abrupt and intensifies over time, pain resolves with removal or passage.
Gross hematuria, urinary urgency, frequency nausea, and vomiting can occur.
When is in the bladders: urinary frequency, dysuria, suprapubic pain and urinary incontinency.

Answer 23

Ureteral colic

Question 24

75% most common stones in the Mediterranean and Middle East are composed of?

Answer 24

Uric acid

Question 25

Failure of the kidney develop a normal size • This could occur bilaterally=renal failure in early childhood. More commonly unilateral defect. • Is seen in low weigh birth infants

Answer 25

Hypoplasia

Question 26

Etiology: formation of stones by supersaturation of the compounds: • magnesium ammonium phosphate • calcium oxalate and phosphate association with patients with hypercalcemia (increased Ca+2 in blood), hypercalciuria (increased Ca+2 in urine), hyperparathyroidism, diffuse in bone disease, sarcoidosis.

Answer 26

Urolithiasis

Question 27

Most frequent in males (in children’s) • As a result of urethral valve or pelviureteral junction obstruction • If the obstruction is in early development the kidney fails to develop but if is bilateral -\> high mortality rates • If is in later gestation and is unilateral hydronephrosis and nephron loss still occurs. Epidemiology: 10% of the pIeople are born with malformation of the urinary system, hereditary.

Answer 27

Congenital urinary tract obstruction

Question 28

structural or functional changes in the urinary tract that impede normal urine flow.

Answer 28

Obstructive uropathy

Question 29

Answer 29

Ectopic kidney

Question 30

**Physical findings:** costovertebral angle tenderness. Is not consistent and intense as in pyelonephritis, abdominal examination negative, hypertension and tachycardia

Answer 30

Ureteral colic

Question 31

Can affect the upper or lower part of the urinary tract. It will be by intrinsic or extrinsic causes. ## Footnote **Causes**: • Urinary calculi • Benning prostatic hypertrophy • Tumors • Malignant disease (carcinoma of the cervix or uterus) • Inflammation (prostatitis, ureterisis, urethritis)

Answer 31

Acquired urinary tract obstruction

Question 32

Abnormally frequent urination

Answer 32

Urinary frequency

Question 33

Noninvasive, fast, low cost, but low sensitivity. Excellent in detecting: hydronephrosis and hydroureter.

Answer 33

Ultrasound

Question 34

The development of the metanephros into the kidney may occur in ectopic foci. • This kidney lies above the pelvic brim or within the pelvis it can be small or normal size. • Because of the abnormal position, the ureters may cause obstruction to the urinary flow. -can lead to bacterial infections

Answer 34

Ectopic kidney

Question 35

Urinary tract calculi or stone

Answer 35

Urolithiasis

Question 36

Answer 36

Acquired urinary tract obstruction

Question 37

genetic defects in renal absorption of AA like cysteine -\> cystinuria. This stones form at low pH

Answer 37

Cysteine stones

Question 38

High grade obstruction is also known as?

Answer 38

Complete obstruction

Question 39

Obstruction above vesicoureteral junction

Answer 39

Upper urinary tract obstruction

Question 40

Answer 40

Horseshoe kidney

Question 41

If there's hematuria in the urinalysis most likely there is?

Answer 41

Active stone disease

Question 42

Fusion of the upper or lower poles of the kidney and is continues across the midline anterior to the great vessels. • Found in 1 in 500 to 1000 autopsies.

Answer 42

Horseshoe kidneys

Question 43

How will the pH in the urinalysis be in patients with calcium phosphate stones?

Answer 43

Increased pH

Question 44

Stones in the kidney

Answer 44

Nephrolithiasis

Question 45

Intrinsic causes in upper urinary tract obstruction?

Answer 45

Stones