UTI/Nephrolithiasis/Chronic Renal Failure

Question 1

Cystitis Presentation

Answer 1

Dysuria and increased freq/urgency/suprapubic pain, but systemic signs like fever often absent

Question 2

Gold Standard for Cystitis

Answer 2

> 100k colony forming units

Question 3

Most Common Cause for Cystitis

Answer 3

E. coli

Question 4

Sterile Pyuria (what it is and like 2 causative agents)

Answer 4

> 10 WBCs/hpf and leukocyte esterase but negative urine culture (which was gold standard). Suggests urethritis from Chylamydia trachomatis or N. gonorrhea

Question 5

Notable Urine Finding in Pyelonephritis

Answer 5

WBC casts

Question 6

Chronic Pyelonephritis Gross, Histo, and Urine Characteristic Findings

Answer 6

Scarring at upper/lower poles if vesicoureteral reflux
Thyroidization of kidney from proteinaceous material in atrophic tubules
Waxy casts in urine

Question 7

Calcium Oxalate/Phosphate Stone (most common cause, treatment)

Answer 7

Idiopathic hypercalciuria - calcium high in urine but normal in blood (can just be good old fashioned hypercalcemia though)
Treat with hydrochlorothiazide, Ca-sparing diuretic

Question 8

Ammonium magnesium phosphate stone (cause, classic finding, treatment)

Answer 8

Usually urease-positive organism (P. vulgaris or Kleibsiella) -> alkaline urine leads to stone
Forms staghorn canaliculi in adults which can cause UTI
So surgical removal and eradicate pathogen

Question 9

Uric Acid Stone (radiograph, risk factor, treatment)

Answer 9

Radiolucent unlike other stones
Anything that increased uric acid like myeloprolif or leukemia
Treatment involves hydration and alkalinization of urine with like potassium bicarb, maybe allopurinol for gout

Question 10

Cysteine stone classic finding (cause and classic finding)

Answer 10

From cystinuria, genetic defect where tubules can’t reab cysteine
Staghorn canaliculi in children

Question 11

Hyperkalemia in End Stage Renal Failure

Answer 11

AG metabolic acidosis

Question 12

Anemia in End Stage Renal Failure (specific cells)

Answer 12

Decreased EPO from Renal Peritubular Interstitial Cells

Question 13

2 Causes of Hypocalcemia in End Stage Renal Failure

Answer 13

Decreased 1-alpha-hydroxylation of Vit D

Hyperphosphatemia bc can’t excrete and binds

Question 14

3 Causes of Renal Osteodystrophy from End Stage Renal Failure

Answer 14

Secondary hyperparathyroidism from low Ca
Osteomalacia from decreased mineralization
Osteoporosis from metabolic acidosis being buffered by Ca from bone

Question 15

Dialysis Gross Effect on Kidneys and At-Risk-For

Answer 15

Cysts with shrunken kidney (different from PCKD)

Increased risk of RCC