UTI & Stones & ESRD

Question 1

Gold standard for UTI infection diagnosis

Answer 1

> 100,000 colony forming units

Question 2

Positive Leukocyte Esterase, Negative Nitrate

Answer 2

Pyuria, Not gram-negative (e.g. Enterococcus)

Question 3

Positive Leukocyte Esterase, Positive Nitrate

Answer 3

Pyuria, Gram-negative

Question 4

Alkaline urine with ammonia scent, motility causes “swarming” on agar

Answer 4

Proteus mirabilus

Question 5

Associated with struvite (ammonium magnesium phosphate) stones

Answer 5

Klebsiella and Proteus (urease positive)

Question 6

Some strains produce a red pigment, often nosocomial and drug-resistant

Answer 6

Serratia marcescens

Question 7

1st, 2nd, 3rd leading causes of UTI

Answer 7

1. E. Coli
2. Saprophyticus
3. Klebsiella

Question 8

Large mucoid capsule and viscous colonies

Answer 8

Klebsiella

Question 9

Sterile pyuria (pyuria as determined by > 10 WBCs/hpf and + LE with a negative urine culture) suggests…

Answer 9

Urethritis due to Chlamydia or Gonorrhea

Dominant presenting sign is dysuria

Question 10

Most common pathogens for pyelonephritis

Answer 10

1. E Coli
2. Klebsiella
3. Enterococcus

Question 11

unusual form of chronic pyelonephritis characterized by granulomatous abscess formation, severe kidney destruction, and a clinical picture that may resemble renal cell carcinoma and other inflammatory renal parenchymal diseases

Answer 11

Xanthogranulomatous Pyelonephritis

Question 12

Due to vesico-ureteral reflux or obstruction (BPH or cervical carcinoma)

Answer 12

Chronic Pyelonephritis

Question 13

Leads to cortical scarring with blunted calyces; scarring at upper and lower poles is characteristic of VUR

Answer 13

Chronic Pyelonephritis

Question 14

Atrophic tubules containing eosinophilic proteinaceous material resembling thyroid follicles; waxy casts in urine

Answer 14

Chronic Pyelonephritis - “thyroidization” of kidney

Question 15

Most common type of kidney stone

Answer 15

Calcium (oxalate or phosphate)

Question 16

Calcium stones precipitate at high/low pH?

Answer 16

High - Calcium Phosphate

Low - Calcium Oxalate

Question 17

Crystals associated with ethylene glycol poisoning or Vitamin C abuse

Answer 17

Oxalate crystals (envelope shaped)

Question 18

Treatment for recurrent calcium stones

Answer 18

HTZ and citrate

Question 19

Most common cause of calcium stones?

Answer 19

Idiopathic hypercalciuria and normocalcemia

Question 20

Which stone forms in the renal calyces and often requires surgical removal and UTI treatment?

Answer 20

Staghorn Calculi (AMP stones)

Question 21

AMP stones precipitate at high/low pH?

Answer 21

High, associated with urease organisms (Klebsiella, Proteus, Staph)

Question 22

Third most common type of stone that is RADIOLUCENT

Answer 22

Uric acid

Question 23

Risk factors for this type of stone include hot, arid climates, low urine volume, and acidic pH

Answer 23

Uric acid

Question 24

Visible on CT and ultrasound, but not X-ray

Answer 24

Uric acid stones

Question 25

Strong association with hyperuricemia, gout. Often seen in diseases with increased cell turnover (leukemia)

Answer 25

Uric acid stones

Question 26

Uric acid stone treatment

Answer 26

Hydration

Alkanization of urine

Question 27

Rare cause of kidney stones, most seen in children

Answer 27

Cysteine stones

Question 28

Secondary stones to cystinuria. Hexagonal crystals. Treat with alkalinization of urine.

Answer 28

Cysteine stones

Question 29

Type of stones in Crohn’s patients

Answer 29

Calcium Oxalate

Fat malabsorption – binds with Ca – frees up Oxalate. Increase calcium in diet.

Question 30

Clinical features of uremia -

Answer 30

Nausea
Anorexia
Pericarditis
Platelet dysfunction
Encephalopathy with asterixis
Deposition of urea crystals in skin

Question 31

What cells in kidney produce EPO?

Answer 31

Renal peritubular interstitial cells

Question 32

Cystic bone filled with brown fibrous tissue in ESRD is called…

Answer 32

Osteitis Fibrosa Cystica (caused by increased PTH)

Question 33

______ often develop with SHRUNKEN end stage kidneys during dialysis, increasing the risk for ____________________

Answer 33

Cysts

Renal Cell Carcinoma