Icm Hematuria

Front 1

what is hematuria

gross
micro

Back 1

blood in the urine- gross or micro

Gross: visible to naked eye. SERIOUS. cola color when from kidney. Bright when from bladder or urethra, can have clots

Micro: detected by dipstick, then confirmed

Front 2

what gross hematiuria is cola color, what about bright

Back 2

Cola: from kidney

Bright: bladder or urethra

Front 3

what is the typical presentation of a pt with PSGN

Back 3

previous UNTREATED strep infection

*edema

Front 4

what is the most common cause of hematuria worldwide

Back 4

schistosomiasis

**any blood in urine must be worked up!

Front 5

what is pseudohematuria and what causes it

Back 5

red urine (-) for blood

1. meds
2. veggies
3. Antiseptics- iodine
4. metabolites

Can also have false + for blood of urine has seman, basic, or cleaners in it

Front 6

is a + urine dipstick for blood synomous with hematuria

Back 6

nope, confirm with micro analysis

False +:
seman
alkaline urine
contamination with perineal cleaning agenst

Front 7

what can seman in the pee, basic pee, or contamination of pee with perineal cleaners do to UA

Back 7

test + for blood

+ UA for blood is NOT always hematuria

Front 8

ok so fale + hematuria on UA due to seman, aalkaline, cleansers. what can cause a flase -

Back 8

vit C is large amts- more rare

**highly sensitive test so typically a neg is a neg but a + can sometimes be false

**confirm with micro analysis

Front 9

what things can make a urine dipstick + for blood

Back 9

1. Blood
2. False +: seman, basic, cleansers
3. Hemoglobinuria (from hemolysis)
4. Myoglobulinuria (from mm injury)

Front 10

if your rapid UA is + but the micro is - what are you thinking

Back 10

1. Hemoglobinuria: increased LDH, bilirubin
2. myoglobinuria: increased CPK

**or false + from seman, basic, cleansers

Front 11

what are the causes of true hematuria

Back 11

1. Intrarenal: glomerular, or non glomerular

2. Extrarenal: infection, malignancy, Meds, Stones, Trauma, Irritation, Endometriosis

Front 12

what are non glomerular renal causes hematuria

Back 12

malignancy
papillary necrosis
trauma
vascular infectious

Front 13

what are some of the glomerular renal causes of hematuria

Back 13

PRIMARY
alport syndrome- x linked, hearing loss too
IgA nephrophathy- recent URI
thin BM disease

SECONDARY:
goodpastures
henoch schoniein purpura
post infectious glomerulonephritis
lupus
wegners: vasculitity. upper airway, lung, kidney. C ANA

Front 14

what things will tell you if a hematuria is glomerular

Back 14

1. RBC casts
2. dysmorphic RBC
3. Dark Urine
4. Proteinuria

Non glomerulat menas clots

Front 15

if you have clots and hematuria where is the blood coming from

if you have RBC casts, dysmorphic RBC, dark urine, and proteinuria where did the blood come from

Back 15

renal in each case

*glomerular

**non glomerular

Front 16

strep tx prevents what? what wotn it prevent

Back 16

prevents rheumatic fever but NOT PSGN

Front 17

what are hte expected values in PSGN

1. C3
2. C4
3. ASO

Back 17

1. C3 decreased
2. C4 WNL
3. ASO increased

**if it were IgA nephropathy

Front 18

what does the presence of RBC casts or dysmorphic RBC indicate as to the location of problems

Back 18

glomerular- also dark urine and perhaps proteinurua

Front 19

what is the role of renal biopsy in the typical pt presenting with PSGN. what would be the findings of EM

Back 19

biopsy not normally needed

EM: C3 granular supepithelial humps

Front 20

at the time of presentaiton of a pt with PSGN what is likely to be the result of a rapid sccreenin test for the presence of b hemolytic strep

Back 20

negative, but ASO titer will be high

Front 21

if BUN and creatinine are elevated what does this imply about GFR

Back 21

indicated glomerular disease. decreasd GFR

Front 22

briefly describe the pathogenesis of PSGN

Back 22

immune complex mediated

GABHS --> AB --> AB:AG deposit --> compliment

Front 23

does treatment with AB prevent PSGN

Back 23

nope. it will prevent rheumatic fever

Front 24

what are the causes of pseudohematuria and what can cause a false - or false + for blood

Back 24

Pseudohematuria: red pee, no blood
1. Meds
2. Veggies
3. Antiseptics
4. Metabolites

False -
Vit C

False +
seman, soap, basic
hemoglobin
myoglobin

Front 25

when will the dipstick be + but the microscopic be - for blood

Back 25

false +

hemoglobin
myoglobbin

Front 26

schistosomiasis causes what

Back 26

most common case of hematuria worldwide

Front 27

does anticoagulant therapy sufficiently explain a persons hematuria

Back 27

nope, work it up!

Front 28

recent URI with hematuria can susggest what

Back 28

1. PSGN: ASO titer is high, C3 low, C4 WNL. PE will show increased BP and edema

2. IgA nephropathy

Front 29

RBC casts are associated with

WBC casts are associated with

Back 29

glomerulonephritis

pyelonephritis

Front 30

if a adult has hematuria w/o glomerular indications (REB cast, dysmorphic RBC, dark urine, protein) how can you rule out malignancy

Back 30

x ray
cytology
cytoscopy
MDCTU- multidetector CT urography

**in kidss do US

Front 31

should we screen for hematuria in healthy ppl

Back 31

nope

Front 32

what are hte things associated with glomerulonephritis

Back 32

1. inflammatory- RBC casts, dysmorphic RBC,
2. hematuria
3. edema
4. HTN
5. recent sore throat
6. increased BUN creatinine--> DECREASED GFR
7. icnreased ASO (NOT INCREASED RELATIVE TO DISEASE), decreased C4, C4 WNL
8 rapid strem can be -

Front 33

so we get the immune complex mediated PSGN after what kind of strep infection

Back 33

throat (1-3 weeks) or skin (3-6 weeks)

AB:AG complex that activates compliment

Front 34

what happens to BIN and creatinine in PSGN

Back 34

increased. indicated renal insufficiency. decreased GFR

Front 35

whats the tx for PSGN

Back 35

self limited, most children recover completly

*tx aimed at sx:
mgmt of HTN and fluid retention- use LOOPS NOT K sparring
*diet to decrease salt adn protein and K

**AB to stop carrier state but wont affect disease

Front 36

shoujdl K sparring diuretics be given to tx sx of PSGN

Back 36

NOPE@ give loops

Front 37

how do we monitor that the PSGN followed a self limited course and healed with no problemo

Back 37

check C3 (was originally low), shold be normal in 6 weeks

check creatinine- normal in a month

hematuria resolves in 3-6 months

Front 38

whats alports

Back 38

X linked

assocaited with renal failure nad deafness in males

Front 39

what is thin BM disease

Back 39

causes benign familial hematuria

**fx hx of hematuria but not renal failure

Front 40

what is goodpasture (anti glomerular BM disease)

Back 40

pulm hemmorage
*autoimmune disease: deposits lead to
-glomerulonephritis
-pulm hemmoarage
-ANTI GBM AB

*+ ANCA

**aggressive, mortality high

Front 41

IgA nephropahty aka bergers disease is

Back 41

most common cause of glomerulonephritis world wide

**associatd with URI
**ASO and compliment are normal (PSGN is high ASO, low C3)
**onset 5 days after infectino (PSGN is weeks)
**hematuria is presistent (PSGN goes away in 6 mo)

Front 42

what is the work up for + RBC in an adult

Back 42

1. H & P
2. BUN/Creatinine
3. MDCTU
4. Urine Cytology, x first 3 voids
5. Cytology/ureteroscopy