Johns Hopkins Chapter 36 - Hematuria And Stones

Front 1

Define hematuria

Back 1

variable, > 3 RBCs/hpf (microscopic hematuria)

Front 2

false positive hematuria in urine dipstick - DDx? (4)

Back 2

presence of heme despite no RBCs -- myoglobinuria, hemolysis, povidone-iodine, or presence of oxidizing agents

Front 3

presence of red urine but no blood or heme

Back 3

pseudohematuria

Front 4

etiologies of pseudohematuria (5)

Back 4

food (beets, rhubarb) or meds (pyridium, phenothiazines) or diseases (porphyria).

Front 5

transient hematuria - differentials? (4)

Back 5

fever, exercise, CHF, menstrual blood

Front 6

initial hematuria - implication?

Back 6

urethral source

Front 7

terminal hematuria - implication?

Back 7

bladder source

Front 8

clue: hematuria and analgesic use

Back 8

papillary necrosis

Front 9

clue: hematuria and antibiotic use

Back 9

AIN

Front 10

clue: hematuria and FH or renal failure (both men and women affected)

Back 10

ADPKD

Front 11

clue: hematuria and FH of hematuria in men only

Back 11

Alport syndrome (esp with deafness)

Front 12

clue: hematuria and tobacco use or dye exposure

Back 12

bladder cancer

Front 13

findings in urinalysis that rules out a glomerular source

Back 13

clots

Front 14

findings in urinalysis that indicates a glomerular source

Back 14

dysmorphic RBCs, RBC casts

Front 15

urinalysis shows dysmorphic RBCs - next diagnostic steps? (8)

Back 15

ANA, RF, complement levels; ANCA, anti-GBM; ASO, hepatitis serologies, cryoglobulins

Front 16

lab test to order if bladder cancer suspected?

Back 16

urine cytopathology

Front 17

4 imaging modalities used to evaluate hematuria

Back 17

IVP, US, CT, CT urogram

Front 18

conditions where an IVP is used as an imaging modality in the evaluation of hematuria

Back 18

IVP is the definitive test for medullary sponge kidney disease and papillary necrosis; it is superior to US for detection of stones or cancer in the ureters

Front 19

When is US more advantageous as imaging modality for hematuria?

Back 19

Superior to IVP for ADPKD, renal cell CA, small bladder CA

Front 20

What are the disadvantages to using renal US?

Back 20

Limited in detection of small solid lesions (<3 cm)

Front 21

When should CT be used in the evaluation of hematuria?

Back 21

Superior to IVP for nephrolithiasis; mass observed with US - CT better defines the mass

Front 22

most sensitive test for hematuria

Back 22

CT urogram

Front 23

2 subtypes of ADPKD

Back 23

ADPKD1 (85% to 95%) - chromosome 16; ADPKD2 (5% - chromosome 4

Front 24

usual clinical presentation of ADPKD

Back 24

gross or microscopic hematuria in 50%; hypertension; +/- flank pain, palpable abdominal mass

Front 25

diagnostic test for papillary necrosis

Back 25

IVP or CT urogram

Front 26

conditions that precipitate papillary necrosis

Back 26

SCD, DM, NSAIDs, obstruction, TB

Front 27

nonglomerular causes of hematuria

Back 27

exercise-induced, ADPKD, papillary necrosis, stones, infections, malignancies

Front 28

3 most common glomerular causes of isolated hematuria without significant proteinuria (<500 mg/day)

Back 28

IgA nephropathy, thin basement membrane disease, and Alport syndrome

Front 29

diagnostic test for IgA nephropathy

Back 29

Renal biopsy; IgA immune complex deposits along glomerular mesangium

Front 30

treatment for IgA nephropathy

Back 30

ACEI/ARB (if + proteinuria), Immunosuppressive agents (if creatinine rising rapidly or if urine protein >1 g/day); Fish oil if >1 g/day proteinuria

Front 31

treatment for thin basement membrane disease (benign familial hematuria)

Back 31

no treatment

Front 32

treatment of Alport syndrome

Back 32

supportive

Front 33

associated findings in Alport syndrome (5)

Back 33

High-tone sensorineural deafness; Lenticonus or cataracts; Microscopic or gross hematuria; proteinuria (late);ESRD in majority by age 35

Front 34

another name for Alport syndrome

Back 34

hereditary nephritis

Front 35

most common types of kidney tones

Back 35

Calcium-based (oxalate and phosphate): 75% (pure calcium phosphate: 5%)

Front 36

first step in work-up of kidney stones

Back 36

rule out obstruction (CT, US, IVP)

Front 37

gold standard imaging study for nephrolithiasis

Back 37

noncontrast stone protocol CT

Front 38

Standard initial studies (bloodwork) for suspected kidney stones

Back 38

BMP, calcium, phosphorus, uric acid levels

Front 39

risk factors for stones recurrence (needs 24-hour urine collection for stone risk profile)

Back 39

family history in middle-aged white men, malabsorption (Crohn or UC), chronic diarrhea, gout, and procedure required to remove stone

Front 40

24 hour urine tests should be sent for ? (11)

Back 40

volume, sodium, creatinine, sulfate or urea nitrogen, calcium, phosphate, uric acid, oxalate, citrate, cystine, and pH.

Front 41

Identify the type of kidney stone: Envelope-shaped crystals

Back 41

calcium oxalate

Front 42

Identify the type of kidney stone: Radiolucent crystals

Back 42

uric acid

Front 43

Identify the type of kidney stone: Crystals resemble coffin lids

Back 43

struvite

Front 44

Identify the type of kidney stone: Hexagonal greenish-yellow crystals

Back 44

cystine

Front 45

Identify the type of kidney stone: Respond poorly to lithotripsy

Back 45

cystine

Front 46

risk factors for calcium oxalate stones

Back 46

hypercalciuria, hyperoxaluria, hyperuricosuria, hypoctiraturia

Front 47

foods high in oxalate

Back 47

Baked potatoes, strawberries, okra, spinach, brewed tea, nuts, chocolate

Front 48

treatment of calcium oxalate stones

Back 48

(depends on etiology) hypercalciuria - low Na diet, thiazide diuretics; hyperoxaluria - avoid calcium lmitation; hyperuricosuria - decrease purine intake / allopurinol; hypocitraturia - potassium citrate

Front 49

treatment of calcium phosphate stones

Back 49

treat hypercalciuria - low Na diet, thiazide diuretics

Front 50

risk factors for calcium phosphate stones

Back 50

type 1 RTA, primary hyperPTH, alkaline urine

Front 51

RF for uric acid stones

Back 51

high uric acid (gout,myeloprolif disorder), acidic urine

Front 52

RF for struvite stones

Back 52

UTI with urease-producing bacteria (Proteus)

Front 53

treatment of struvite stones

Back 53

Antibiotics; stone removal by urology

Front 54

RF for cystine stones

Back 54

decreased tubular reabsorption of cystine (genetic defect)

Front 55

treatment of cystine stones

Back 55

increase fluid intake (decrease cystine conc); Alkalinize urine; meds with sulfhydryl groups to increase cystine solubility (e.g., tiopronin, penicillamine)