Kidney And Upper Urinary Tract

Front 1

What is the definition of hematuria?

Back 1

>3 RBC/high powered field in urinary sentiment

Front 2

If someone has a positive dipstick for hematuria, what should you do?

Back 2

LOOK AT THE URINE UNDER THE SCOPE

PPV of the dipstick is 35%

Front 3

What is more severe: gross or microscopic hematuria?

Back 3

Gross

Front 4

If you have gross hematuria, where are possible places where you could have lesions?

Back 4

Initial: urethra
Terminal: bladder neck/prostate
Total: interior of bladder/upper tract

Front 5

If the urine is red but the dipstick is negative for blood, what should you think?

Back 5

Something else is causing the red urine!

Dyes

Front 6

What shoud you think if the dipstick is + but there are no RBC under the scope?

Back 6

False positie test

Front 7

If there are bacteria in the urine, what should you think?

Back 7

Possible infection at any point in the genitourinary tract

Front 8

If you see proteinuria(<2+) or dysmorphic RBCs/casts, what should you tink?

Back 8

Glomerulonephritis

Front 9

What is flank pain indicative of while taking a history of someone with kidney related disease?

Back 9

Stones

Front 10

If someone presents with urologic symptoms and have dysuria/bladder irritability, what should you think?

Back 10

Bladder, prostateinfection

Front 11

How does someone with sicke cell or diabetes present with renal symptoms?

Back 11

Papillary necrosis

Front 12

What environmental exposures put a person at incrased risk for renal or urothelial cancers?

Back 12

Tobacco use
Environmental exposures to aromatic dyes

Front 13

If someone presents with visible blood at the urethral meatus, what should you tink?

Back 13

Urethral source of the hematuria

Front 14

If somoene presents with fever, hematuria, and costovertebral angle tenderness, what should you tink?

Back 14

Pyelonephritis

Front 15

If someone presents with hematuria and positive for an infection, what should you do?

Back 15

Treat with antibiotics and see what happens

If hematuria clears, don't do anything else

If it doesn't work them up

Front 16

What are the imaging modalities that are commonly used when a person presents with hematuria?

Back 16

Intravenous uretogram

Abdominal film + US

CT scan

Front 17

What are the big three on you differential diagnosis fo hematuria?

Back 17

Infection
calculi
Cancer

Farther down:
Obstruction
Trauma/Exertional hematuria
Medical renal disease
Benign familial hematuria

Front 18

What are some infections that can cause hematuria?

Back 18

Kidney infections:
Pyelonephritis
Pyonephrosis
Renal abscess

Bladder infections

Prostate infections

Urethritis

Front 19

Where are some of the different places that calculi are that can cause hematuria?

Back 19

Kidney
Ureter
Bladder

Front 20

What are some of the cancerous causes of hematuria?

Back 20

Kidney
Upper collecting system
Bladder
Urethra
Prostate

Front 21

What are some benign neoplasms/lesions that can cause hematuria?

Back 21

Kidney:
-simple cysts
-cystic renal diseases
-angiomyolipoma

Ureter:
-hemangioma

Bladder
-endometrioma

Urethra
-condyloma

Front 22

What are some kinds of obstructions that can cause hematuria?

Back 22

Obstructions of the ureter:
-Ureteropelvic junction
-Intrinsic strictures
-Extrinsic obstruction

Bladder
-Outlet obstruction (BPH

Uretura
-strictures

Front 23

Can you assume that truama/exertional is the cause of hematuria?

Back 23

NO!

You've got to still do the full workup; you can't miss something

Front 24

What is the classic presentation of a person with ureteropelvic junction obstruction?

Back 24

Young: it's congenital

Flow dependent: increased fluid intake, more pain

*caused by histologic disorganization

Front 25

What parts of the GU system are especiall vulnerable to obstruction? What site is the most commonly congenitally obstructed?

Back 25

Ureteropelvic junction
Crossing of the iliac vessels
Ureterovesical junction

UPJ

Front 26

What diagnostic tests are good to order up for ureteropelvic junction obstruction?

Back 26

Diuretic renal scintigraphy: the obstructed kidney will get rid of the tracer faster

IV urogram: hydronephrosis, nonvisualization of the effected side

Front 27

What is the treatment for ureteropelvic junction obstruction?

Back 27

Generally, it's minimally invasive

Put in a stent, it's usually fixed

Front 28

What is the primary cause of UPJO?

Back 28

It's congenital.

Histological disorganization at the UPJ:
-Loss of longitudinal muscle fibers
-Increased collagen
-Attenuation of muscle bands

Also, crossing vessels, high insertion, kinks, bands

Front 29

What are secondary cases of UPJO?

Back 29

CANCER-->external compression

Scarring due to doctors effing with things

Front 30

If a kidney has been for a long time without function, what should you do?

Back 30

Just take it out!

They recover function poorly.

Front 31

What is more serious: non-obstructive or obstructive dilation of the urinary tract?

Back 31

Obstructive

Front 32

What are causes of non-obstructive dilation of the urinary tract?

Back 32

Ureteral reflux
Prior obstruction
Extra-renal pelvis
Diuresis

Front 33

How does obstruction cause damage to the kdieny?

Back 33

Increased pressure causes a loss of organ function

Front 34

What does an obstructed kidney look like on ultrasound?

Back 34

TOo much fluid inside-->hydronephrosis

Front 35

What changes occur upon ultrasonography with restrictive indices in an obstructed kidney?

Back 35

Decreased diastolic flow velocity

Front 36

What is the best test to look for an obstructed kidney?

Back 36

Whitaker test

Look at the pressure within he renal pelvis

Front 37

What are the treatment options for UPJO?

Back 37

Most invasive --> least invasive

Open pyeloplasty
Laparoscopic pyeloplasty
Percutaneous endopyelotomy
Retrograde baloon dilation, dendopylotemy

Front 38

What are the symptoms of an acutely obstructing distal uretral calculus?

Back 38

Sudden onset of flank pain
Initial gross hematuria
Restless, moving about
Nausea

Front 39

How can you tell that a stone is lodged in the distal ureter?

Back 39

Distal ureter shares innervation with the bladder --> frequent urination.

Front 40

What is the expected radiation of the pain in a stone?

Back 40

Flank-->scrotum

Front 41

What is the difference in the presentation of someone with a peritoneal problem versus a stone?

Back 41

If you have a peritoneal process, you're rigid on the table. Everything hurts. If you've got a retroperitoneal process, you're rolling around, trying to get away from the pain.

Front 42

What is the differential diagnosis for an acute ureteral obstruction?

Back 42

Intrinsic: calculi, tumor, clot, edema

Extrinsic: compression by tumor, lymph node

Front 43

What imaging studies should you order when there's acute ureteral obstruction?

Back 43

1. KUB + US
2. CT - most diagnostic

KUB
IVU
Ultrasound

Front 44

If a stone is 5 mm, what's it's chance of passing?

Back 44

50%

Front 45

What types of stones won't show up on CT?

Back 45

People who are on antiretrovirals won't have their stones show up on CT

Front 46

What will an obstructed kidney look like on CT?

Back 46

It wont' have as much contrast going to it: there's vasoconstriction to prevent blood flow from going to it.

Front 47

What would be reasons for doing an IV urography instead of a CT?

Back 47

Already compromised renal function

Front 48

What types of stones are dissolvable? Are they radiolucent or radioopaque?

Back 48

Uric acid

Radio-lucent

Front 49

What is the most common cause of a filling defect on a contrast study?

Back 49

Urothelial neoplasm

Front 50

What are indications for surgical treatment of urolithiasis?

Back 50

Upper tract UTI
Significant obstruction
Pain refractory to oral meds
Other:
-Staghorn calculi
-Long-standing ureteral calculi
-Occupational reasons

Front 51

How does one take density of stones into account when considering treatment modalities?

Back 51

Less dense: SHOCKWAVES

More dense: more invasive procedures

Front 52

When should you think about doing a metabolic assessment of someone with renal calculi?

Back 52

Young
FH

Chronic:
-Multiple calculi present
-Residual calculi after tx.
-More than 1 stone in past year

Front 53

What factors in the urine favor stone formation?

Back 53

Hypercalcemia
Hyper oxaluria
Hyperuricosuria

Front 54

What factors in the urine inhibit stone growth?

Back 54

Citrate
Mg

Front 55

What is a common presentation of someone with pyelonephritis?

Back 55

Initial dysuria, urinary frequency, urgency
Febrile
Fight flank pain
CVAT

Front 56

How can you distinguish pyelonephritis from a UTI?

Back 56

Systemic involvement

Front 57

What is the most common bug to cause acute pyelonephritis?

Back 57

E. Coli

Front 58

What are possible complications from acute pyelonephritis?

Back 58

Papillary necrosis
Pyonpehrosis
Abscess
Sepsis

Front 59

What are some factors that can predispose a person to pyelonephritis?

Back 59

Obstruction
Calculi
Vesico-ureteral reflux
Debilitated: DM, ill, immune suppressed

Front 60

What is the treatment for a person who is obstructed with acute pyelonephritis?

Back 60

Drain the kidney: otherwise, it's an incubation pot for bacteria!

Front 61

What type of person is most likely to get Renal cell carcinoma?

Back 61

60ish years old
Man
Smoking puts you at increased risk

Front 62

What is the presentation of a person with renal cell carcinoma?

Back 62

Gross hematuria
Flank pain

Front 63

What is the most lethal carcinoma of the GU system?

Back 63

Renal cell carcinoma: 30%!

Front 64

What are risk factors for RCC?

Back 64

Cigs
Obesity
HTN
Occupationsl exposures
Dialysis
Hereditary

Front 65

What are some hereditary risk factors for RCC?

Back 65

von Hippel-Lindau disease
Tuberous sclerosis

Front 66

What is the conduit for RCCs to spread through the body?

Back 66

Along the veins! WILD!

There are some that can make it all the way to the PULMONARY ARTERY! WILD!!!

Front 67

Where are the most common sites of metastasis for RCC?

Back 67

Lung
Liver
Bone
Adrenal
Other kidney

Front 68

What is the most common type of RCC?

Back 68

Clear cell

RCCCC: Renal cell carconima clear cell

Front 69

What's the inheritance of von-hippel lindau syndrome?

Back 69

Autosomal dominant

Front 70

What kinds of tumors happen in von-hippel lindau syndrome?

Back 70

Cerebellar
Retinal
RCC

Front 71

What is the the most common gene mutation in RCC?

Back 71

VHL mutation

Front 72

What are the most common symptoms/signs of RCC?

Back 72

Hematuria (30-60%)
Flank pain (14-51%)
Flankmass (21-47%)

Front 73

What is Stauffer's syndrome? What does it signify?

Back 73

LFT elevation

Liver problems secondary to kidney cancer

Front 74

What percent of renal masses are simple cysts?

Back 74

85%

Front 75

What sign on ultrasound signifys a simple cyst?

Back 75

Posterior acoustic enhancement. No reflection back through the cyst. At the back there's a lot more amplitude that can reflect back--> posterior enhancement

Front 76

What signs on ultrasound make you think of a stone?

Back 76

Posterior shadowing. All of the waves are absorbed up front by the stone, so the stuff behind looks slighgly like a shadow.

Front 77

What makes you think of a solid mass upon ultrasound of hte kidney?

Back 77

Solid mass;no shadowing,but different density than the kidney parenchyma itself

Front 78

What's the gold standard for kidney mass diagnosis?

Back 78

CT

Front 79

If the kidney tumor is larger than 4 cm, what should you think?

Back 79

RCC!

Front 80

If the kidney tumor is under 4 cm, what should you think?

Back 80

1: STILL RCC

Others:
Oncocytoma
Angiomyolipmoa
Inflammatory mass
Lymphomas

Front 81

What does an oncocytoma look like on CT?

Back 81

Stellate scar in the middle

Front 82

Are oncocytomas benign or malignant?

Back 82

Benign

Front 83

Are lipomas benign or malignant?

Back 83

Benign

Front 84

What is the staging for RCC?

Back 84

1: <7 cm
2: >7 cm
3: Other structures, a lymph node
4. Mets, more spreading

Front 85

What is the treatment for RCC stages 2, 3?

Back 85

Radial nephrectomy

Front 86

What is the treatment for RCC stage 4?

Back 86

Systemic therapy

Front 87

What is the presentation of someone with ADPKD?

Back 87

Middle aged
FH
HTN - ALMOST ALWAYS!

Front 88

Where else can you get cysts in a person with ADPKD?

Back 88

Hepatic
Pancreatic
Splenic

Cerebral aneurysms

Front 89

What makes a cyst complicated?

Back 89

Hemorrhage
Infection