Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Hematuria & Stones
Clinical Medicine II
| Question | Answer |
|---|---|
| Definition of hematuria | > 3 RBCs per High Power field in 2-3 properly collected urine over 2-3 weeks (by AUA) |
| Evaluation of hematuria indications | >2 RBCs by HPF |
| “Clean Catch” Urine sample | spread labia/retract foreskin, swab urethral area, start urination, then bring sterile container into stream (don’t stop flow) 1-2 Tbsp of urine |
| What are some false positives for blood w/ urine dipstick | menstrual, myoglobinuria, Hbguria, semen, betadine, bacterial enzymes from vaginal infections, dehydration |
| Urine Dipstick checks for | blood/heme, protein, nitrite, pH, glucose, ketones, bilirubin, leukocytes, specific gravity |
| 3 steps to urinalysis | physical color/appearance, specific gravity, microscopic appearance (RBCs, WBCs, mucus, crystals, bacteria) |
| Colors indicate what, dark yellow, Orange, gree, blue, pink/red/cola-colored | Dark: dehydrated, O: foods/meds, bilirubin, Green: foods/meeds, UTI pseudomonas B: F/M, familia hypercalciuria, P/R/C: blood |
| Usually NOT found in urine | hgb, nitrates, WBCs, RBCs >2-3, glucose, ketones, protein, bilirubin |
| Cath UA indications | kids w/ FOD to young to CC, menstruating-UTI, vaginal discharge, to debilitated, sepsis or severe illness |
| Does degree of hematuria correspond to seriousness of underlying cause | no |
| Suspicions <40 and >40 cause | <40: renal stones, UTIs, >40: same, + bladder, kidney, prostate cancers |
| RBCs + proteinuria means what | glomerular source |
| Why does proteins suggest glomerular source | the rents are disrupted and RBCs are damaged: and ↓ of filtration |
| Color for glomerular hematuria | often brown or cola-coloared d/t ↑ transit time, RBC casts and damaged RBCs often found |
| Causes for glomerular hematuria | glomerulonephritis, IaA nephropathy, thin basement membrane nephropathy, hereditary nephritis, lupus, vasculitis, chronic interstitial nephritis |
| Vasculitis cause of glomerular hermaturia think what – wegener’s granulomatosis | |
| Hereditary nephritis | alport syndrome |
| igA nephropathy | Berger’s Disease |
| If blood is urine is nl suggests what aka no dysmorphic casts | extraglomerular hematuria |
| Causes of extraglomerular hematuria | infx, nephrolithiasis (kidney), calculus, malignancy, cystic dz, vascular d/o, endometriosis, BPH, urethritis, urethral trauma |
| MC cause of hematuria | infections, Renal stones, BPH, cancer |
| Glomerular blood | red, smoky brown, no clots, protein could be >500mg/day, dysmorphic RBCs, casts |
| Extraglomurlar blood | red, pink, maybe clots, <500mg/day proteins, nl RBC, no RBC casts |
| Why would a dipstick be + for blood | hemoglobinuria: hemolysis, and Myoglobinuria: rhabdomyolysis |
| Medications that cause false + | rifampin, nitrofurantoin, phenytoin, ibuprofen |
| What are some food dyes that may cause pseudohematuria | beets, rhubarb, berries |
| Ddx for dysuria, pyuria, fever | UTI, pyelo, prostatitis, urethritis, malignancy |
| DDx for urethral discharge | urethrisits, prostitis |
| DDx for flank pain | pyelo, stones, neoplasms, ischemia, GN |
| DDx for hesitancy, dribbling | BPH |
| DDX for gross, painless hematuria | bladder cancer, postinfectious GN |
| DDx for fevers, rash arthritis | GN assoc w/ SLE vasculitis |
| DDx for pt w/ hematuria and recent ravel | schistosoma, Tb |
| DDx for suprapubic tendernesss | UTI |
| DDx for CVA tenderness | pyelonephritis |
| MC causes of Hematuria | UTI, urolithiasis, BPH, Urologic Malignancy |
| What electrolytes should we remember to check | Na, K, Ca, P |
| If + urine cultures, or stones what should we do | repeat UA 2-6weeks, Stones: repeat after stone clearance |
| Limitations of imaging for IV urogram | poor sensitivity to characterize renal parenchymal masses. IV contrast (same as retrograde pyelogram) |
| When does proteinuria become concerning | >500mg/dl |
| Gold standard for images | CT urogram (lg radiation, and expensive) later step |
| Indications of cystoscopy | lower urinary track suspicion, can do biopsy (urether and bladder) |
| If there is a bladder tumor, what else should we do | do upper urinary tract imaging (same cell lines) |
| What is urine cytology especially good at | ↑specific/sensitivity for high grade urothelia carcinoma (limited for low grade dz) (can do urine cytology from cystoscopy) |
| If no clear cut cause found, what do we do | MUST follow up, usually infx/stones though |
| Nephrolithiasis | urinary tract stones: crystalline mineral concentrations (recurrence common) |
| Stone composition | calcium, oxalate, Uric acid, phosphate |
| Causes of stone development | supersturation, deficiency of stone inhibitors, substrate stone formation, ↓ water vol |
| Risks for Calcium oxalate stones | ↓ urine vol, Hyper calcemia, calciruia, oxalurai, hypocitraturia, gouty diathesis (MC w/ 36-70%) |
| Risks for Calcium phosphate | ↓urine, UTI, hyperPTH, distal renal tub acidosis |
| Mixed oxalate and phosphate risks | all of the above |
| Infectio-related causes of stones | called struvite: UTI, urea splitting organisms |
| Urea splitting organism | proteus, klebsiella, pseudomonas, staph, |
| Uric acid stone RF’s | ↓ urine, pH<6, obesity, hyperuricemia, uricosuria, gout alcohol abuse, gongenetial metabolic erros, nephropathy, gouty arthritis |
| Cystine stone RF’s | cystinuria, congenital intestinal tract defect, congenital transport error |
| Hx of congenital anatomic defects | medullary sponge kidney, horseshoe kidney, urethropelvic jxn obstruction |
| Where is Ca++ absorbed | 90% small intestine, 20-40% in pt’s w/ stones |
| Dietary RF’s | drinking <1L of water a day, ↓ vol urine, ↑ animal protein, |
| Environmental factors for kidney stones | hot arid climate, excessive fluid loss from sweating, ↓ urine vol |
| Signs of kidney stones | Severe pain: tachy, HTN, fever: UTI, pylo |
| What are clinical signs of large stones | urinary tract obstruction, |
| Reccurent stones, what do we do | Urology, 24 hr collection, check for Ca+, uricosuria, citraturia analyze stones |
| What size of stones will uaually pass | <5mm |
| What are some medical expulsive therapies | CCBs, alpha-blockers |
| What do larger stores require | llithotripsy or surgical management |
| What is the preferred tx for most renal stones | Extracorporeal shock wave lithotripsy (ESWL) |
| Most common complication of ESWL | pain, hematomas in 5-20% |
| When do we use percutaneous nephrolithotomy (PCNL) | stones >2cm near the pelvis, many complications |
| Chronic stone management | ^fluid 2.5L a days, ↓Na+, diruetics, reduce pH to below 6.0 for struvite stones |
| Chronic management for uric acid stones | allopurinol, high pH, citrate |
| Why do we alkalize urine to tx chronic stone management | cysteine stones, K+ citrate to maintain pH 6.5-7 |
Created by:
becker15
Popular Clinical Skills sets