Adult Renal Part 2

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Questions and Answers

Which of the following conditions is characterized by the formation of stones within the kidney?

  • Nephrolithiasis (correct)
  • Glomerulonephritis
  • Cystitis
  • Pyelonephritis

What is a common composition of kidney stones?

  • Magnesium sulfate
  • Calcium salts (correct)
  • Sodium bicarbonate
  • Potassium chloride

Which of the following is NOT typically a direct cause of renal stone formation?

  • Obstruction of the urinary tract
  • Vitamin A toxicity (correct)
  • Kidney infection
  • Urinary stasis

How does dehydration contribute to the formation of kidney stones?

<p>By concentrating urine and increasing mineral saturation (C)</p> Signup and view all the answers

Which dietary factor is least likely to elevate the risk of kidney stone formation?

<p>Diets high in leafy green vegetables (C)</p> Signup and view all the answers

What dietary element is most associated with increasing risk of kidney stone formation?

<p>Excessive sodium (D)</p> Signup and view all the answers

Which demographic is more prone to developing calcium phosphate stones?

<p>Pregnant women (D)</p> Signup and view all the answers

Which type of kidney stone is most common?

<p>Calcium oxalate stones (D)</p> Signup and view all the answers

Which metabolic condition is least likely to be associated with uric acid stones?

<p>Hypercalcemia (B)</p> Signup and view all the answers

Struvite stones are often associated with which condition?

<p>Urinary tract infections (C)</p> Signup and view all the answers

Cystine stones are a consequence of what type of disorder?

<p>Autosomal recessive disorder (B)</p> Signup and view all the answers

During the formation of kidney stones, what occurs when mineral substances in the urine exceed their normal solubility?

<p>Substance deposit (C)</p> Signup and view all the answers

Which urinary condition facilitates the trapping and growth of crystal combinations within the renal system, leading to stone enlargement?

<p>High urine pH (D)</p> Signup and view all the answers

Which factor is directly associated with promoting crystalluria and predisposing to renal stones?

<p>Certain medications (B)</p> Signup and view all the answers

What microscopic feature is most characteristic of struvite stones?

<p>Flat and consist of hexagon-shaped crystals (C)</p> Signup and view all the answers

What is a typical symptom associated with nephrolithiasis, particularly when an upper stone is present?

<p>Sudden renal colic/flank pain on one side that comes in waves (B)</p> Signup and view all the answers

What specific symptom is likely to manifest if a patient has a lower kidney stone?

<p>Pain radiating to the groin/vagina/penis (D)</p> Signup and view all the answers

Which finding is most indicative of nephrolithiasis on a routine urinalysis?

<p>Hematuria (C)</p> Signup and view all the answers

When evaluating a patient with suspected nephrolithiasis and elevated calcium levels, what is the next step?

<p>Draw PTH levels and Vitamin D levels (B)</p> Signup and view all the answers

What imaging technique is considered the gold standard for diagnosing nephrolithiasis?

<p>Noncontrast helical CT scan (A)</p> Signup and view all the answers

Which condition is least likely to be included in the differential diagnosis of nephrolithiasis?

<p>Myocardial infarction (C)</p> Signup and view all the answers

Which of the following is a primary treatment goal in managing nephrolithiasis?

<p>Prevent subsequent recurrence (C)</p> Signup and view all the answers

In managing calcium oxalate stones, what dietary recommendation would least likely be made?

<p>Increase purine intake (A)</p> Signup and view all the answers

What is generally the first-line pharmacological treatment for pain management in nephrolithiasis?

<p>NSAIDs (D)</p> Signup and view all the answers

What intervention is typically recommended for kidney stones larger than 10 mm?

<p>Flexible ureteroscopy combined with laser lithotripsy (D)</p> Signup and view all the answers

After passing a kidney stone, what step is important for follow-up in order to help prevent future occurrences?

<p>Bringing the stone to the office to send to lab (A)</p> Signup and view all the answers

For a patient with uric acid stones, which dietary modification is commonly recommended?

<p>Low-purine and refined sugar diet, rich in fruits/veggies (D)</p> Signup and view all the answers

What is a common recommendation regarding fluid intake for patients who have had kidney stones?

<p>Increase fluid intake to six to eight 8-ounce glasses per day (B)</p> Signup and view all the answers

Which type of renal tumor is most prevalent?

<p>Renal cell carcinomas (A)</p> Signup and view all the answers

Which of the following is a known risk factor for developing renal tumors?

<p>Exposure to asbestos (C)</p> Signup and view all the answers

What late-stage sign is most indicative of advanced renal disease?

<p>Dull, achy flank pain or abdominal mass, intermittent, painless, hematuria (C)</p> Signup and view all the answers

What is a typical initial diagnostic test for renal tumors?

<p>CBC with diff (D)</p> Signup and view all the answers

What imaging technique is used to initially confirms a renal mass?

<p>Renal mass initially confirmed by IVP (B)</p> Signup and view all the answers

What is the primary goal of tissue biopsy samples and flow cytometric analysis in the diagnostic process for renal tumors?

<p>Determine the DNA content of the tumor (B)</p> Signup and view all the answers

Which diagnostic method offers visualization of lesions for bladder tumors?

<p>Cystoscopy and biopsy (D)</p> Signup and view all the answers

For bladder tumors, what does a Stage 0 classification indicate?

<p>Tumor is confined to the mucosa (C)</p> Signup and view all the answers

In diagnosing bladder tumors, painless hematuria suggests it's essential to rule out what other conditions?

<p>Kidney stones (D)</p> Signup and view all the answers

Which of the following urinary conditions is most likely to predispose an individual to the formation of struvite stones?

<p>Alkaline urine with the presence of urea-splitting organisms (D)</p> Signup and view all the answers

A patient presents with a history of gout and is now diagnosed with uric acid stones. Which dietary modification is most important for managing this patient's condition?

<p>Adopting a diet low in purines and refined sugars (A)</p> Signup and view all the answers

Which of the following clinical presentations would most strongly suggest nephrolithiasis involving a stone in the lower urinary tract?

<p>Sudden onset of severe flank pain radiating to the groin (D)</p> Signup and view all the answers

Following the diagnosis of nephrolithiasis, a patient is found to have hypercalciuria. Which of the following is the most appropriate next step in management?

<p>Evaluate parathyroid hormone levels and vitamin D levels. (B)</p> Signup and view all the answers

A patient who has passed a kidney stone is seeking advice on preventing future occurrences. Which of the following recommendations is most appropriate for long-term prevention?

<p>Increasing daily fluid intake and modifying diet based on stone composition (C)</p> Signup and view all the answers

Which of the following dietary changes is most likely to benefit a patient with calcium oxalate kidney stones?

<p>Reducing animal protein and sodium intake (B)</p> Signup and view all the answers

What is the primary rationale for using nonsteroidal anti-inflammatory drugs (NSAIDs) in the initial management of nephrolithiasis?

<p>To alleviate pain and reduce ureteral smooth muscle spasm. (D)</p> Signup and view all the answers

Which statement best describes the rationale for recommending increased fluid intake to individuals with a history of nephrolithiasis?

<p>It dilutes urine, reducing supersaturation of minerals and crystal formation. (C)</p> Signup and view all the answers

Which of the following factors is most directly associated with an increased risk of calcium phosphate stone formation?

<p>Conditions leading to increased urine pH (B)</p> Signup and view all the answers

A patient is diagnosed with cystine stones. What is the most critical aspect of their long-term management plan?

<p>Adhering to a low-sodium diet and maintaining a high fluid intake. (B)</p> Signup and view all the answers

Which pathophysiological process primarily explains how dehydration leads to the formation of kidney stones?

<p>Supersaturation of minerals in the urine (C)</p> Signup and view all the answers

What is the significance of identifying the composition of a patient's kidney stone after it has been passed or removed?

<p>It guides dietary and medical interventions to prevent recurrence. (A)</p> Signup and view all the answers

Which of the following is the most common presenting symptom in patients diagnosed with bladder tumors?

<p>Painless hematuria (C)</p> Signup and view all the answers

What is the clinical significance of performing a cystoscopy with biopsy in the evaluation of bladder tumors?

<p>To visualize the lesion and obtain tissue for diagnosis and staging (C)</p> Signup and view all the answers

For bladder tumors, what does a staging of 'Stage A' indicate about the extent of the tumor's progression?

<p>The tumor has invaded the lamina propria. (D)</p> Signup and view all the answers

Besides bladder tumors, what other conditions must be considered in the differential diagnosis of an elderly patient presenting with painless hematuria?

<p>Kidney stones, infections, trauma, and glomerulonephropathies. (D)</p> Signup and view all the answers

Which of the following is considered the most common type of malignant renal tumor?

<p>Renal cell carcinoma (C)</p> Signup and view all the answers

What is the primary diagnostic method for confirming a suspected renal mass?

<p>Intravenous pyelogram (IVP) (D)</p> Signup and view all the answers

Which of the following is a common initial indication that a patient might have a renal tumor?

<p>Gross hematuria (B)</p> Signup and view all the answers

What is the purpose of tissue biopsy and flow cytometric analysis in the diagnostic process for renal tumors?

<p>To determine the DNA content and morphology of the tumor cells (C)</p> Signup and view all the answers

Which of the following factors is most associated with an increased risk of developing renal tumors?

<p>Exposure to asbestos (A)</p> Signup and view all the answers

In the context of managing renal tumors, when is surgical intervention most likely to be considered as a potential cure?

<p>When the tumor is small and localized within the kidney (D)</p> Signup and view all the answers

If a patient is suspected of having acute kidney injury (AKI), which of the following findings would be most indicative of the condition?

<p>Sudden and rapid decrease in renal function (D)</p> Signup and view all the answers

Which condition is most commonly associated with intrarenal acute kidney injury (AKI)?

<p>Renal hypoperfusion or nephrotoxins (A)</p> Signup and view all the answers

What is the primary characteristic of prerenal azotemia in the context of acute kidney injury (AKI)?

<p>Reduced blood flow to the kidneys (D)</p> Signup and view all the answers

In the context of acute kidney injury (AKI), which of the following conditions typically results in postrenal azotemia?

<p>Bilateral ureteral obstruction (A)</p> Signup and view all the answers

A patient with known diabetes presents with acute kidney injury (AKI). What specific aspect related to their diabetes should be assessed in the initial evaluation?

<p>Blood pressure control and the presence of diabetic retinopathy (C)</p> Signup and view all the answers

Which of the following diagnostic findings is most indicative of acute tubular necrosis (ATN) as the cause of acute kidney injury (AKI)?

<p>Urinary sodium greater than 40 mEq/L (B)</p> Signup and view all the answers

What is the primary reason for monitoring serum electrolyte levels in patients with acute kidney injury (AKI)?

<p>To manage potential life-threatening abnormalities secondary to renal disease (D)</p> Signup and view all the answers

After hospitalization for acute kidney injury (AKI), what is an important aspect to monitor during follow-up visits?

<p>Signs and symptoms of fluid overload (A)</p> Signup and view all the answers

A patient is suspected of having acute kidney injury (AKI) due to allergic interstitial nephritis (AIN). Which diagnostic finding is most suggestive of this condition?

<p>Eosinophiluria in the urine (D)</p> Signup and view all the answers

A patient is in the oliguric stage of acute kidney injury. What pathophysiological process is occurring during this stage?

<p>Renal repair begins as tubular cells regenerate, but nephrons become obstructed with inflammatory products. (B)</p> Signup and view all the answers

What factor distinguishes uric acid stones from calcium oxalate stones in terms of visibility on imaging?

<p>Uric acid stones are often undetectable on X-ray. (D)</p> Signup and view all the answers

Which element in urine primarily contributes to the development and rapid growth of struvite stones?

<p>Alkaline pH and urea-splitting organisms. (B)</p> Signup and view all the answers

What dietary modification should be implemented to decrease risk of uric acid stones, particularly in patients with gout?

<p>Reduce intake of purine-rich foods and refined sugars. (B)</p> Signup and view all the answers

A patient is diagnosed with low-stage bladder cancer. What is the most essential next step in management after initial diagnosis?

<p>Surgical resection followed by intravesical therapy. (B)</p> Signup and view all the answers

What is indicated by a bladder tumor that has been classified as Stage B?

<p>The tumor invades the muscular layer. (A)</p> Signup and view all the answers

Which of the following factors is most likely to result in prerenal AKI?

<p>Hypovolemia from severe dehydration. (A)</p> Signup and view all the answers

Why is renal biopsy important in the diagnostic workup of acute kidney injury (AKI)?

<p>To provide a definitive diagnosis of the underlying kidney damage. (D)</p> Signup and view all the answers

What is the primary goal when managing a patient in the oliguric phase of acute kidney injury (AKI)?

<p>To maintain fluid and electrolyte balance while addressing the underlying cause. (C)</p> Signup and view all the answers

A patient presenting with renal colic and microscopic hematuria is suspected of having nephrolithiasis. What is the next most appropriate step in diagnosis?

<p>Perform noncontrast helical CT scan. (A)</p> Signup and view all the answers

Which of the following is the most typical initial symptom of kidney cancer?

<p>Painless hematuria. (C)</p> Signup and view all the answers

What is the key rationale for recommending an increased fluid intake to patients prone to forming kidney stones?

<p>To dilute the concentration of minerals in the urine. (C)</p> Signup and view all the answers

In managing calcium oxalate stones through dietary changes, what recommendation is most appropriate?

<p>Decrease intake of oxalate, sodium, and animal protein. (B)</p> Signup and view all the answers

Which of the following is the most common type of renal malignancy?

<p>Renal cell carcinoma. (C)</p> Signup and view all the answers

What is the primary utility of performing a cystoscopy with biopsy when evaluating bladder tumors?

<p>To visualize the lesion, obtain tissue for diagnosis, and determine the stage. (B)</p> Signup and view all the answers

A patient is diagnosed with uric acid stones. Which dietary modification is most appropriate for managing this patient's condition?

<p>Reduce intake of animal proteins and alcohol. (C)</p> Signup and view all the answers

What is the rationale for using nonsteroidal anti-inflammatory drugs (NSAIDs) in the initial management of nephrolithiasis?

<p>To provide analgesia and reduce ureteral spasm. (D)</p> Signup and view all the answers

What is the primary reason for monitoring serum electrolyte levels in patients experiencing acute kidney injury (AKI)?

<p>To detect and manage potentially life-threatening abnormalities. (A)</p> Signup and view all the answers

What factor is most likely to predispose an individual to the formation of calcium phosphate stones?

<p>Alkaline urine pH. (B)</p> Signup and view all the answers

A patient presents with gross hematuria, and a subsequent CT scan reveals a renal mass. What is the next most appropriate step in managing this patient?

<p>Perform a biopsy of the mass for histological analysis. (B)</p> Signup and view all the answers

Which diagnostic finding is most indicative of prerenal azotemia in the context of acute kidney injury (AKI)?

<p>Low fractional excretion of sodium (FeNa). (D)</p> Signup and view all the answers

Which type of renal stone is commonly associated with staghorn calculi?

<p>Struvite. (B)</p> Signup and view all the answers

Why is it essential to determine the composition of a kidney stone after it has been passed or removed?

<p>To guide dietary and medical strategies aimed at future prevention. (A)</p> Signup and view all the answers

What is the primary focus of long-term management for a patient diagnosed with cystine stones?

<p>Alkalinization of the urine and high fluid intake. (D)</p> Signup and view all the answers

What is the significance of performing a urinalysis on a patient suspected of a bladder tumor?

<p>To confirm the presence of malignant cells. (B)</p> Signup and view all the answers

An elderly patient presents with painless hematuria. Besides bladder cancer, what other differential diagnosis needs to be considered?

<p>Kidney stones, infections, trauma, arteriovenous malformations, or glomerulonephropathies. (B)</p> Signup and view all the answers

What would be the most suggestive of allergic interstitial nephritis (AIN) rather than acute tubular necrosis (ATN) as the primary cause of AKI?

<p>Eosinophiluria. (D)</p> Signup and view all the answers

What is the rationale for recommending an acidic, high-meat-content-diet for kidney stone prevention?

<p>This is not a recommended dietary approach for kidney stone prevention. (B)</p> Signup and view all the answers

What is the common initial treatment for bladder cancer?

<p>Transurethral resection of the prostate. (B)</p> Signup and view all the answers

What are Noninvasive or invasive surgical procedures used for kidney stones?

<p>All the above. (C)</p> Signup and view all the answers

What laboratory results would indicate routine diagnostic testing signs show?

<p>Decreased GFR, increased serum Creatinine and albumin in urine. (C)</p> Signup and view all the answers

What are the preventive measures for kidney stones?

<p>All the above. (A)</p> Signup and view all the answers

What abnormalities are characterized after suffering from Uremic Syndrome?

<p>All the above. (D)</p> Signup and view all the answers

Initial signs when suffering from renal tumors are?

<p>All the above. (D)</p> Signup and view all the answers

What does Ureteroscopy or ultrasonography with IVP use for?

<p>To differentiate potential neoplastic tissue from cyst formation. (A)</p> Signup and view all the answers

Cystine stones are created due to?

<p>Rare autosomal recessive disorder called cystinuria. (A)</p> Signup and view all the answers

Common risk factors for Renal tumors are?

<p>All the above. (C)</p> Signup and view all the answers

Calcium oxalate stones are?

<p>All the above. (D)</p> Signup and view all the answers

Besides obstruction, urinary stasis, and dehydration, what other factor significantly contributes to the formation of renal stones?

<p>Infection (C)</p> Signup and view all the answers

Which dietary modification is least likely to be recommended for reducing the risk of calcium oxalate stones?

<p>Increasing intake of green, leafy vegetables (A)</p> Signup and view all the answers

Which of the following stone types is most likely to be associated with a urinary tract infection (UTI) involving urea-splitting organisms?

<p>Struvite stones (C)</p> Signup and view all the answers

A patient is diagnosed with cystinuria. What is the underlying genetic cause of their kidney stone formation?

<p>Autosomal recessive disorder (D)</p> Signup and view all the answers

Supersaturation of urine with mineral substances is crucial for kidney stone formation. What directly results from this supersaturation?

<p>Deposition of crystals out of solution (A)</p> Signup and view all the answers

Which of these medications promotes crystalluria that increase crystal size and predispose patients to renal stones?

<p>Crixivan (D)</p> Signup and view all the answers

What physical characteristic is unique to calcium oxalate stones when viewed under a microscope?

<p>Resemble red blood cells (C)</p> Signup and view all the answers

A patient presenting with renal colic and pain radiating to the groin is suspected of having a kidney stone. Where is the most probable location of the stone?

<p>Lower ureter (B)</p> Signup and view all the answers

What does the presence of both gross or microscopic hematuria and elevated creatinine levels suggest in a patient suspected of nephrolithiasis?

<p>Possible renal damage due to the stone (C)</p> Signup and view all the answers

If a patient with suspected nephrolithiasis has elevated calcium levels, what additional diagnostic test should be considered?

<p>Parathyroid hormone (PTH) levels (B)</p> Signup and view all the answers

Which condition should be ruled out in the differential diagnosis of nephrolithiasis due to similar presenting symptom of abdominal pain?

<p>Appendicitis (B)</p> Signup and view all the answers

What is the primary purpose of using alpha-blockers in the management of nephrolithiasis?

<p>Relax ureteral smooth muscle (A)</p> Signup and view all the answers

For which type of kidney stone is allopurinol commonly prescribed as part of the management strategy?

<p>Uric acid (B)</p> Signup and view all the answers

What long-term preventive measure is particularly important for patients who have had cystine stones?

<p>Limiting sodium intake and increasing fluid intake (B)</p> Signup and view all the answers

Why are thiazide diuretics sometimes prescribed for patients with calcium oxalate stones?

<p>To lower urinary calcium excretion (C)</p> Signup and view all the answers

Which lifestyle factor is least likely to increase the risk of developing renal tumors?

<p>High-fiber diet (A)</p> Signup and view all the answers

Which of the following initial signs may indicate the presence of renal tumors?

<p>Fever, anemia, and cachexia (A)</p> Signup and view all the answers

What is the role of flow cytometric analysis in the diagnostic workup of renal tumors?

<p>To determine the DNA content of the tumor cells (C)</p> Signup and view all the answers

If a renal mass is discovered using imaging studies, what is essential for differentiating potential neoplastic tissue from cyst formation?

<p>Ureteroscopy or ultrasonography with IVP (A)</p> Signup and view all the answers

Which patient population is most likely to develop Wilms tumor?

<p>Children under 15 (A)</p> Signup and view all the answers

What is the first step in the treatment for bladder cancer?

<p>TURP (Transurethral Resection of the Prostate) (D)</p> Signup and view all the answers

What is the significance of confirming a diagnosis of bladder tumor through cystoscopy and biopsy?

<p>Provides visualization and tissue sample for staging and grading (D)</p> Signup and view all the answers

If a bladder tumor is classified as Stage B, what does this indicate about the extent of the tumor's progression?

<p>Invades the muscular layer (D)</p> Signup and view all the answers

Which other condition is the most essential to rule out when an elderly patient presents with painless hematuria?

<p>Kidney stones (A)</p> Signup and view all the answers

Which factor is least likely to be a cause of prerenal AKI?

<p>Unilateral renal artery stenosis (A)</p> Signup and view all the answers

What is a key finding for diagnosing allergic interstitial nephritis (AIN) as a cause of AKI?

<p>Eosinophiluria (B)</p> Signup and view all the answers

What is the most likely cause of intrarenal AKI?

<p>Acute tubular necrosis (D)</p> Signup and view all the answers

In the oliguric phase of AKI, what is happening in the kidneys?

<p>Tubular cells are regenerating and nephrons are obstructed (A)</p> Signup and view all the answers

What diagnostic sign is most suggestive of prerenal azotemia?

<p>Urinary sodium &lt; 20 mEq/L (C)</p> Signup and view all the answers

Why is renal biopsy performed in the diagnostic workup of AKI?

<p>To determine if AKI caused by glomerulonephritis is present (A)</p> Signup and view all the answers

Following hospitalization for AKI, what assessment should be included during follow-up visits?

<p>Assess for signs and symptoms of fluid overload (A)</p> Signup and view all the answers

If you cannot see uric acid stones on imaging, they are:

<p>Radiolucent (A)</p> Signup and view all the answers

Which one of the following complications is created after suffering from acute kidney injury?

<p>Anemia (A)</p> Signup and view all the answers

What action is recommended for the patient to take?

<p>Urology consult for stones &gt; 10 mm (C)</p> Signup and view all the answers

What is the first line treatment for pain when suffering from kidney stones?

<p>NSAIDs (D)</p> Signup and view all the answers

How much fluid intake should you increase?

<p>Six to eight 8-ounce glasses per day (A)</p> Signup and view all the answers

What helps kidney mass initially confirm?

<p>IVP (C)</p> Signup and view all the answers

Flashcards

Nephrolithiasis

Kidney stones; a condition in which stones originate in the kidney.

Kidney stone composition

Calcium salts, struvite, uric acid, and cystine that form renal stones.

Calcium oxalate stones

Renal stones resulting from a high oxalate food diet.

Cystine stones

Stones created because of a rare autosomal recessive disorder called cystinuria.

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Renal cell carcinomas (RCC)

Most common type of renal tumor.

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Acute Kidney Injury (AKI)

Sudden and rapid deterioration of renal function over 7 days or less.

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Prerenal azotemia

A type of AKI caused by conditions that decrease blood flow to the kidneys.

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Intrarenal azotemia

A type of AKI caused by issues within the kidney itself.

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Postrenal azotemia

A type of AKI resulting from obstruction of urine flow from the kidneys.

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Uremic syndrome

A common complication of AKI characterized by nausea and nervous system abnormalities.

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Nephrolithiasis treatment goals

Decrease the symptoms and complications arising from existing stonesand prevent subsequent recurrence.

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Nephrolithiasis Pain Onset

Sudden renal colic/flank pain, often radiating.

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Risk Factors for Nephrolithiasis

High environmental temperatures, sedentary lifestyle, urinary issues, and diet.

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Nephrolithiasis Diagnostic Tests

Routine urinalysis, CBC, BMP, and imaging.

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Gold standard imaging for nephrolithiasis

CT scan without contrast.

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Nephrolithiasis Management

Increase fluid intake, dietary changes, and medications.

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Medical Expulsive Therapy (MET)

Calcium channel blockers or alpha blockers

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ESWL

Extracorporeal shock wave lithotripsy.

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Preventing Nephrolithiasis

Change fluid intake, diet, and use potassium citrate.

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Nephrolithiasis: Patient Education

Instruct to increase fluid intake to six to eight 8-ounce glasses per day, monitor input and output and strain urine for passed stones with toilet hat.

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Risk Factors for Bladder Tumors

Smoking, exposure to dyes, chronic UTI, recurrent nephrolithiasis.

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Bladder Cancer Symptoms

Often asymptomatic until hematuria presents.

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Diagnosing Bladder Cancer

Visualization via cystoscopy and biopsy.

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Bladder Cancer Referral

Critical to refer to a urologist or surgical oncologist for evaluation and treatment.

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Hallmark of AKI

Characterized by rapid decrease in renal function and elevated serum creatinine.

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AKI: Diagnostic Testing

Monitor serum electrolyte levels; potentially life-threatening abnormalities develop secondary to renal disease

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AKI: Follow-up and Referral

After hospitalization, follow up is necessary at dedicated timeframes; Assess for signs and symptoms of fluid overload

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Nephrolithiasis (Kidney stones)

A condition in which stones originate in the kidney, stones form from calcium salts, struvite, uric acid, and cystine.

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Nephrolithiasis: Crystal formation

Stone formation occurs when normally soluble mineral substances supersaturate the urine and deposit out of solution as crystals.

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Causes of Renal Stones

Renal stones can cause obstruction, urinary stasis, and infection.

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Urinary conditions promoting stones

Increased calcium, high oxalate, low citrate, high pH.

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Risk factors for calcium phosphate stones

Women, acidification disorders, high urine pH, increased calcium.

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Risk factors for calcium oxalate stones

Men, high oxalate diet.

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Risk factors for uric acid stones

Gout, diabetes, metabolic syndrome.

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Risk factors for struvite stones

Women, UTI, alkaline urine, urea-splitting organism.

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Nephrolithiasis Clinical Presentation

Variety of signs and symptoms depending on location, size, and type of stone.

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Nephrolithiasis: Rule out

Appendicitis, diverticulitis, pancreatitis.

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Medications for Calcium Oxalate Stones

Hydrochlorothiazide 25 mg BID, Allopurinol 100-300 mg daily, Potassium citrate to increase pH 30-90 mEq/day

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Uric Acid stone diet

2.5-3 L/day, low purine and refined sugar diet, rich in fruits/veggies

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Preventive measures for nephrolithiasis

Increase fluid intake (2-4 L/day) and take thiazide diuretics

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Renal Tumors

Characterized by abnormal tissue formations on or around the kidney.

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Renal Tumors: Diagnostic Testing

Renal mass initially confirmed by IVP. Ureteroscopy or ultrasonography with IVP used to differentiate potential neoplastic tissue from cyst formation

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Bladder Tumors

Abnormal tissue masses that occur in the bladder wall lining

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Immediate plan for Bladder Tumors

Critical to refer to a urologist or surgical oncologist for evaluation and treatment Urinalysis and cystoscopy every 3-6 months

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Bladder Tumors: Staging

Stage 0: confined to the mucosa,Stage A: invade the lamina propria

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Causes of Postrenal AKI

Any etiology that might lead to an obstruction of flow of urine from the kidneys.

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AKI: main cause

Most common cause of AKI: hospitalization with concomitant reduced renal perfusion and exposure to nephrotoxins or drugs that interfere with intrarenal hemodynamics

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AKI: Symptoms

Oliguria (less than 400 ml/day) or anuria (less than 100 ml/day).

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Struvite stones association

Staghorn stones are more likely to be this type

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Calcium oxalate stones visibility

Visible on X-ray or unenhanced CT imaging.

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Renal Stone Causes

Obstruction, urinary stasis, infection, dehydration, and dietary factors.

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Renal Colic

Sudden, severe flank pain, often radiating, due to kidney stones.

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Extracorporeal Shock Wave Lithotripsy

Non-invasive procedure using shock waves to break up kidney stones.

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Nephrolithiasis effect

Elevated blood pressure may occur

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Uric Acid

Radiolucent and red-orange

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Stone Characteristics: Cystine

Lemon yellow, hexagonal, and sparkle under light microscopy

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Nephrolithiasis symptoms

Variety of signs and symptoms based on location and type of stone

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Wilms Tumor

The most common malignant renal tumor

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RCC: Clinical Presentation

Present with gross hematuria as the only symptom

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Bladder cancer diagnostic

Urine for cytologic studies: spiral CT, ultrasound, IVP, CT

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Bladder Tumor followup

Critical to refer to a urologist or surgical oncologist for evaluation and treatment Urinalysis and cystoscopy every 3-6 months

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Bladder Tumor care

With advanced metastatic disease: refer to an oncologist. Home health or hospice may also be appropriate

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Hallmark of AKI: lab work

Characterized by rapid decrease in renal function and elevated serum creatinine

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AKI: Electrolyte Management

Monitor serum electrolyte levels; potentially life-threatening abnormalities develop secondary to renal disease

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AKI: Follow up

After hospitalization, follow up is necessary at dedicated timeframes; Assess for signs and symptoms of fluid overload

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Symptoms: Kidney Injury

Sudden onset of oliguria, edema, and weight gain complaints of lethargy, nausea, and loss of appetite

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Nephrolithiasis: Stone Formation

The process where soluble minerals in urine become supersaturated and form crystals, leading to stone formation.

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Upper stone symptoms

Sudden renal colic/flank pain on one side indicates a possible upper stone.

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Renal Stone Analysis

A renal stone's type can be determined through lab analysis.

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Nephrolithiasis: key risk factors

A sedentary lifestyle, high temperatures, and inadequate fluid intake.

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Elevated Calcium + stones

Increased Calcium: suspect PTH and draw levels

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Diet for kidney stones

Acidic diet higher in meat content; High fiber, low animal protein, low sodium, low oxalate

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Lithotomy: Definition

Incision into bladder or ureter to remove calculi or place a ureteral stent

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Nephrolithotomy definition

Denotes arthroscopic extraction of a renal stone from the bladder

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Lithonephrotomy: Definition

Incision into the kidney to remove a stone

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RCC Metastasis

The most common metastatic site of Renal Cell Carcinoma.

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Wilms Tumor: Definition

A malignant renal tumor most often affecting children under 15.

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Acute Kidney Injury (AKI): Clinical Presentation

Sudden onset of oliguria, edema, weight gain, lethargy and/or nausea

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AKI diagnostic signs

Decreased GFR, increased serum creatinine & albumin in urine indicate kidney injury.

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Kidney questions

Check patient history/possible renal concerns

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Acute Kidney Injury (AKI): diagnosis

Presence of an AKI episode or GFR < 60, or decrease in GFR by 35% or increase in serum creatinine by 50%

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Acute Kidney Injury (AKI): perfusion

Any problem causing decreased blood flow to the kidneys

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Study Notes

Acute Kidney Injury: Clinical Presentation

  • The most common symptoms stem from the accumulation of toxic metabolites.
  • Other symptoms include Oliguria of less than 400 ml/day and Anuria of less than 100ml/day
  • Additional symptoms include fatigue, malaise, anorexia, nausea, vomiting, pruritus (itching), and mental status changes such as listlessness and confusion.

Acute Kidney Injury: Clinical Presentation (cont'd)

  • Initiating stage: kidney is injured, decreased urine volume; anorexia, lethargy, nausea, headache, muscle cramps, and fatigue may be present.
  • Oliguric stage: lasts 5-15 days; renal repair begins as tubular cells regenerate; nephrons become obstructed with inflammatory products; decrease in glomerular filtration, tubular transport of substances, urine formation, and renal clearance occur; the longer this stage persists, the poorer the prognosis.
  • Diuretic stage: characterized by urine output that is greater than 400mL/day and BUN begins to fall.
  • Recovery stage: extends from the time BUN is stable and urine output is normal to the day the patient returns to normal activity; the entire process can take up to 10 months.
  • Some patients never recover and instead progress to chronic renal failure.

Acute Kidney Injury: Clinical Presentation (cont'd) Objective data

  • Objective data to note included orthostatic vital signs, skin turgor, and distention of jugular veins to assess fluid balance.
  • Key things to assess in diabetic patients are AV nicking, diabetic retinopathy, and papilledema.
  • Fluid depletion may indicate prerenal etiology while fluid overload suggests a greater degree of renal impairment.
  • JVD, adventitious lung sounds, a third heart sound, and edema indicate volume overload.
  • Severe proteinuria may lead to generalized edema.
  • Abdominal renal artery bruits can suggest renovascular disease.

Acute Kidney Injury: Diagnostic Testing

  • Hallmark diagnostic signs: decreased GFR, increased serum creatinine and albumin in urine. These indicators can establish the diganosis of ARF
  • Elevated BUN and serum creatinine levels assist in establishing the diagnosis of ARF.
  • Monitor serum electrolyte levels because potentially life-threatening abnormalities develop secondary to renal disease.
  • Presence of RBCs suggests a vascular or glomerular lesion.
  • WBCs with associated infection
  • Eosinophiluria is indicative of allergic interstitial nephritis (AIN) due to renal toxic drugs.
  • Urinary sodium tends to be less than 20 mEq/L in prerenal disease, and Urinary sodium values typically greater than 40 mEq/L indicate ATN.
  • In diabetic or hypertensive patients, regular urinalysis should have the calculation of the urinary albumin to creatinine ratio (ACR) to allow for early detection of kidney damage (can lead to CKD).

Acute Kidney Injury: Diagnostic Testing (cont'd)

  • Diagnostic tools involve renal ultrasound, CT scan, retrograde pyelogram, and cystoscopy.
  • A renal biopsy is performed to confirm diagnosis of acute nephritic syndrome, to better characterize nephritic syndrome or suspected vasculitis, and to aid in the diagnosis of acute or subacute renal failure of unknown etiology.

Acute Kidney Injury: Follow-up and Referral

  • Following hospitalization, schedule follow-up appointments about one week, one month, three months, and six months after, and annually thereafter.
  • At each follow-up visit, check a basic metabolic profile and CBC.
  • Regularly assess for signs and symptoms of fluid overload during follow ups.

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