Chapter 15 "Disorders of the Urinary Tract"

True or false? Urge incontinence is the most common type of incontinence in the elderly.

True

Gout can cause tubulointerstitial inflammation due to deposition of ________________ crystals.

Urate

Dysfunction of what anatomic structure in the collecting system predisposes a patient to infection?

Ureterovesical junction (UVJ)

What is the quantitative definition of proteinuria?

> 150 mg/day or 5 mg/dL

Name the 4 stages of chronic kidney disease.

1) Diminished renal reserve 2) Renal insufficiency 3) Chronic renal failure 4) End-stage kidney failure

Name the 3 components of diabetic nephropathy.

1) ischemic necrosis at renal medullae tips 2) bacterial pyelonephritis 3) glomerulosclerosis

A 57-year-old Caucasian male with a past medical history significant for uncontrolled hypertension presents to the hospital with a two-week history of progressive fever, polyuria, polydipsia, and a rash. His medications include an ACE inhibitor and the recent addition of a diuretic (one month ago). His urinalysis is positive for hematuria, proteinuria, and leukocytes (previously normal) and his blood work reveals peripheral eosinophilia. From what kidney disease does he suffer?

Acute drug-induced interstitial nephritis

A 25-year-old Caucasian female presents to the ER complaining of unilateral pain in her lower back. She describes the pain as constant and 10 out of 10. She also reports a fever of 102.5°F and a two-week history of painful, frequent urination. What is her diagnosis?

Acute pyelonephritis

Which of the following findings suggests a bacterial infection? A) Presence of leukocyte esterase and nitrite in the urine B) Alkaline urine pH C) A staghorn calculus D) All of the above

All of the above

Which of the following statements regarding proteinuria is true? A) The kidney excretes < 150g of protein/day, too small to be detected by routine tests B) Intermittent (transient) proteinuria is a normal finding, occurs in 5% of population. C) Orthostatic proteinuria occurs when patients are erect, but not when lying down. D) All of the above

All of the above

18yo African American male presents to clinic w/ blood in urine. Concerned because maternal uncle died of renal failure. Urinalysis confirms hematuria, and blood lab reveals elevated BUN and creatinine. Recent note on chart that says he has bilateral hearing loss. What is the underlying cause of the patient's hematuria?

Alport syndrome

A 32-year-old African American male with a past medical history significant for hypertension presents to the clinic complaining of blood in his urine. Imaging demonstrates large kidneys bilaterally with hundreds to thousands of cysts. What is likely to be the underlying etiology?

Autosomal dominant polycystic kidney disease

What 2 blood tests are used to measure kidney health?

Blood Urea Nitrogen (BUN), Blood Creatinine

True or false? The majority of GF leaves the body as urine.

False (99% reabsorbed)

True or false? Peak incidence of stones is b/t ages 50 to 70.

False (ages 20-30)

T or F? Urobilinogen and bilirubin are normal urine components.

False (bilirubin is never normal, a little urobilinogen is normal)

True or false? Magnesium stone are the most common type of urinary stone.

False (calcium; magnesium is 2nd)

True or false? Hemoglobinuria is the presence of hemoglobin within intact RBCs in the urine.

False (from lysed RBCs)

True or false? Obstructive nephropathy tends to cause scarring at the poles of the kidney.

False (it's reflux nephropathy)

T or F? The male urethra is the same length as the female urethra.

False (its 5-6x the length as female)

True or false? Infection is more often associated w/calcium stones than w/ magnesium stones?

False (magnesium stones = infection)

True or false? MG is the most common cause of nephrotic syndrome in children, and responds well to steroids.

False (minimal change disease is most common cause)

True or false? Most patients who form a stone will never form another one.

False (most form another w/in 10yrs)

True or false? Unilateral renal artery stenosis is the most cause of HTN.

False (only accounts for a small percent of patients w/HTN)

True or false? The lower urinary tract is entirely lined by urothelial cells.

False (terminal urethra lined by squamous)

True or false? Uremia is renal failure that manifests only by lab tests.

False (that would be azotemia; Uremia is renal failure w/ clinical signs and symptoms)

True or false? Malignant nephrosclerosis is characterized by hyaline arteriosclerosis.

False (that would benign nephrosclerosis, malignant has onion-skin arteriolar hyperplasia)

True or false? The cause of death of patients w/ adult polycystic kidney disease is invariably renal failure.

False (usually CAD or hypertensive heart disease; sometimes from ruptured berry aneurysms)

What are the 3 phases of acute kidney injury?

Initiating, Maintenance, and Recovery

What is the most common cause of Acute Tubular Injury (ATI)?

Ischemia

Azotemia is most aptly described as which of the following... GN, Lab findings, Proteinuria, or Urinary obstruction

Lab findings

Renal cell carcinoma and Transitional cell carcinoma are benign or malignant?

Malignant

A four-year-old Caucasian female is brought to the clinic by her mother, who is concerned over her daughter's "puffiness." She reports that it began shortly after her daughter received her four-year immunizations. A urinalysis reveals marked proteinuria and lipiduria. You prescribe a month course of steroids. Her follow-up urinalysis after steroid completion is completely normal. What was the likely cause of the child's symptoms?

Minimal change disease

Invades renal veins, sometimes extending into the inferior vena cava.

Renal cell carcinoma

Lung or bone metastasis may occur w/ this.

Renal cell carcinoma

55-year-old African American male with a past medical history significant for irritable bowel disease and multiple urinary tract infections (cultures negative to date) presents to the clinic with dysuria and urgency despite several courses of antibiotics. His physical exam reveals abdominal discomfort above the pubis. A cystoscopy reveals inflammation and Hunner ulcers. Although it rarely occurs in men, it appears that the patient has what disease?

Nonbacterial cystitis

Characterized by increased numbers of mitochondria and enlarged cytoplasm.

Oncocytoma

May grow very large before it is found.

Oncocytoma and Renal cell carcinoma

Tumor of renal tubular epithelial cells.

Oncocytoma and Renal cell carcinoma

Chronic analgesic nephropathy is caused by excessive use of analgesics that contain__________________.

Phenacetin/acetaminophen, aspirin, caffeine, codeine

What are 3 parts of the male urethra?

Prostatic, Membranous, Penile

The barrier function of the glomerulus prevents which one of the following from entering the glomerular filtrate? Glucose, Protein, Amino acids, or Creatinine

Protein

A 35-year-old Hispanic female presents to the clinic with fever, fatigue, nausea, and vomiting. Her physical exam is pertinent for both hypertension and edema, and her urinalysis reveals hematuria with red cell casts as well as proteinuria. She confirms that weeks ago she had an influenza-like illness, but indicates that she took no medications, prescribed or over the counter. You order additional labs, including a test for anti-GBM, which is positive. You tell the patient that the best treatment for her disease is plasmapheresis: the removal of plasma, treatment of it to remove antibodies, and return of it to her circulation. What is the most likely diagnosis?

Rapidly progressive glomerulonephritis

May be accompanied by paraneoplastic syndromes.

Renal cell carcinoma

Smokers have twice the risk of nonsmokers.

Renal cell carcinoma

What is the single most important risk factor in bladder cancer?

Smoking

Diminished renal reserve

Stage 1; abnormal GFR, normal BUN and creatinine

Renal insufficiency

Stage 2; GFR = 20-50% of normal

Chronic renal failure

Stage 3; GFR < 20-25% of normal

End-stage kidney failure

Stage 4; GFR < 5% of normal, uremic

True or false? About 40% of long-standing insulin-dependent diabetics develop advanced renal disease.

True

True or false? Acute renal failure features rapid onset of azotemia and oliguria or anuria w/ urine output about 400ml/day.

True

True or false? Almost all primary glomerular disease is autoimmune.

True

True or false? E. coli and other fecal flora are the most common causes of acute pyelonephritis.

True

True or false? Infection is always present in acute pyelonephritis.

True

Which of the following statements about the male urethra is true? A) The internal sphincter is composed of skeletal muscle and is under voluntary control B) The internal sphincter is composed of smooth muscle and is controlled by the autonomic NS C) The external sphincter encircles the urethra immediately above the internal sphincter D) The external sphincter is composed of smooth muscle and under voluntary control.

The internal sphincter is composed of smooth muscle and is controlled by the autonomic NS

True or false? Infection is not necessary to produce chronic pyelonephritis.

True

True or false? Precursor lesions are usually not demonstrable in high-grade urothelial malignancies.

True

True or false? Renal cell carcinoma accounts for 90% of renal malignancies.

True

True or false? The most common cause of urethritis is a sexually transmitted disease.

True

True or false? The most frequent cause of urinary obstruction in young men is urethral stricture, usually caused by sexually transmitted disease.

True

Membranoproliferazive glomerulonephritis (MPGN) is characterized by what pathological findings?

Thickening and splitting of the basement membrane, glomerular hypercellularity, and infiltration of the glomerulus by leukocytes

Diagnosed by cytologic study of urine revealing malignant cells.

Transitional cell carcinoma

May occur at multiple points in the urinary tract.

Transitional cell carcinoma

May regrow a second primary at a new site after removal of original.

Transitional cell carcinoma

Papillary and fragile.

Transitional cell carcinoma

T or F? Atherosclerosis is the most common cause of HTN.

True

T or F? Glomeruli are only found in the cortex of the kidney.

True

T or F? Malignant HTN is a medical emergency requiring vigorous and prompt treatment w/ antihypertensive drugs.

True

T or F? Malignant nephrosclerosis causes fibrinoid necrosis of the afferent arteriole and onion-skin hyperplasia of cells in the walls of small arterioles.

True

T or F? The innermost layer of the glomerulus is capillary endothelium.

True

T or F? The signs and symptoms of malignant nephrosclerosis include seizures, headache, nausea and vomiting, and papilledema.

True

True or False? The presence of protein in urine is an abnormal finding.

True

What 2 categories of drugs are useful in the treatment of urinary retention in men w/ benign prostatic hyperplasia (BPH)?

alpha-adrenergic blockers, 5alpha-reductase inhibitors

Oncocytoma is benign or malignant?

benign

What is another name for Rapidly Progressive Glomerulonephritis (RPGN), and from where does it derive its name?

crescentic glomerulonephritis, because it is characterized by arcs (crescents) of cells that proliferate in Bowman's space.

Bacterial cystitis is usually caused by which type of bacteria?

gram-negative fecal organism (coliforms) such as Escherichia coli

What laboratory abnormalities accompany nephritic syndrome?

hematuria (with RBC casts), proteinuria, azotemia (elevated BUN and Cr), and low complement.