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GU: Hematuria/Proteinuria
GU: Hematuria/Proteinuria
83
Anatomy
Graduate
02/04/2012

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Term
If a pt has irritative symptoms (burning, dysuria, frequency), a __ should be ordered.
Definition
culture
Term
Dipstick UA hematuria must be followed up with __.
Definition
microscopy
Term
Symptoms of glomerularnephritis:
Definition
- Fever
- Rash
- Lymphadenopathy
- Abdominal/Pelvic mass
Term
Proteinuria is excessive protein in urine, generally greater than ___.
Definition
150-200mg/day
Term
Greater than 1 gram protein/day in urine suggests a __ origin.
Definition
glomerular
Term
Greater than __ grams of protein/day in urine is entering the __ __.
Definition
- 3.5 g protein/day
- nephrotic
Term
microalbuminuria:
Definition
30-150 mg protein in urine/day
Term
Bence Jones proteins:
Definition
Multiple Myeloma
Term
Tubular proteinuria is caused by faulty reabsorption of normally filtered proteins in the __ ___ such as __ __ and ___ __ ___. Causes of this include:
Definition
- proximal tubule
- Beta 2 microglobulins
- immunoglobulin light chains
- acute tubular necrosis
- lead/aminoglycoside injury
- interstitial nephritis
- Wilson's disease
- Fanconi disease
Term
DM may result in __ proteinuria.
Definition
glomerular
Term
Dipstick UA detects __ and __ __ but NOT __ __ __ of ___.
Definition
- albumin
- intact globulins
- NOT positive light chains of immunoglobulins
Term
For patients with undetermined causes of hematuria, what should be done for follow up?
Definition
- Repeat UA and cytology every 6 months
- Repeat Cystoscopy every year
Term
Best to estimate GFR based on __ __, not __ __ b/c this tends to overestimate it.
Definition
- Serum Creatinine
- Creatinine Clearance tends to overestimate it
Term
Any proteinuria on dipstick of 1+ or more, the ___ to __ ratio should be done.
Definition
protein: Cr ratio
Term
proteinuria screening should be done __ in at risk patients (DM, HTN, etc.).
Definition
annually
Term
Hematuria ddx for ages 0-20 y/o:
Definition
- UTI
- Acute Glomerularnephritis
- Congenital
- Trauma
Term
Ages 20-40 ddx for hematuria:
Definition
- UTI
- Trauma
- Stones
- Cancer
Term
Age 40-60 ddx for hematuria:
Definition
- UTI
- Cancer
- Stones
Term
Greater than 60 ddx for hematuria:
Definition
- UTI
- Cancer
- Vaginal
- Stones
Term
Greater than 60 male, ddx for hematuria:
Definition
- UTI
- BPH
- Cancer
- Stones
- Trauma
Term
Causes of renal cell cancer:
Definition
- Genetics (von Hippel-Lindau)
- Smoking (dose-dependent)
- HTN
- Obesity
- Solvent exposure
- Heavy metal exposure
Term
Types of Renal Cell Cancer tumors from most common to least common:
Definition
- Clear cell (65%)
- Papillary (7-14%)
- Chromophil/phobe (6-11%)
Term
At presentation, __% of pts with renal cell carcinoma are at stage 3 or 4.
Definition
30%
Term
Tmt for stage 1 and 2 renal cell carcinoma:
Definition
- Radical nephrectomy
- More conservative excision if tumor less than 4 cm
Term
Tmt for stages 3 and 4 renal cell carcinoma:
Definition
- Resection- cell volume reduction
- Chemo/radiation
- Immunomodulators
- Multikinase inhibitors
Term
4th MC cancer in men, 9th MC cancer in women:
Definition
Bladder cancer
Term
__% of bladder cancer is associated with environmental exposures.
Definition
80%
Term
Risks for Bladder Cancer:
Definition
- Smoking
- Hydrocarbon exposure/solvents: cleaners, industrial manufacturing, dye industry, painters, hairdressers
Term
Types of bladder cancer urothelial tumors from most common to least common:
Definition
- Transitional Cell (90%)
- Squamou Cell (3%)
- Adenocarcinoma (2%)
Term
Locations for bladder cancer from most common to least common:
Definition
- Bladder (90%)
- Renal Pelvis (8%)
- Ureters/Urethra (2%)
Term
Bladder cancer symptoms:
Definition
- Painless gross hematuria
- Irritative symptoms
- Lower abdominal discomfort
- Rectal fullness
- Pain (worrisome)
Term
Bladder cancer superficial disease treatment:
Definition
- Endoscopic resection
- Intravesicular chemo: Bacillus Calmette- Guerin (BCG)
Term
Bladder cancer muscle invasive disease (T2 or greater) treatment?
Definition
- radical cystectomy and pelvic lymphadenectomy
- chemo
Term
Metastatic bladder cancer tmt:
Definition
- radical cystectomy and pelvic lymphadenectomy
- chemo
Term
Where does prostate cancer occur?
Definition
Peripheral zone (the area you are palpating on DRE)
Term
Where does BPH occur?
Definition
transitional zone
Term
Obstructive symptoms:
Definition
- decreased force and caliber
- intermittent stream
- urinary hesitancy
Term
Irritative symptoms:
Definition
- frequency
- urgnecy
- nocturia
Term
ACS DRE screening guidelines for the average male:
Definition
- starting at age 50 in men who are expected to live 10 years or more
Term
ACS DRE screening guidelines for those at high risk for prostate cancer (African Americans and men with one close relative with prostate cancer):
Definition
- starting at 45 years old
Term
ACS DRE screening guidlines for men with multiple close relatives with prostate cancer:
Definition
starting at age 40
Term
Most common non-cutaneous cancer in men:
Definition
prostate cancer
Term
What race is at increased risk for prostate cancer:
Definition
African Americans
Term
Gleason Score is used to stage, grade, and determine aggressiveness of tmt for __ __.
Definition
prostate cancer
Term
Race at risk for testicular cancer:
Definition
Scandinavian Countries
Term
Age group most commonly affected by testicular cancer:
Definition
15-35 y/o
Term
95% of testicular tumors are __ __ __.
Definition
germ cell tumors
Term
Risk factors for UTI:
Definition
- Shorter urethra (females)
- Foreskin (uncircumscribed)
- Sexual activity
- Postmenopausal changes
- Foreign substances (diaphragm, spermicide, catheter)
- Pregnancy
- Hospitalization
- Medical conditions: DM, BPH, Neurogenic bladder
- Functional abnormalities: Vesicoureteral Reflux
Term
Medical conditions that increase risk for UTI:
Definition
- DM
- BPH
- Neurogenic bladder
- Vesicoureteral reflux
Term
What type of bacteria with a UTI cause you to consider a struvite stone in your dx?
Definition
- Staph
- Klebsiella
- Proteus
- Pseudomonas
Term
3 most commonly used antibiotics for UTI:
Definition
- TMP-SMX (Bactrim)
- Fluoroquinolones
- Nitrofuantoin
Term
Antibiotic used to treat psuedomonas UTI:
Definition
Aminoglycosides (Gentamycin, Streptomycin, Neomycin)
Term
Antibiotics used for UTIs in pregnant women and peds:
Definition
- Penicillins
- Cephalosporins
Term
pain tmt for cystitis:
Definition
Phenazopyridine aka Peridium aka Azo Standard
Term
Recurrent UTI definition:
Definition
- 3 or more episodes in one year after successful treatment
Term
Management of Recurrent UTIs:
Definition
- Antibiotics
- Suppressive Therapy: either 12 month course of abx, post-intercourse prophylaxis, or patient initiated therapy
Term
What type of casts occur with pyelonephritis?
Definition
WBC casts
Term
In patient pyelonephritis tmt:
Definition
IV PCN and Aminoglycoside
Term
Out patient Pyelonephritis tmt:
Definition
Fluoroquinolones (7-14 days)
Term
Indications for radiologic exam with pyelonephritis:
Definition
Potential ureteral obstruction
e.g. stone, ureteral stricture, tumor  
 
History of calculi, especially infectious (struvite) stones   

Concern about papillary necrosis
e.g. pt with sickle cell, analgesic abuse

History of GU surgery that predisposes to obstruction
e.g. ureteral reimplantation or ureteral diversion  
Poor response to appropriate antimicrobial after 5 to 6 days of treatment

Diabetes mellitus, Polycystic kidneys, Renal insufficency
 
Neuropathic bladder   

Unusual infecting organisms
(e.g. TB, fungus, or urea-splitting organisms (i.e. Proteus))


These would cause you to order CT.
Term
In patient prostatitis tmt:
Definition
- IV PCN and Aminoglycoside
Term
Outpatient Prostatitis tmt:
Definition
Fluroquinolones (14-28 days)

(7-14 days for pyelonephritits, 14-28 days for prostatitis)
Term
Tmt of chronic prostatitis:
Definition
- TMP/SMX or Fluoroquinolones for 4-6 weeks
- NSAIDs
- Sitz bath
Term
With non-bacterial prostatitis there is __ but no __ and cultures are __.
Definition
- pyuria
- no bacteriuria
- negative
Term
nonbacterial prostatisis presesnts like __ __
Definition
chronic prostatitis
Term
Management of non-bacterial prostatitis:
Definition
- Empiric antibiotics for 2 weeks, continue for 8 weeks if improving (TMP-SMX or Fluoroquinolones)
- NSAIDs
- Alpha blockers
- Sitz bath

SCREEN FOR PROSTATE CANCER
Term
With ____ there will by pyuria, but with ___ there will NOT be pyuria.
Definition
- Non-bacterial Prostatitis- pyuria
- Prostatodynia- NO pyuria
Term
Prostatodynia and Non-bacterial prostatiis both present like __ __, how can you tell them apart?
Definition
chronic prostatitis
non-bacterial there will be pyruia, prostatodynia no pyuria
Term
Prostatodynia tmt:
Definition
- Alpha blockers for spasma
- Diazepam for pelvic floor dysfunction
- Sitz bath

(symptom focused treatment)
Term
With non-bacterial prostatitis the UA is __ and the culture is __. With prostatodynia the UA is __ and the culture is __.
Definition
Non-bacterial prostatitis, UA is positvie and culture is negative. With prostatodynia, the UA and culture are both negative.
Term
Tmt for gonococcal urethriis:
Definition
250 mg Ceftriaxone IM
Term
Tmt for non-GC urehtritis:
Definition
1 gram Azithromycin + 100 mg Doxy bid x 7days
Term
Amiodarone can cause:
Definition
acute epididymitis
Term
Risk factors for acute epididymitis:
Definition
- sex
- strenuous physical activity
- prolonged sitting
- uro surgery
- obstructive uropathy
Term
Acute epididymitis is often associated with ___.
Definition
orchitis
Term
If suspecting epididymitis in a young male, __ __ should always also be on ddx.
Definition
testicular torsion
Term
If suspecting epididymitis in a young male, __ __ should always also be on ddx.
Definition
testicular torsion
Term
(-)Prehn's sign, absent cremasteric reflex:
Definition
testicular torsion
Term
(+)Prehn's Sign, + Cremasteric reflex:
Definition
Epididymitis
Term
Tmt of acute epididymitis:
Definition
- Fluorquinolone x 14 days
- NSAIDs
- Scrotal support
Term
Clinical syndrome of daytime and nightime increased urinary fequency, urgency, and pelvic pain.
Definition
INTERSTITIAL CYSTITIS
- MC in Caucasion females
- Cystoscopy shows submucosal hemorrhages and ulcers
Term
UA and culture findings with Interstitial Cystitis:
Definition
- UA usually normal but may show hematuria/pyuria
- culture is negative
Term
pregnant women with pyelonephritis should be :
Definition
hospitalized
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