T6 Renal and Urologic Problems

• What is hydronephrosis?

  Kidney swelling.
• What are treatments for hydronephrosis?

  Insertion of tube, surgery, or urinary diversion.
• What demographic are kidney stones more common with?

  Men, whites than blacks, Hispanics, Asians, those with a family history, Southeast US, Southwest US, Midwest, Summer.
• What happens to Jewish men in regards to urinary tract calculi?

  Uric acid stones.
• How does higher pH urine influence kidney stones?

  Calcium and phosphate are less soluble.
• How does lower pH urine influence kidney stones?

  Uric acid and cysteine are less soluble.
• What are the most common types of urinary stones?

  Calcium stones.
• What is the first symptom of renal calculi?

  Sudden, severe pain (renal colic).
• What are common sites for urinary stone obstruction?

  UPJ - ureteropelvic junction (along costovertebral flank)

  UVJ - ureterovesical junction (lower abdomen, testicular or labial)
• What treatments are done for struvite stones?

  Antibiotics, acetohydromaxic acid, surgery.
• What size of stones may pass spontaneously?

  4mm or less.
• What can be done if the stones are too large to pass spontaneously (more than 7mm)?

  Lithotripsy, open surgical stone removal, endourologic.
• What should you do with a urinary diversion if the patient has excessive pain or drainage around the tube?

  Check for patency.
• If irrigation is ordered for a urinary diversion, how much sterile normal saline solution can you give at most?

  5 mL.
• What are endourologic procedures for kidney stones?

  • Cytoscopy - remove stone in bladder
  • Cystolitholapaxy - Large stones broken up with lithotrite
  • Cystoscopic lithotripsy - ultrasonic waves break stones
  • Lithotripsy ultrasonic laser electrohydraulic - used to break stones during ureteroscopes and percutaneous nephrolithotomy.
• What is a lithotripsy?

  Procedure to eliminate stones from urinary tract.
• What are ureteral stents for?

  Allow passage of sand through urinary tract.
• How long are ureteral stents placed for?

  2 weeks.
• What are primary reasons for surgery for kidney stones?

  Pain, infection, obstruction.
• What type of surgery to remove a kidney stones is for the renal pelvis?

  Pyelolithotomy.
• How much water should a patient drink after a urolithiasis?

  About 3 liters a day to produce 2.5 L of urine/day.
• What drinks should be avoided for those who get kidney stones?

  Colas, coffee, tea.
• What are the most common kidney cancers?

  Renal cell carcinoma.
• What demographics are more susceptible to renal cell carcinoma?

  Men, smokers, obese individuals, asbestos exposure, and those with a family history of renal cell carcinoma (first degree relatives).
• What are symptoms of kidney cancer in early stages?

  Asymptomatic.
• What is the most common cause of renal trauma?

  Blunt trauma.