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Med Surg > 45 - Renal + Urologic Problems > Flashcards

45 - Renal + Urologic Problems Flashcards

1
Q

UTI

A

infections that affect the urinary tract

  • 2nd most common bacterial disease
  • most common bacterial infection in women
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2
Q

most common pathogens causing UTI

A

E.coli

2nd candida albicans

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3
Q

which pathogen is commonly assoc w indwelling catheter

A

candida albicans

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4
Q

bacterial counts for diagnosis of UTI

A

> 10^5 microbe/mL
or
10^2-10^3 microbe/mL + s/s

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5
Q

can fungus + parasites cause UTI

A

yes but uncommon

-often occurs in patients who are immunosuppressed, have diabetes, kidney problems, or receive multibe abx therapy

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6
Q

inflammation of the bladder

A

cystitis

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7
Q

inflammation of renal parenchyma + collecting system

A

pyelonephritis

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8
Q

inflammation of urethra

A

urethritis

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9
Q

urosepsis

A

UTI has spread systemically

-life threatening

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10
Q

uncomplicated UTI

A

occurs in normal urinary tract

-usually only involves bladder

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11
Q

complicated UTI

A

occurs in a person w a structural or functional problem in urinary tract
ex) obstructions, stones, catheters, abnormal GU tract, AKI, CKD, renal transplant, diabetes, or neurogenic disease

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12
Q

how does the body maintain sterility to prevent UTI?

A
  • normal voiding w complete emptying
  • UVJ competence
  • ureteral peristaltic activity (propels urine toward bladder)
  • acidic pH of urine (<6pH)
  • high urea concentration
  • abundant glycoproteins
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13
Q

organisms that cause UTI originate in the ___

A

perineum

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14
Q

common cause of ascending infection is ____

A

urologic instrumentation such as catheters, cystoscopic exams

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15
Q

hematogenous transmission

A

blood borne bacteria invade the kidneys, uretersm or bladder fr elsewhere in the body
***for hematogenous transmission to occur, there must be injury to urinary tract like obstruction of ureter, stone damage, or renal scars.

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16
Q

most common health care assoc infection?

A

CAUTI

-caused by e.coli or pseudomonas.

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17
Q

LOWER Urinary Tract Syndromes [LUTS] occur in patients who have _____ UTI

A

UPPER urinary tract UTI

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18
Q

symptoms of problems w bladder storage or emptying

A
  • dysuria
  • frequency (more than Q2hr
  • urgency
  • suprapubic pressure

-urine may be hematuria, cloudy, or sediment

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19
Q

symptoms of upper UTI (renal parenchyma, pelvis, or ureters)

A

fever, chills, flank pain

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20
Q

T/F UTI confined to the lower urinary tract does not usually have systemic manifestations

A

T

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21
Q

instead of dysuria, + suprapubic pain, older adults tend to have…

A

nonlocalized abdominal discomfort

-may have cognitive impairment or generalized clinical deterioration

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22
Q

if patients are suspected w UTI, what diagnostic procedures should we run?

A

1 dipstrick urinalysis for presence of nitrates, WBC, leukocyte esterase
2 urine culture

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23
Q

which is the best diagnostic study for recurrent UTI, complicated UTI, CAUTI

A

URINE CULTURE

-also when infection is unresponsive to empiric therapy or diagnosis is questionable

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24
Q

2 most accurate diagnostic studies

A

1 specimen obtained by catheter

2 specimens obtained by clean catch method

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25
Q

urine culture with _________ can determine the bacteria’s susceptibility to a variety of abx drugs

A

sensitivity testing

26
Q

uncomplicated vs complicated UTI

abx treatment

A

UNC: short term course abx (3 days)

COMP: longer, 7-14 days or more

27
Q

first choice abx for uncomplicated UTI

A
  • trimethoprim/sulfamethoxazole TMP/SMX
  • nitrofurantoin
  • cephalexin
  • fosfomycin
28
Q

which abx should only be used to treat COMPLICATED UTI

A

fluoroquinolone

like levoFLOXACIN and ciproFLOXACIN

29
Q

which abx should be used for patients with fungal UTI

A

fluconazole aka Diflucan

30
Q

phenazoprydine

A

a urinary analgesic to relieve severe dysuria

31
Q

phenazopyridine

A

azo dye excreted in urine

  • topical analgesic on urinary tract mucosa
  • *causes urine to turn ORANGE or RED
32
Q

how does pyelonephritis usually begin?

A
  • infection of LOWER tract via ascending urethral route
  • —usually bacteria found in intestinal tract
  • vesicoureteral reflux
  • dysfunction of LOWER tract
  • —–like BPH or stones
33
Q

vesicoureteral reflux

A

mvmt of urine from lower tract to upper

-one of the causes of pyelonephritis

34
Q

acute pyelonephritis often starts in the _____ and spreads to the ____

A

renal medulla

adjacent cortex

35
Q

one of the most important risk factors for acute pyelonephritis

A

pregnancy-induces physiologic changes

36
Q

acute pyelonephritis

classic s/s

A
  • fever +chills
  • N/V
  • malaise
  • flank pain
  • may include LUTS (dysuria, urge, freq)
  • CVA tenderness to percussion
37
Q

acute pyelonephritis

diagnostic

A

urinalysis (WBC, bacteria, pyuria, cast)

ultrasound/CT scan (anatomic abnorm, hydronephrosis, abscess, obstructing stone)

38
Q

chronic pyelonephritis

A

kidneys become inflamed
-develop fibrosis (scarring)>
»loss of renal function>
»atrophy (shrinking)

39
Q

chronic pyelonephritis is usually the result of…

A
  • anatomic abnormalities
  • recurrent infection
  • may occur absent of hx of UTI
40
Q

chronic pyelonephritis

diagnostics

A
  • radiologic imaging

- renal biopsy can show loss of functioning nephrons, infiltration of parenchyma w inflammatory cells, fibrosis

41
Q

chronic pyelonephritis can progress to ____

A

ESRD

42
Q

glomerulonephritis

A

affects both kidneys equally

-3rd leading cause of ESRD

43
Q

although the glomerulus is the primary site of inflammation in glomerulonephritis, ______, ________ ,________ w/in the kidney can occur

A

1 tubular + interstitial changes
2 vascular scarring
3 glomerulosclerosis

44
Q

acute post-streptococcal glomerulonephritis [APSGN] is most common in ___

A

children, young adults, and adults over 60yr

45
Q

acute post-streptococcal glomerulonephritis [APSGN] develops about 1-2 wks after an ______

A

infection of the tonsil pharynx, or skin by nephrotoxic strains of A-Bhemolytic streptococci

46
Q

APSGN s/s

A
  • generalized body edema
  • hypertension
  • oliguria
  • hematuria
  • varying proteinuria
47
Q

edema occurs in APSGN bc of

A

decreased GFR

-first appears in low pressure tissue like orbitals then moves to body

48
Q

titers for APSGN

A

ANTISTREPTOLYSIN-O

[ASO]

49
Q

______ is highly suggestive of APSGN

A

ERYTHROCYTE CAST

50
Q

chronic glomerulonephritis

A

syndrome of permanent + progressive renal fibrosis

  • can lead to ESRD
  • cause may not be found
51
Q

chronic glomerulonephritis

onset

A
  • slowly over time

- most are discovered accidentally during diagnostic studies for something else

52
Q

chronic glomerulonephritis

s/s

A
  • proteinuria
  • hematuria
  • slow dvlpt of uremia
  • INCR bun + serum creatinine
53
Q

goodpasture syndrome

A

autoimmune disease

  • antibodies attack glomerular +alveolar basement membranes
  • super rare
54
Q

goodpasture syndrome

s/s

A
  • flu-like
  • pulmo (cough, SOB)
  • hemopytisis
  • crackles
  • pulmo insufficiency
  • hematuria
  • weakness
  • pallor
  • anemia
55
Q

rapidly progressive glomerulonephritis [RPGN]

A

glomerular disease w glomerular crescent formation

–loss of renal function over days to weeks

56
Q

possibly causes of RPGN

A
  • complication of inflammatory/infectious disease (APSGN or goodpasture)
  • complication of systemic disease
  • idiopathic disease
57
Q

RPGN

s/s

A
  • hypertension
  • edema
  • proteinuria
  • hematuria
  • RBC cast
58
Q

Interstitial Cystitis [IC]

A

chronic painful inflammation of BLADDER
-urinary pain that CANNOT be attributed to other causes
-cause is unknown
AKA bladder pain syndrome or painful bladder syndrome PBS

59
Q

IC/PBS

s/s

A

PRIMARY S/S: pain + bothersome LUTS (urge+freq)

  • severe cases may void 60x+ a day
  • suprapubic, vagina, rectum pain
60
Q

IC/PBS is a diagnosis of ____

A

exclusion

  • necessary to rule out other possible causes that produce similar symptoms like cancer, stones, sndometriosis
  • absence of bacteria in utine
  • HUNTER LESIONS (distinct inflammatory area on bladder wall)
61
Q

IC/PBS

treatment

A
  • abx does NOT help
  • nutri + drug therapy
  • -eliminate caffeine, alcohol, citrus, carbonation, anything that can cause lower pH
  • pentosan (Elmiron) is the only drug approved

Med Surg (18 decks)

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