45 - Renal + Urologic Problems Flashcards
UTI
infections that affect the urinary tract
- 2nd most common bacterial disease
- most common bacterial infection in women
most common pathogens causing UTI
E.coli
2nd candida albicans
which pathogen is commonly assoc w indwelling catheter
candida albicans
bacterial counts for diagnosis of UTI
> 10^5 microbe/mL
or
10^2-10^3 microbe/mL + s/s
can fungus + parasites cause UTI
yes but uncommon
-often occurs in patients who are immunosuppressed, have diabetes, kidney problems, or receive multibe abx therapy
inflammation of the bladder
cystitis
inflammation of renal parenchyma + collecting system
pyelonephritis
inflammation of urethra
urethritis
urosepsis
UTI has spread systemically
-life threatening
uncomplicated UTI
occurs in normal urinary tract
-usually only involves bladder
complicated UTI
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
how does the body maintain sterility to prevent UTI?
- normal voiding w complete emptying
- UVJ competence
- ureteral peristaltic activity (propels urine toward bladder)
- acidic pH of urine (<6pH)
- high urea concentration
- abundant glycoproteins
organisms that cause UTI originate in the ___
perineum
common cause of ascending infection is ____
urologic instrumentation such as catheters, cystoscopic exams
hematogenous transmission
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.
most common health care assoc infection?
CAUTI
-caused by e.coli or pseudomonas.
LOWER Urinary Tract Syndromes [LUTS] occur in patients who have _____ UTI
UPPER urinary tract UTI
symptoms of problems w bladder storage or emptying
- dysuria
- frequency (more than Q2hr
- urgency
- suprapubic pressure
-urine may be hematuria, cloudy, or sediment
symptoms of upper UTI (renal parenchyma, pelvis, or ureters)
fever, chills, flank pain
T/F UTI confined to the lower urinary tract does not usually have systemic manifestations
T
instead of dysuria, + suprapubic pain, older adults tend to have…
nonlocalized abdominal discomfort
-may have cognitive impairment or generalized clinical deterioration
if patients are suspected w UTI, what diagnostic procedures should we run?
1 dipstrick urinalysis for presence of nitrates, WBC, leukocyte esterase
2 urine culture
which is the best diagnostic study for recurrent UTI, complicated UTI, CAUTI
URINE CULTURE
-also when infection is unresponsive to empiric therapy or diagnosis is questionable
2 most accurate diagnostic studies
1 specimen obtained by catheter
2 specimens obtained by clean catch method
urine culture with _________ can determine the bacteria’s susceptibility to a variety of abx drugs
sensitivity testing
uncomplicated vs complicated UTI
abx treatment
UNC: short term course abx (3 days)
COMP: longer, 7-14 days or more
first choice abx for uncomplicated UTI
- trimethoprim/sulfamethoxazole TMP/SMX
- nitrofurantoin
- cephalexin
- fosfomycin
which abx should only be used to treat COMPLICATED UTI
fluoroquinolone
like levoFLOXACIN and ciproFLOXACIN
which abx should be used for patients with fungal UTI
fluconazole aka Diflucan
phenazoprydine
a urinary analgesic to relieve severe dysuria
phenazopyridine
azo dye excreted in urine
- topical analgesic on urinary tract mucosa
- *causes urine to turn ORANGE or RED
how does pyelonephritis usually begin?
- infection of LOWER tract via ascending urethral route
- —usually bacteria found in intestinal tract
- vesicoureteral reflux
- dysfunction of LOWER tract
- —–like BPH or stones
vesicoureteral reflux
mvmt of urine from lower tract to upper
-one of the causes of pyelonephritis
acute pyelonephritis often starts in the _____ and spreads to the ____
renal medulla
adjacent cortex
one of the most important risk factors for acute pyelonephritis
pregnancy-induces physiologic changes
acute pyelonephritis
classic s/s
- fever +chills
- N/V
- malaise
- flank pain
- may include LUTS (dysuria, urge, freq)
- CVA tenderness to percussion
acute pyelonephritis
diagnostic
urinalysis (WBC, bacteria, pyuria, cast)
ultrasound/CT scan (anatomic abnorm, hydronephrosis, abscess, obstructing stone)
chronic pyelonephritis
kidneys become inflamed
-develop fibrosis (scarring)>
»loss of renal function>
»atrophy (shrinking)
chronic pyelonephritis is usually the result of…
- anatomic abnormalities
- recurrent infection
- may occur absent of hx of UTI
chronic pyelonephritis
diagnostics
- radiologic imaging
- renal biopsy can show loss of functioning nephrons, infiltration of parenchyma w inflammatory cells, fibrosis
chronic pyelonephritis can progress to ____
ESRD
glomerulonephritis
affects both kidneys equally
-3rd leading cause of ESRD
although the glomerulus is the primary site of inflammation in glomerulonephritis, ______, ________ ,________ w/in the kidney can occur
1 tubular + interstitial changes
2 vascular scarring
3 glomerulosclerosis
acute post-streptococcal glomerulonephritis [APSGN] is most common in ___
children, young adults, and adults over 60yr
acute post-streptococcal glomerulonephritis [APSGN] develops about 1-2 wks after an ______
infection of the tonsil pharynx, or skin by nephrotoxic strains of A-Bhemolytic streptococci
APSGN s/s
- generalized body edema
- hypertension
- oliguria
- hematuria
- varying proteinuria
edema occurs in APSGN bc of
decreased GFR
-first appears in low pressure tissue like orbitals then moves to body
titers for APSGN
ANTISTREPTOLYSIN-O
[ASO]
______ is highly suggestive of APSGN
ERYTHROCYTE CAST
chronic glomerulonephritis
syndrome of permanent + progressive renal fibrosis
- can lead to ESRD
- cause may not be found
chronic glomerulonephritis
onset
- slowly over time
- most are discovered accidentally during diagnostic studies for something else
chronic glomerulonephritis
s/s
- proteinuria
- hematuria
- slow dvlpt of uremia
- INCR bun + serum creatinine
goodpasture syndrome
autoimmune disease
- antibodies attack glomerular +alveolar basement membranes
- super rare
goodpasture syndrome
s/s
- flu-like
- pulmo (cough, SOB)
- hemopytisis
- crackles
- pulmo insufficiency
- hematuria
- weakness
- pallor
- anemia
rapidly progressive glomerulonephritis [RPGN]
glomerular disease w glomerular crescent formation
–loss of renal function over days to weeks
possibly causes of RPGN
- complication of inflammatory/infectious disease (APSGN or goodpasture)
- complication of systemic disease
- idiopathic disease
RPGN
s/s
- hypertension
- edema
- proteinuria
- hematuria
- RBC cast
Interstitial Cystitis [IC]
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
IC/PBS
s/s
PRIMARY S/S: pain + bothersome LUTS (urge+freq)
- severe cases may void 60x+ a day
- suprapubic, vagina, rectum pain
IC/PBS is a diagnosis of ____
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)
IC/PBS
treatment
- 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
