Genitourinary Textbook Information Flashcards
What is the primary function of the kidney?
Maintain the composition and volume of the body fluids in equilibrium
What are the 3 process of the kidney?
Reabsorption - in blood
Secretion - releasing
Excretion - urine
The structural and functional unit of the kidney is called the what?
Nephron
The renal pelvis is what shape?
Funnel shape
What is the forward movement of urine from the kidney to the bladder called?
Efflux
What is the abnormal of flow of urine, typically backward is called?
Reflux
What are the 3 big things we are looking at for kidneys in labs?
Bun
Creatinine
GFR
The following flashcards are terminology and definition based
What does bacteriuria mean?
Presence of bacteria in the urine
What does asymptomatic bacteriuria mean?
Significant bacteriuria with no evidence of clinical infection
What does symptomatic bacteriuria mean?
Bacteriuria accompanied by physical signs of urinary infection
( Dysuria, suprapubic discomfort )
What does recurrent urinary tract infection mean?
Repeated episode of bacteriuria or symptomatic UTI
What does persistent urinary tract infection mean?
Persistence of bacteriuria despite antibiotic treatment
What is febrile uti mean)
Bacteriruria accompanied by fever, usually a presence of a fever means pyelonephritis
What does cystitis mean?
Inflammation of the bladder
What does urethritis mean?
Inflammation of the urethra
What does pyelonephritis mean?
Inflammation of the upper urinary treat and kidneys
What does Urosepsis mean?
Febrile UTI coexisting with systemic signs of bacterial illness ; blood culture reveals presence of urinary pathogen
Genitourinary tract disorders
Urinary tract infections!!
What is a urinary tract infection?
Urinary tract infection is when a variety of organisms, like e.coli go into the uthrea and cause problems
Other pathogens like staphy and enterocccus is common too
What gender has the most common occurrence of UTI?
Female
( male who are uncircumcised as well )
After the bacteria invades the body, what will the body do to try to get rid of this infection?
Voiding
Why do females tend to get more uti than males?
And explain why?
Females have shorter urethras, which measure to 2cm in kids and 4cm in women,
Why do uncircumcised males get more urinary tract infections than those who are circumcised?
Because the foreskin can hold pathogens inside
And they can eventually travel the long 8 inch urthrea
Is urine sterilize? And why?
No
It isn’t
Because of all the bacteria or waste the body is trying to get rid of
What is another big factor in why kids may get urinary tract infections?
Not being able to empty their bladder out complete
Otherwise known as
Urinary stasis
Incomplete bladder emptying ( stasis ) may result in what?
Backward travel of the urine into the kidneys
Reflux ^
What is some common clinical manifestation of UTI?
Frequency !
Urgency !
Incontienice!
Enuresis
Constipation
Encopresis
Incomplete bladder emptying
What are some other extrinsic factors, other than bacteria that may cause UTI?
Think of surgery??
Think of love??
Think of fun??
Think of medicine??
Urinary caths
Intercourse
Bubble baths and shampoo
Antibiotics
Why is it important to pee after sex?
To flush out all that bacteria that may have entered
What type of symptoms will an infant show who has UTI?
Fever
Hypothermia
Jaundice
Tachypena
Cyanosis
What type of symptoms will toddlers show with UTI!?
Fever
Lethargy
Poor feeding
Vomit
Diarrhea
What type of symptoms will school age children will show?
Enuresis
Daytime Incontience
Malordois urine
What are some symptoms of dysfunctional voiding?
Urinary tract infection without fever
Changes in urinary frequency
Constipation
Squatting to holding to stay dry
Daytime or nighttime pee
Straining to void
Urgency to void
What is the biggest indicator that the infection traveled up to the kidney and causing pyelonephritis?
Flank pain!!
Costovertebral angel tenderness
In older children with uti they are the (3?)
Urgency
Frequency
No real fever
What do we usually do to test for UTI?
Urinalysis and culture
How does the urine usually look like?
Hazy
Cloudy
Thick
Noticeable strands of muscus and pus
Malodorous
What is the key distinguishing true UTI is finding what in the urine?
Pyuria
What do we usually do for infants and some children in which urine analysis or even collection is hard to do!?
Catherization and potential suprapubic aspirations
What and how do we do a clean catch urine!!?
When a child sits on the toilet facing the tank and labia are naturally seperated
What is the treatment we do for children with Urinary tract infections?
Elimate it by usage of antibiotics
What are some antibiotics we used for UTI?
Amoxicillin
Trimethroprim-sulfamethoxazole
What is another thing you may think young girls typically get more UTI?
Think of school age
They are not wiping currently
Back to front
EDUCATE TO FRONT TO BACK!!
What are some things we will encourage parents and children to do with UTI?
Fluid
Good toilet habits
Fiber
Cleaning front to back
Fluid requirements in children
First 10kg = how much ml/day
Second 10kg ?
Each 1Kg ?
Example
Child weight 25kg
How much of fluid needed
100
50
20
1000
5000
20x5= 100
1600
How can we help prevent urinary tract infections?
Avoid scratching between legs and anal area
Routine daily hygiene
Girls to pee after sex
Now onto
Vesicoureteral reflux
VUR
What is Vesicoureteral reflux??
It refers to the retrograde flow of the urine from the bladder into the upper urinary tract
Reflux!
When a bladder pressure is high enough what can occur?
Reflux back into the ureter and renal pelvis
There are two types of reflux which are?
Primary and secondary
What is primary reflux?
Congenital anomaly that effects the ureterovesical junction
This usually is where the bladder has an anti reflux mechanism
What is secondary reflux?
Abnormally high pressure in the bladder
Or function bladder obstruction
Reflux with infection is most common cause of what?
Pyelnoephritis
What is the treatment for VUR?
Examples?
Continous antibiotic prophylaxis
Trimethoprim-sulfamethoxazole
What is the surgical management of VUR!
Where they insert refluxing ureter and consisten of open surgical and reimplantation of the ureters
When is surgical interventions indicated with VUR?
Renal damage
Disease
Scaring
grade 5 reflux
What is a minimally invasive treatment for VUR?
Injection to help bulk up the ureter and help allow urine to be pushed down and not go back up
Overall we want to educate parents and children on what for medication?
Follow the regime !
Glomerular disease
Acute glomerulonephritis
What is acute glomerulonephritis?
Post infectious gleoneruooneprhotis
Where strep throat goes untreated and leads into the kidneys
Group A beta hemolytic streptococci
Of the throat 3-6 weeks
What are clinical manifestation of APSGN?
Period oral edema
( face(eyes) then goes to extremities )
Anorexia
Cola colored urine
How does the urine look like in ASPGN?
Cola colored urine ( or tea )
On examination what vital sign will we see?
Slight high blood pressure
What are some major complications of APSGN?
Hypertension
Encephalopathy
Kidney injury
Hypervolemia ( due to that excessive urine inside )
What will we see in the urine analysis? (3)
Hematuria
Proreinuria
Increased specific gravity
How will we manage or treat this disease?
Usually we can’t because strep is usually gone but this is the after effect so supportive care really
Is bed rest necessary for ASPGN?
No not really
How are we going to manage fluid balance for ASPGN? Remember edema!
Record weight
Monitor intake
Usage of diuretics too
How we will treat the edema in ASPGN?
Diuretics
(Furosemide, lasix )
How we will treat the hypertension in ASPGN?
Usually again with thiazide or loop diuretic
What type of avoidance of food will we tell these kids ?
No sodium!
Because of that edema
We want to reduce it
When will we use antibiotics for these ASPGN?
Only if the infection still is present
What is chronic or progressive glomerulonephritis?
The progressiveness of the ASPGN
And usually resulting in worsen outcomes
Everything remains the same just worse and could lead to renal damage and potential kidney disfunction
Now onto nephrotic syndrome!
What is nephrotic syndrome?
It is the most common glomerular injury in children
What are the big 4 clinical manifestation of nephrotic syndrome?
We often define it as?
Proteinuria
Hypoalbuminemia
Hyperlipidemia
Edema
What are the 3 nephrotic syndrome types?
Minimal change
Secondary
Congenital - Finnish
What is minimal change nephrotic syndrome?
Usually a nonspecific illness, may be from a viral respiratory infection
What is secondary nephrotic syndrome?
Damage to the glomerular
AGN or CGN
It’s usually from collagen vascular disease like lupus or toxic drugs or even immune compromise
What is congenital nephrotic syndrome, Finnish type?
A recessive gene that causes it
Usually babies are super small for age and proteinuira and edema first months of life
How does the urine look in nephrotic syndrome?
Darkly oplascent and frothy
Usually children with nephrotic syndrome will have either weight gain or weight loss?
Weight gain due to edema
But weight loss can happen due to all The protein loss but rare
What does the hypoalbuminemia due or present to us in children with nephrotic syndrome?
Muehrcke, white nails
Notes
Periorbial, abdominal, gonadal, lower edema
Weight gain from edema
Decreased urine output
Pallor or fatigue
Neprhotic syndrome
Again what will we see in that urine test? (3)
Proteinuria
Hypoalbumnimemia
Hypercholestrolemia
What will be the diet for nephrotic syndrome?
NO SALT!
What type of medications will we give to nephrotic syndrome? (3)
Steroids
Diuretics
Immunosuppressants
What is the steroid name for nephrotic syndrome and why do we give it?
Prednisone ! With FOOD!
Help with inflammation
Why do we give diuretics and name explain for nephrotic syndrome?
To reduce edema
Furosemide lasix
Nephrogenic diabetes insipidus!
What is nephrogentic diabetes insipidus?
Defect in the ability to concentrate urine
( distal tubules and collecting ducts are insensitive to ADH )
What are the clinical manifestation of NDI? (4)
Vomit
Unexplained fever
Severe dehydration
Hypernatremia
What is the treatment for this NDI?
Adequate volumes of water
Why would potassium be needed or a concern for us for NDI?
Supplemental potassium would be indicted because we are losing a lot of fluid
Why might NDAIDS be used for NDI?
To help reduce the amount of urination
What type of diet for NDI?
No salt!
Miscellaneous renal disorders
Hemolytic uremic syndrome
Familial nephritis ( alport syndrome )
Unexplained proteinuria
What is hemolytic uremic syndrome? (3)
acute kidney injury
Hemolytic anemia
Thrombocytopenia
What is the etiology/cause of hemolytic uremic syndrome?
Diarrhea positive (D+)
( ingestion of a toxic )
Diarrhea negative (D-)
( genetic disorders )
What is the patho behind hemolytic uremic syndrome?
So the infection attacks RBC and these RBC are removed from the spleen causing that acute hemolytic anemia
And thrombocytopenia is shown from the platelet aggregation with the damage blood vessels
What are the clinical manifestation of hemolytic uremic syndrome? (2) big ones
Diarrhea
Vomiting
Lethargic
Pallor
HEMORRHAGIC MANIFESTATION!!
Bruising, purpura, rectal bleeding
Could potentially be seizures!!
What are the labs?
hemolytic anemia
Bun and creatinine are high
Low hemoglobin and hematocrit
High reticulocyte
What is the treatment for these kids normally?
Blood transfusions
What medication is contraindicated for this?
Heparin!!
More bleeding!
What is familial nephritis? Alport syndrome
High-tone sensorineural deafness, ocular disorders
Usually hematuria is present and progression of ESRD is not treated
What is unexplained proteinuria?
Usually no cause of it
May be from exercise or dehydration
But just repeated examination may help
Renal failure!!
Acute vs chronic!
What does renal failure mean?
The inability of the ones to excrete waste material, concentrate urine and conserve electrolytes
What is acute kidney injury?
When the kidneys suddenly are unable to appropriate regulate volume and composition of urine in response to fluid and food intake
What is the principle feature of AKI?
Oligoanuria
( low urine output )
What are some pre reneal causes that can cause AKI?
What about intrinstic?
Post renal?
Dehydration
Hypovolemia
Nephrotoxic drugs
Obstruction
Is AKI reversible?
Yes
What are some clinical manifestation of AKI?
Oliguria
Dehydration
What are some findings with acute rebels failure like
Electrolyte why
Sodium?
Potassium?
Calcium?
Hypo natremua
Hyper kalemia
Hypo calcemia
What is the treatment for AKI?
Fluid therapy!
Do we use diuretics in AKI?
No!
Since patients are losing fluid and calories, how are we going to help them with AKI?
Helping control water balance
Intake and output
Since the patient develops water intoxication and hyponatremia, these both make it hard to provide calories to help maintain the child need ?
High in (2)
Low in (3)
High in carbs & fat
Low in protein potassium and sodium
Since hyperkalemia is a thing in AKI, what will we do!?
Monitor and ECGS
Avoid any potassium foods too
Since hypertension plays a good role in most kidneys problems how are we going to help aid the patient with hypertension who has AKI?
Well the most common cause of hypertension in aki is over expansion of the ECF and plasma.
Usually we are going to be given kids beta blocks like labetalol and sodium nitroprusside
Anemia is not as common in AKI but a blood transfusion may be indicted if what?
They are below 6
If a patient has a seizure what do we give?
Antipileptic drugs
If the patient experiences cardiac failure or pulmonary edema from their hypervolemia
We usually do what?
Give diuretics
DOMT GIVE DIGOXIN!
Chronic kidney disease
Think CHRONIC!!
Replacement
Dialysis !!
What is hemodialysis has what type of line?
Best used for kids who come in how many times?
And it’s best and rapid of?
Central line!!
3x for 4-6 hours
Correction of fluid and electrolyte abnormalities
What is peritoneal dialysis?
Who is it best for?
Where does it go into?
Fluid always are what?
Is this preference method for kids?
Chronic children
Into the abdominus
Warm!
Yes
What is Continous venovenous hemofiltration?
Usually given to people who don’t tolerate hemodialysis well
What is a transplant?
Complete removal of the kidney and fixed everything really
