GU Flashcards
What is the function of the kidneys
-function to regulate the body’s electrolytes and fluids which effects BP
What hormones affect H20 Reabsorption
ADH and Aldosterone
What is considered average urine output?
1,500mL/day
What is the definition of oliguria
<400ml/day
What is normal values for creatinine
Males 0.7-1.3mg/dL
Females 0.6-1.1mg/dL
What affects creatinine levels
- gender (males)
- race (Black people have more muscle mass)
- Muscle mass
What does the creatinine clearance (24 hour urine) evaluate
Microalbuminuria, albuminuria, proteinuria
What is the best test of kidney function
eGFR
How is the eGFR calculated
creatinine, age and gender
What makes an eGFR less reliable
- pregnancy
- muscle wasting
- elderly
- lower extremity amputee
What is a normal eGFR
> 90mL/min
What is CKD Stage 1
> 90mL/min; damage but normal function
What is CKD Stage 2
60-89mL/min
What is CKD Stage 3a
45-59mL/min
What is CKD Stage 3b
30-44mL/min
What is CKD Stage 4
15-30mL/min
What is CKD Stage 5
<15mL/min
What is BUN
measurement of the kidney’s ability to excrete urea (which is a waste product of protein metabolism)
What are causes of increased BUN
- AKI
- High protein diet
- Hemolysis
- CHF
- Drugs
What are causes of decreased BUN
liver damage or disease
What is the BUN: Creatinine ratio useful for
Classifying the type of renal failure
If there is a decreased blood flow to the kidneys then there will be an increased BUN: Creatinine ratio
What does proteinuria indicate?
Kidney damage
What is the most common bacteria to cause a UTI
E. Coli
What are sx of a UTI
- Dysuria
- Urgency
- Frequency
- Hematuria
- Foul-smelling urine
- Sensation of incomplete emptying, scant voiding
- Lower abdominal pain
- Back pain* think pyelo
What is the colony count of a midstream urine that indicates a UTI
> 100,000 CFU
Urine Cultures should be done on:
- Recurrent or refractory infections
- Children and pregnant women
- 65+
What is the most reliable indicator of UTI in a UA
WBC
What DDx should you consider for frequency and urgency of urine with a normal UA
- Pregnancy
- Vaginitis
- STI
- Herpes
- UTI but diluted sample
- Overactive sample
What antibiotic is recommended for uncomplicated UTI
1) Nitrofurantonin (Macrobid) 100mg BID *Not in 3rd trimester of pregnancy
How long should you treat a UTI in:
- men
- individuals with co-morbid conditions
- Complicated UTIs
7-10 days
How long should you treat an uncomplicated UTI
-3 days
What other medications should you consider in UTIs
-Antispasmodics: Phenazopyridine (Pyridium) or Flavoxate
What health promotion should you initiate in UTI
- Hydration
- Avoid Carbonation, ETOH and Caffeine
- Void after Sex
What is a side effect of Phenazopyridine (Pyridium)
Will discolor urine (orange) and stain contact lenses
What are causes of hematuria in adults
- Cancer (renal/bladder)
- Infection
- Stones
- Coagulopathy
- Glomerular Disease
- Hydronephrosis
- Polycystic kidney
- Trauma
- Meds
- Exercise
Risk factors for Bladder Cancer
- Smoking
- Age >40
- Occupational exposure
- Chronic cystitis
- History of pelvic irradiation
- History of analgesic abuse
A patient presents with classic symptoms of a kidney stone what lab abnormality is most likely to be present?
-Hematuria
What medications can help with passing kidney stones?
- Alpha blockers
- CCB
What are risk factors for pyleonephritis
- Untreated or undertreated UTI
- Urinary tract abnormalities
- Elderly
- Fecal Incontinence
- Pregnancy
What findings may be present in a patient with pyleo
- CVA tenderness
- Fever
- Pyuria
- WBC in urine
- Casts
What diagnostic studies are indicated in suspected pyelonephritis
- UA (pyuria, hematuria and maybe mild proteinuria)
- C&S
- CBC (Leukocytosis)
- CVA tenderness
- ESR
What is mgmt of pyelonephritis
-Quinolones: Only oral Abx recommended for outpatient tx
What is the significance of WBC cast
-Pyleonephritis
What are the types of incontinence
1) Urge- detrusor instability
2) Stress- sphincter incompetence
3) Mixed (most common)
What lifestyle changes are indicated in incontinence
- ETOH
- Carbonation
- Coffee or tea
- Citrus
- weight loss
- regular voiding (but not frequent)
- minimize fluids after dinner
Overactive Bladder Management
- Anticholinergics
- Mirabegron (less S/E)
- Estrogen for post-menopausal women
- Biofeedback
- Pelvic floor PT
What is the ODE to anticholinergics
Oh this drug it makes me pink, Sometimes I can't think or even blink I cant see I cant pee I cant spit I cant sh*t
What findings suggest pyleo over UTI
- fever >100.4
- Back/flank pain
- CVA tenderness
- WBC casts
Use of spermicides can ____ risk of UTI
increase
