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AANP Leik and Fitzgerald > GU > Flashcards

GU Flashcards

1
Q

Risk factors for complicated UTI

A 
Males
poorly controlled DM
pregnant
kids
older adults
immunocompromised
recurrent
anatomic abnormalities
recent instrumentation
indwelling catheter
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2
Q

Definition of recurrent UTI

A

3 or more culture positive UTI in one year

OR

2 within 6 months

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3
Q

First line treatment of uncomplicated UTI?

A
  • nitrofurantoin (macrobid) 100 mg BID x 5 days
  • TMP-SMX (bactrim, septra) BID x 3 days
  • fosfomycin 3 g po x single dose
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4
Q

Lifestyle (non-pharm) counselling for treatment of uncomplicated UTI

A
  • increase fluid intake to 2-3 L/day

- restrict dietary oxalate (beans, spinach, beets, chips, fries, nuts, tea)

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5
Q

First line treatment of complicated UTI?

A
  • cipro 500 mg BID or 1000 mg ER once daily
  • levofloxacin 750 mg once daily

-treat for 7 days or longer 7 days

If high risk of multidrug resistant organisms: macrobid 100 mg BID

UA and urine C+S before and after treatment

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6
Q

Adverse effect from long term nitrofurantoin use?

A
  • lung problems
  • chronic hepatitis
  • neuropathy
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7
Q

contraindications to nitrofurantoin use?

A

renal insufficiency (avoid if CrCl 40-60)

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8
Q

cipro side effects:

  • MSK
  • neuro
  • derm
  • endo
  • QTc
A

MSK: tendinitis, tendon rupture (increased risk age > 60, corticosteroids, strenuous physical activity, renal failure, previous tendon disorder, kidney/heart/lung transplant recipients), exacerbation muscle weakness in myasthenia gravis

NEURO: seizures, toxic psychosis, increased intracranial pressure, polyneuropathy

DERM: phototoxicity: clothing & sunscreen protection;

ENDO: hyperglycemia or hypoglycemia

QTc prolongation: concomitant medications that prolong QT and/or cause torsades de pointes

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9
Q

Pyelonephritis

Lab findings

  • urine culture
  • urinalysis
  • CBC
A

Urine C&S: 100,000 CFU/mL

Urinalysis: pyuria (>2-5 leukocytes/HPF)
• WBC casts

CBC
Leukocytosis (WBC >11,000), neutrophilia (>80%), shift to left (bands of immature neutrophils)

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10
Q

Treatment approach for pyelonephritis: which can be treated as outpatient vs hospitalization?

A

Outpatient only for compliant healthy patients with milder infections

Complicated pyelo: renal disease, male, kidney stone, anatomic abnormality, immunosuppression –> refer for hospitalization

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11
Q

First line treatment for uncomplicated pyelonephritis (eg healthy adult female, not pregnnat)

A

ciprofloxacin 500 mg BID x 7 days

  • must treat minimum 7 days or longer
  • close follow up for 12-24 hours
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12
Q

Nephrolithiasis

Risk factors?

A
  • Family hx (double the risk)
  • Dehydration, hyperuricosuria, acidic urine –> increase risk for uric acid stones.
  • Chronic obstruction
  • Diet high in calcium, vit C, oxalate, sodium, protein, purine
  • Pregnancy
  • Chronic infections
  • Foreign bodies
  • IBD, bowel resection, ileostomy –> excessive oxalate formation
  • Medications (Vitamins A,C,D, loop diuretics, calcium-containing medications, sulfa drugs, acyclovir)
  • Obesity
  • Gastric bypass
  • DM
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13
Q

Nephrolithiasis

imaging of choice?

A

Noncontrast CT abdo/pelvis

KUB ultrasound if pregnant

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14
Q

Nephrolithiasis

Classic symptoms?

A

acute onset severe colicky flank pain (unilateral)
lasting 20-60 min
-can be severe with nausea and vomiting

Majority will have. hematuria

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15
Q

Kidney stones

majority are made of ______?

A

calcium oxalate (60-70%)

remainder are struvite (7%), uric acid (7%), cystine (1%)

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16
Q

Nephrolithiasis

Treatment?

A

pain control with NSAIDs and opioids, fluids (hydration)

if stone is small (<5 mm), most people will pass stone within 24-48 hours

If large: lithotripsy

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17
Q

AKI

KDIGO definition?
increase in serum Cr by _____ within ____
urine volume less than _______

A
  • Increase in serum Cr by 0.3+ mg/dL within 48 hours
  • Increase in serum Cr by 1.5+ mg/dL from baseline (known or presumed in last 7 days)

Urine volume <0.5 mL/kg/hr for 6 hours

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18
Q

Causes of AKI

  • prerenal usually due to?
  • postrenal usually due to?
  • intrinsic usually due to?
A

Prerenal: hypoperfusion
eg hypovolemia, decreased cardiac output, third spacing, meds (ACEI, ARB, NSAIDs)

Postrenal: obstruction
eg bladder/urethal/renal obstruction, neurogenic bladder

Intrinsic: acute tubular necrosis
eg ischemia, prolonged hypoperfusion, sepsis, hemorrhage

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19
Q

Definition of microscopic hematuria

A

3 or more RBC/hpf on urine microscopy

urine microscopy must be done at lab **must be analyzed within 2-3 hours

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20
Q

First line imaging for microscopic hematuria?

A

KUB ultrasound

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21
Q

Risk factors for urothelial (bladder) cancer?

A 
age (40+)
sex (male)
SMOKING is most important risk factor (past, present, second hand)
occupational exposure to chemicals
exposure to pelvic radiation
chronic lower urinary tract inflammation
schistosomiasis
22
Q

if microscopic hematuria detected, next step in workup?

A

serum Cr, urine ACR
BP
Kidney/bladder ultrasound

23
Q

Microscopic hematuria

cystoscopy recommended for what categories?

A

Recommended for

  • all patients age >40 with microscopic hematuria
  • any age with risk factors for urothelial cancer
  • any age with suspicious imaging
24
Q

post-strep glomerulonephritis

symptoms?

timing?

A
  • acute onset dark red/brown urine
  • edema
  • proteinuria
  • fatigue
  • decreased urine output

timing:
- 10-21 days after strep throat, scarlet fever, impetigo

25
Q

Oliguria is defined as…..?

A

urinary output <400 mL/day for adults

26
Q

Proteinuria is defined as …..?

A

Excretion of >150 mg/day of protein

27
Q

Microscopic hematuria is defined as …..?

A

presence of 3 or more RBCs/hpf

28
Q

Asymptomatic bacteriuria is defined as …..?

A

presence of one or more species of bacteria (100,000 CFU/mL) in absence of UTI irrespective of pyuria

29
Q

What is the definition of a UTI on urine culture?

A

100,000 CFU/mL of single organism

or

100,000 CFU/mL of one AND 50,000 CFU/ml of second organism

30
Q

What are some benign causes of proteinuria?

A

fever, intense exercise, acute illness, dehydration, emotional stress

31
Q

What are some serious causes of proteinuria?

A

○ Diabetic nephropathy, hypertensive nephropathy, polycystic kidneys, sarcoidosis, lupus, rhabodomyolysis, pre-eclampsia, eclampsia

32
Q

symptoms of acute kidney injury?

WOE with LAN

A
  • weight gain
  • oliguria
  • edema
  • lethargy
  • anorexia
  • nausea
33
Q

cause of high BUN? low BUN?

A 
High BUN
• Acute kidney failure
• High protein diet
• Hemolysis
• CHF
• Drugs

Low BUN
• Liver disease

34
Q

eGFR is less reliable in these situations?

A
  • drastic increase/reduction in muscle mass (bodybuilder, amputee, wasting disorder)
  • pregnancy
  • acute renal failure
  • elderly
35
Q

what do large amount of squamous epithelial cells indicate?

A

contamination

36
Q

what is normal cutoff for WBC in urine?

A

< or equal to 10 WBCs/mL

37
Q

urine dipsticks only detect ____ for proteinuria

A

albumin

*does not capture microalbumin

38
Q

Hyaline casts are seen in …..?

WBC casts seen in …..?

RBC casts seen in ……?

A

Hyaline: “normal” in concentrated urine and after strenuous exercise

WBC: infections (UTI, pyelo)

RBC casts and proteinuria diagnostic of glomerulonephritis

39
Q

true or false

asymptomatic bacteriuria should not be treated in pregnant women

A

false

always treat pregnant women
up to 30% risk of pyelo

40
Q

true or false

UTIs are common in males

A

false

UTIs in males must have follow up evaluation

r/o ureteral stricture, infected kidney stones, anatomical abnormality, acute prostatitis, STI

41
Q

Glomerulonephritis

Etiology/cause?
-3 broad categories

A

• Infection (eg post-strep, bacterial endocarditis, viral infections HIV HBV/HCV)
○ Timing: 1-2 weeks after GBS pharyngitis

  • Immune disease (eg lupus, Goodpastrue’s syndrome, IgA nephropathy)
  • Vasculitis (eg polyarteritis, Wegener’s granulomatosis)
42
Q

Glomerulonephritis

Symptoms?

A 
Symptoms:
	• Pink/cola-coloured urine (hematuria)
	• Foamy urine (proteinuria)
	• HTN
	• Edema of face, hands, feet and abdomen
	• Anemia maybe
43
Q

Sequelae of glomerulonephritis

A 
Sequelae
	• Kidney failure
	• HTN
	• Electrolyte imbalance
        •  syndrome
44
Q

Treatment of glomerulonephritis

A

Treatment
• Acute glomerulonephritis: usually self-limiting. Goal to identify cause, protect from further damage
○ Antihypertensive: to lower BP
○ Antimicrobial: if infection suspected
○ Systemic steroids and immunosuppressives: to reduce inflammation
• If severe case due to immune disease: plasmapheresis to remove Ab and toxic proteins
• If acute kidney failure: dialysis

45
Q

Chronic glomerulonephritis most commonly seen in what population?

A

young men who also have hearing and vision loss

46
Q

diagnostic workup of glomerulonephritis?

A

Diagnosis
• Urinalysis: RBC and RBC casts, WBC, elevated protein
• Bloodwork: Elevated serum Cr and BUN
• Imaging: CT or kidney ultrasound
• Renal biopsy needed to confirm diagnosis

47
Q

Nephrotic syndrome is characterized by what lab findings?

symptoms?

A

lab: heavy proteinuria, hypoalbuminemia, hyperlipidemia, lipiduria

symptoms:

  • edema (peripheral and periorbital)
  • elevated BP
48
Q

What are lab findings in acute renal failure?

A
  • increased Cr and BUN
  • hyperkalemia
  • hypercalcemia
  • hypernatremia

Anemia in chronic renal failure

49
Q

eGFR for stage 4 CKD?

stage 5 CKD?

A

stage 4: GFR 15-29 mL/min

stage 5: <15 mL/min

50
Q

what type of anemia is seen in CKD?

A
  • normocytic
  • normochromic
  • low reticulocyte count

AANP Leik and Fitzgerald (14 decks)

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