GU Flashcards
Risk factors for complicated UTI
Males poorly controlled DM pregnant kids older adults immunocompromised recurrent anatomic abnormalities recent instrumentation indwelling catheter
Definition of recurrent UTI
3 or more culture positive UTI in one year
OR
2 within 6 months
First line treatment of uncomplicated UTI?
- nitrofurantoin (macrobid) 100 mg BID x 5 days
- TMP-SMX (bactrim, septra) BID x 3 days
- fosfomycin 3 g po x single dose
Lifestyle (non-pharm) counselling for treatment of uncomplicated UTI
- increase fluid intake to 2-3 L/day
- restrict dietary oxalate (beans, spinach, beets, chips, fries, nuts, tea)
First line treatment of complicated UTI?
- 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
Adverse effect from long term nitrofurantoin use?
- lung problems
- chronic hepatitis
- neuropathy
contraindications to nitrofurantoin use?
renal insufficiency (avoid if CrCl 40-60)
cipro side effects:
- MSK
- neuro
- derm
- endo
- QTc
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
Pyelonephritis
Lab findings
- urine culture
- urinalysis
- CBC
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)
Treatment approach for pyelonephritis: which can be treated as outpatient vs hospitalization?
Outpatient only for compliant healthy patients with milder infections
Complicated pyelo: renal disease, male, kidney stone, anatomic abnormality, immunosuppression –> refer for hospitalization
First line treatment for uncomplicated pyelonephritis (eg healthy adult female, not pregnnat)
ciprofloxacin 500 mg BID x 7 days
- must treat minimum 7 days or longer
- close follow up for 12-24 hours
Nephrolithiasis
Risk factors?
- 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
Nephrolithiasis
imaging of choice?
Noncontrast CT abdo/pelvis
KUB ultrasound if pregnant
Nephrolithiasis
Classic symptoms?
acute onset severe colicky flank pain (unilateral)
lasting 20-60 min
-can be severe with nausea and vomiting
Majority will have. hematuria
Kidney stones
majority are made of ______?
calcium oxalate (60-70%)
remainder are struvite (7%), uric acid (7%), cystine (1%)
Nephrolithiasis
Treatment?
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
AKI
KDIGO definition?
increase in serum Cr by _____ within ____
urine volume less than _______
- 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
Causes of AKI
- prerenal usually due to?
- postrenal usually due to?
- intrinsic usually due to?
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
Definition of microscopic hematuria
3 or more RBC/hpf on urine microscopy
urine microscopy must be done at lab **must be analyzed within 2-3 hours
First line imaging for microscopic hematuria?
KUB ultrasound
Risk factors for urothelial (bladder) cancer?
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
if microscopic hematuria detected, next step in workup?
serum Cr, urine ACR
BP
Kidney/bladder ultrasound
Microscopic hematuria
cystoscopy recommended for what categories?
Recommended for
- all patients age >40 with microscopic hematuria
- any age with risk factors for urothelial cancer
- any age with suspicious imaging
post-strep glomerulonephritis
symptoms?
timing?
- acute onset dark red/brown urine
- edema
- proteinuria
- fatigue
- decreased urine output
timing:
- 10-21 days after strep throat, scarlet fever, impetigo
