GU 2 Flashcards
positive result is highly indicative of a UTI
nitrites
how to nitrites end up in urine
breakdown of urea into nitrite by bacteria
casts are
shaped like cylinders because they are formed in the renal tubules
cast that is nonspecific
hyaline casts
WBC casts may be seen with
infections (pyelonephritis) or inflammation (interstitial nephritis)
RBC casts are caused by
microscopic bleeding in the glomeruli
suspect glomerulonephritis is you find what cast in urine
RBC cast
UA - positive culture is what number
10 or more colony-forming units of one dominant bacteria
UA - if multiple bacteria are present, think
may be contaminated sample
WBC casts with proteinuria and hematuria are associated with
pyelonephritis
AKI lasts how long
7-21 days
AKI is defined as
2
- increase in serum creatinine by 0.3 or more within 48 hours
- increase in serum creatinine by 1.5 or more from baseline
AKI - urine volume of less than what
< 0.5 ml/kg/hr for 6 hours
most common cause of intrinsic AKI
acute tubular necrosis ATN, 90% of cases and is often a reversible injury
meds that cause prerenal AKI
3
limit the GFR - ACE I, ARB, NSAID
AKI - postrenal causes
3
bladder obstruction
uretheral/renal obstruction
neurogenic bladder
acute pyelonephritis is an acute bacterial infection of the kidney(s) that is most commonly caused by
3
gram negative Enterobacteriaceae such as E. coli (75-95%), Proteus, and Klebsiella
adult pt presents with acute onset of high fever, chills, anorexia, NV, and one sided flank pain
acute pyelonephritis
acute pyelonephritis physical exam
2
- temperature 100.4 or greater
- CVB angle tenderness
acute pyelonephritis dx tests
4 (UA, cases, C&S, CBC)
- UA - presence of leukocytes, hematuria, nitrites, mild proteinuria
- urinary cases - WBC casts
- urine C&S - presence of 10 mL of one organism
- CBC - leukocytosis, neutrophilia >80% with a shift to the left
neutrophils with a shift to the left means
presence of bands, which are immature neutrophils, suggests an infection
OP tx for acute pyelonephritis abx
oral fluoroquinolone (e.g. levofloxacin, ciprofloxacin) 5-7 days
asymptomatic bacteriuria ASB is defined as
the presence of one or more species of bacteria growing in the urine (10 or more CFU/mL) in the absence of UTI symptoms
the presence of one or more species of bacteria growing in the urine (10 or more CFU/mL) in the absence of UTI symptoms
asymptomatic bacteriuria ASB
asymptomatic bacteriuria ASB - indications for screening and abx therapy include
3
pregnancy
undergoing urologic intervention
renal transplant recipients
asymptomatic bacteriuria ASB - not recommended to screen or treat in who
4
- older adults
- pts with DM
- pts with indwelling bladder catheters
- pts undergoing non-urologic surgery
CKD is more common in what gender
females
CKD - calcemia
hypocalcemia
CKD - parathyroid hormone
often elevated parathyroid hormone
CKD - order what imaging
2
kidney US - to assess for abnormalities in the kidney which may warrant further evaluation
vascular duplex US - to evaluate for renal artery stenosis
hematuria - if infection is suspected the UA will often indicate
WBCs with or without nitrites
hematuria - if infection is suspected do what
order UA with urine C&S; the infection should be treated, and the UA should be repeated about 6 weeks after completion of abx therapy to ensure resolution of hematuria
poststreptococcal glomerulonephritis is suspected if pt presents with
6
dark reddish brown urine
edema
proteinuria
fatigue
decreased urine output
recent strep throat
hematuria in female with history of recent sexual activity or exercise
stop exercise and repeat UA in 4-6 weeks
most kidney stones are made up of
2
calcium oxalate 70-80%
calcium phosphate 15%
calcium stones risk factors - diet
high dietary intake of:
calcium
vitamin C
oxalate foods
sodium
protein
lower fluid intake
intake of foods high in sucrose and fructose
majority of patients will pass a stone within how many hours
48 hours
acute onset of severe colickly flank pain
kidney stone - nephrolithiasis
nephrolithiasis - UA will often show what in majority of patients
hematuria
preferred imaging method to dx nephrolithiasis
CT of abd and pelvis w/o contrast - if CT not available or pt is pregnant, then alt test is US of the kidneys and bladder
nephrolithiasis - tx stone <5 mm
will pass on its own, strain urine, bring stone in for analysis by lab
nephrolithiasis - tx for stones 5-10 mm
tamsulosin (alpha blocker) for up to 4 weeks to help relex ureter smooth muscle; can use another alpha blocker or CCB to facilitate passage of stone
nephrolithiasis - for larger stones, methods used to break the stone and remove it include
extracorporeal shock wave lithotripsy ESWL
nephrolithiasis - diet tx
increase fluid intake to 2-3 L/day
nephrolithiasis - avoid foods high in oxalate such as
8
rhubarb
spinach
okra
nuts
beets
chocolate
tea
meats
