GU Flashcards
when you suspect acute renal failure you should look at…
BUN/creatinine, if it is increased this is not a great sign for the kidneys
elevated K, urea
BMP vs CMP
CMP has liver function testing
MCC of community acquired renal failure
prerenal
Caused by decreased perfusion to the kidneys with normal tubular and glomerular function
-hypovolemic states (dehydration)
-fluid sequestration (cirrhosis, pancreatitis, burns)
-decreased CO
intrarenal failure
- acute tubular necrosis
- nephrotoxin (physician prescribed) second MC
postrenal problems are seen primarily in
elderly men
- BPH
- urethral stones
how to treat prerenal conditions?
renal?
postrenal?
IVF (NS/LR)
avoid nephrotoxins
not making urine, foley cath. If prostate problem insert foley then go home with bag
who determines if dialysis is necessary?
nephrologist
Usually made if BUN >100 or Creatinine>10
Conditions for EMERGENT dialysis
Cardiac instability(acidosis, hyperkalemia)
Intractable Volume overload(pulmonary edema), uremia
with hyperkalemia we are concerned about…
cardiac effects
6.5-7.5 peaked T waves
7.5-8 QRS widens
above 8 heart block and vfib
hyperkalemia tx
- calcium gluconate
- insulin
- albuterol
- bicarb
- kayexalate
MCC ESRD
DM followed by HTN
remember in pts with ESRD
noted to have elevated troponins in the absence of acute MI. Some studies quote as high as 70% of patients with kidney disease have elevated troponins without an acute MI, repeat test to check for increase
lower tract vs
upper tract UTI
urethritis/cystitis
pyelonephritis
Males younger than 50 with dysuria and increased frequency think
urethritis caused by STD
flank pain(CVAT), fever, and nv(look toxic appearing) think
pyelo
who to treat vs not treat for UTI
- any pregnant pt gets treated regardless of symptoms
- young pt that has no symptoms but is positive no need to treat
nitrites are specific for
UTI
Take home message is a positive nitrite or leukocyte test results supports the diagnosis of UTI but a negative test result does not exclude it
uncomplicated UTI, treat with…
macrobid (nitrofurantoin)
first choice anbiotic for all pts including pregnant
keflex/bactrim is another option
complicated UTI, treat with…
cipro or levofloxacin or cefpodoxime
in pts with renal insufficiency (high BUN/creatinine) or the elderly you should avoid these meds
macrobid or fluorquinolones
pyelo tx
ceftriaxone, safe for pregnancy
gross hematuria suggests….
microscopic suggests.
lower UT source
renal source
MCC acute urinary retention in men
BPH, dx via US
how to treat acute urinary retention
catheter
oxybutynin may be prescribed for spams
anybody complaining of testicular pain you must rule out
testicular torsion
GU emergency
