GU Flashcards
S&S of lower UTI
**dysuria=key sxs
Diagnosis of UTI
- UA= pyuria (>10 WBCs)
- presence of nitrate (very specific, but not sensitive test for bacteriuria)
- esterase (very sensitive, but not specific)
Common abx in treatment of lower & upper UTI
-Bactrim -Cipro -Augmentin (amoxicillin/clavulanate)
Duration of abx in lower UTI
3 days
Duration of abx in upper UTI
14 day
S&S of upper UTI
-flank, low back pain, abd pain may be present -fever , chills -N/V -**mental status changes in elderly
systemic changes are not evident until overall renal function is _________.
<20-25% of normal
Normal BUN
10-20
Normal Cr
0.5-1.5
Normal BUN/Cr ratio
10:1
diminished renal reserve
50% nephron loss; Cr doubles
Renal Insuffiiciency
75% nephron loss; mild azotemia present
ESRD
90% nephron loss, azotemia, metabolic alterations
Criteria for dialysis
*AEIOU* acidosis electrolyte imbalance (Ca++, K+) intoxication oliguria uremia
In chronic renal failure, what are the limitations with protein?
40g/d
most common cause of intrinsic renal failure
nephrotoxic agents
Normal urine specific gravity
1.010-1.030
Prerenal disease 1.serum BUN/Cr ratio: 2. UNa: 3. Specific gravity: 4. urinary sediment: 5. FENa:
- >10:1 (usu 20:1) 2. <20 3. >1.015 4. nL/few hyaline casts 5. <1
Intrarenal Disease 1.serum BUN/Cr ratio: 2. UNa: 3. Specific gravity: 4. urinary sediment: 5. FENa:
- 10:1 2. >40 3. <1.015 4. *granular/white casts 5. >3
Postrenal Disease 1.serum BUN/Cr ratio: 2. UNa: 3. Specific gravity: 4. urinary sediment: 5. FENa:
- 10:1 2. >40 3. >1.015 4. normal 5. usu >3
Calcium Renal calculi are more common in which gender?
men
what type of stone accounts of 80% of renal calculi?
calcium
what type of renal calculi is more common in women?
struvite
Diagnostic tests for renal calculi?
**CT -xray
Management of renal calculi?
-hydration -analagesia (trio) 1. dilaudid or morphine, 2. toradol (ketorolac), 3. reglan -if stone obstructing flow or + infection–>need removal (extracoporeal, percutaneous lithotripsy or cystoscopy if larger)
Diagnostic workup of BPH
**UA (r/o infection) PSA (>4ng/ml=abnormal)
Medications used in the treatment of BPH
alpha blockers (“cin”/”sin”) 5-alpha reductase inhibitors (“rides”)
Terazocin (hytrin) is what class of med?
alpha antagonist
Finasteride (proscar) is what class of med?
5-alpha reductase inhibitor
Prazocin (minipress) is what class of med?
alpha antagonist
Dutasteride (avodart) is what class of med?
5-alpha reductase inhibitor
Tamsulosin (flomax) is what class of med?
alpha antagonist
What types of meds should be avoided that worsen BPH sxs?
OTC antihistamines (benadryl) decongestants (pseudoephedrine, oxymetazoline -afrin spray) SSRIs
Calculation for creatinine clearance?
(140-age) x (weight-kg)/ 72 x serum Cr *multiply calculated value by .85 for females
normal CrCl for males <40yr
107-139ml/min or 1.8-2.3ml/sec (**dec by 6.5ml/min for every 10 yr after age 20)
normal CrCl for females <40yr
87-107ml/min or 1.5-1.8ml/sec (**dec by 6.5ml/min for every 10 yr after age 20)
most common illness for adults >65yr
UTI
Differential dx of testicular pain?
kidney stone torsion epidydimitis
Which disease state will there be a loss of the cremastor reflex?
torsion
What class of medications would be contraindicated w/renal angiogram?
ACEIs
