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infection, failure Flashcards

1
Q

urinary tract infection (UTI) is

A

inflammation of urinary tract

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2
Q

urinary tract infection presents as

A
  1. suprapubic pain
  2. dysuria
  3. urinary frequency
  4. urgency
    SYSTEMIC SYMPROMS ARE USUALLY ABSENT
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3
Q

Dysuria

A

painful or difficult urination.

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4
Q

UTI risk factors

A
  1. female (short urethra)
  2. sexual intercourse (honeymoon cystitis)
  3. idwelling catheter
  4. diabetes mellitus
  5. impaired bladder emptying
  6. GU malformation
  7. obstruction
  8. pregnancy
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5
Q

UTI - bags

A
  1. E. Coli
  2. S. saprophyticus
  3. Klebsiella pneumoniae
  4. Serratia marcescens
  5. Enterococcus
  6. Proteus mirabilis
  7. Pseudomonas aeruginosa
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6
Q

3 MCC of UTI (in order)

A
  1. E. Coli
  2. S. saprophyticus
  3. Klebsiella pneumoniae
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7
Q

Serratia marcescens - special features (2)

A
  1. red pigment (some stains)

2. often nosocomial and drug resistance

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8
Q

UTI seen in suxually active women (2 bugs in order)

A
  1. E. Coli

2. S. saprophyticus

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9
Q

UTI - diagnostic markers

A
    • leukocyte esterase –> WBC activity
    • Nitrate test –> reduction of urinary nitrates by bacterial species (indicates gram (-) organism, esp E. coli)
    • Urease test –> urease-producing bags (eg. Proteus, klebsiella)
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10
Q

Sterile pyiria and (-) urine cultures suggest

A

urethritis by Neisseria gonorrhoeae or Chlamydia trachomatis

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11
Q

Acute pyeonephritis is the

A

neutrophil infiltration of renal interstitium

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12
Q

Acute pyeonephritis affects …. (location)

A

cortex with rekative sparing of glomeruli/vessels

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13
Q

Acute pyeonephritis - clinical presentation

A
  1. fever
  2. flank pain (costovertebral angle tenderness)
  3. nausea/vomiting
  4. chills
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14
Q

causes of Acute pyeonephritis

A
  1. ascending UTI (E. coli is the MC)

2. hematogenous spread to kidney

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15
Q

acute pyeonephritis - lab

A

WBCs in urine +/- WBCs casts

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16
Q

acute pyeonephritis - CT

A

striated parenchymal enhancement

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17
Q

acute pyeonephritis - risk factors

A
  1. indwelling urinary catheter
  2. urinary tract obstruction
  3. vesicoulateral reflux
  4. DM
  5. pregnancy
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18
Q

acute pyeonephritis - complications

A
  1. chronic pyeonephritis
  2. Renal pupillary necrosis
  3. perinephric abscess
  4. urosepsis
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19
Q

Urosepsis?

A

sepsis started from UTI

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20
Q

acute pyelonephritis - treatment

A

antibiotics

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21
Q

chronic pyelonephritis is the result of

A

recurrent episodes of acute pyelonephritis

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22
Q

chronic pyelonephritis is the result of recurrent episodes of acute pyelonephritis - typically requires

A

predisposition to infection such as vesicoulateral reflux or chronically obstruction kidney stones

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23
Q

Chronic pyelonephritis - gross and histological appearance

A

coarse, asymmetric corticomedullary scarring, blunted and dilated calyx. Tubules can contain esoniphilic casts resembling thyroid tissue (thyroidization of kidney)

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24
Q

Xanthogranulomatous pyelonephritis?

A

a rare condition characterized by widespread kidney damage due to granulomatous tissue containing foamy macrophages

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25
Q

Diffuse cortical necrosis - definition

A

Acute generalized cortical infraction of both kidneys

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26
Q

Diffuse cortical necrosis is likely due to

A

combination of vasospams and DIC

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27
Q

Diffuse cortical necrosis is associated with

A
  1. obstetric catastrophes (eg, abruptio placentae)

2. septic shock

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28
Q

Acute kidney injury is AKA

A

acute renal failure

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29
Q

acute renal failure (Acute kidney injury) - definition

A

abrupt decline in renal function as measured by increased creatinine and increased BUN

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30
Q

acute renal failure (Acute kidney injury) - TYPES

A
  1. Prerenal azotemia
  2. Intrinsic renal failure
  3. postrenal azotemia
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31
Q

Prerenal azotemia - mechanism

A

Due to decreased RBF (eg. hypotension) –> decreased GFR –> Na+/H20 and BUN retained by kidney in an attempt to conserve volume –> increased BUN/creatining ratio (BUN is reabsrobed, creatinine not) and decreased FENa

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32
Q

Prerenal azotemia - urine osmolairty (mOsm/Kg), urine Na+ meq/L, FENa, Serum BUN/Cr

A
  • urine osmolairty –> more than 500
  • urine Na+ less than 20
  • FENa less than 1%
  • Serum BUN/Cr >20
33
Q

Intrinsic renal failure - due to

A
  • acute tubular necrosis or ischemia/toxins

- less commonly due to acute glomerulonephritis (RPGN, hemolytic uremic syndrome) or acute interstitial nephritis

34
Q

Intrinsic renal failure in acute tubular necrosis - mechanism

A

debris obstructing tubuleand fluid backfolow across necrotic tubule –> decreased GFR –> BUN reabsorption is impaired -> low BUN/creatinine ratio

35
Q

acute tubular necrosis - casts?

A

epithelial/granular casts

36
Q

intrinsic failure - urine osmolairty (mOsm/Kg), urine Na+ meq/L, FENa, Serum BUN/Cr

A
  • urine osmolairty –> less than 350
  • urine Na+ more than 40
  • FENa more than 2%
  • Serum BUN/Cr less than 15
37
Q

postrenal azotemia - mechansim

A 
outflow obstruction (stones, BPH, neoplasia, congenital abnormalities) - develops only with bilateral obstruction 
--> at the begining: increased pressure, low GFR, increased BUN:Cr ratio --> long standing: tubular damage ensue with decrease BUN reabsorption, BUN:CR increased
38
Q

postrenal azotemia - urine osmolairty (mOsm/Kg), urine Na+ meq/L, FENa, Serum BUN/Cr

A
  • urine osmolairty –> less than 350
  • urine Na+ more than 40
  • FENa more than 1% (mild) or 2% (severe)
  • Serum BUN/Cr varies
39
Q

Renal failure is the inability

A

to make urine and excrete nitrogenous wastes

40
Q

Consequences of renal failure

A 
mnemonic: MAD HUNGER
Metabolic acidosis 
Dyslipidiemia (esp high TG)
Hyperkalemia
Uremia
Na+/H20 retention 
Growth retardation and developmental delaty 
Erytrhopoietin failure (anemia)
Renal osteodystrophy
41
Q

Renal failure - dyslipidemia?

A
  • maturation of HDL is impaired and its composition is altered
  • clearance of triglyceride-rich lipoproteins and their atherogenic remnants is impaired
42
Q

Uremia?

A 
clinical syndrome marked by increased BUN:
Nausea and anorexia
Pericarditis
Asterixis
Encephalopathy
Platelet dysfunction
43
Q

Chronic renal failure - due to

A
  1. DM (MC)
  2. Hypertension
  3. Chronic glumerulonepritis (esp RPGN and Focal Segmental Glomerulosclerosis)
  4. Cystic renal diasease
44
Q

Acute interstitial renal nephritis is AKA

A

tubulointesritital nephritis

45
Q

Acute interstitial renal nephritis (tubulointesritital nephritis) - clinical presentation/findings

A 
IT CAN BE ASYMPTOMATIC
1. Fever
2. rash
3. hematuria (casts)
4. costovertebral angle tenderness 
5. pyuria (classically eosinophils) 
6. azotemia
7. oliguria
(days to weeks after the factor) 
RESULTS IN ACUTE RENAL FAILURE
46
Q

causes of Acute interstitial renal nephritis (tubulointesritital nephritis)

A
  1. drugs that act as haptens, inducing hypersensitivity (eg. diuretics, penicillin derivatives, PPIs, sulfonamides, rifampin, NSAID)
  2. Systemic infections (eg. mycoplasma)
  3. Autoimmune diseases (eg. Sjogren syndrome, SLE, sarcoidosis)
47
Q

example of a systemic infection that causes Acute interstitial renal nephritis (tubulointesritital nephritis)

A

mycoplasma

48
Q

example of autoimmune diseases that cause Acute interstitial renal nephritis (tubulointesritital nephritis)

A

Sjogren syndrome, SLE, sarcoidosis

49
Q

drugs that cause Acute interstitial renal nephritis (tubulointesritital nephritis)

A

drugs that act as haptens, inducing hypersensitivity (eg. diuretics, penicillin derivatives, PPIs, sulfonamides, rifampin, NSAID)

50
Q

Acute interstitial renal nephritis (tubulointesritital nephritis) may progress to

A

renal papillary necrosis

51
Q

renal papillary necrosis?

A

sloughing of necrotic renal failure

52
Q

renal papillary necrosis - symptoms/findings

A
  1. gross hematuria
  2. proteinuria
  3. flank pain
53
Q

causes of renal papillary necrosis

A
  1. Sickle cell disease or trait
  2. acute pyelonephritis
  3. NSAID (or phenacetin)
  4. DM
  5. Acute interstitial renal nephritis
    May be triggered by recent infection or immune stimulus
54
Q

Renal papillary necrosis can be triggered by

A
  1. recent infection

2. immune stimulus

55
Q

Acute intersitial nephritis - treatment

A

stop the factor (eg. cessation of the drug)

56
Q

MCC of acute kidney injury in hospitalized patients

A

Acute tubular necrosis

57
Q

Acute tubular necrosis - prognosis

A

can be fatal, esp during initial oligurinc phase

58
Q

Acute tubular necrosis - FENa

A

more than 2%

59
Q

Acute tubular necrosis - key finding

A

granular (muddy brown) casts

60
Q

Acute tubular necrosis - stages

A
  1. inciting event
  2. Maintenance phase - oliguric
  3. Recovery phase - oliguric
61
Q

Acute tubular necrosis - duration of maintenance phase

62
Q

Acute tubular necrosis - maintenance phase - risk for

A
  1. hypokalemia
  2. metabolic acidosis
  3. uremia
63
Q

Acute tubular necrosis - Recovery phase - findings

A

BUN and creatinine fall

64
Q

Acute tubular necrosis - recovery phase - risk for

A

hypokalemia

65
Q

Acute tubular necrosis can be caused by …. (groups)

A
  1. ischemic factors

2. nephrotoxic factors

66
Q

Acute tubular necrosis - ischemic factors - mechanism

A

2ry to low RBF (eg. hypotnesion, shock, sepsis, hemorrhage, HF) (often preceded by renal azotemia) –> Resutls in death of tubular cells that may slough into tubular lumen

67
Q

Acute tubular necrosis - areas that are highly susceptible to ischemic injury

A
  1. PCT

2. Thich ascending limb

68
Q

Acute tubular necrosis - nephrotoxic factors - mechanism

A

2ry to injury resulting from toxic substance (eg. aminglycosides, radiocontrasts agents, lead, cisplatin), crush injury (myoglobinuria), hemoglobinuria

69
Q

Acute tubular necrosis - areas that are highly susceptible to nephrotoxic injury

70
Q

Acute tubular necrosis - areas that are highly susceptible to ischemic injury vs nephrotoxic injury

A

ischemic injury –> PCT, Thich ascending limb

nephrotoxic injury –> PCT

71
Q

Renal osteodystrophy?

A

hypocalcemia, hyperphosphatemia and failure of vitD hydroxylation associated with chronic renal disease –> secondary hyperparathyroidism
ALSO hyperphosphatemia decreases serum Ca2+ by causing tissue calcifications wheres low Vit D –> low intestinal Ca2+ absorption

72
Q

Renal osteodystrophy causes ….. (on bones)

A

subperiosteal thinning of bones

73
Q

Hydronephrosis - defnition

A

distention/dilation of renal pelvis and calyces

74
Q

causes of hydronephrosis

A
  • usually caused by urinary tract obstruction (stones, PBH, cervical cancer, injury to ureter)
  • orher causes –> retroperitoneal fibrosis, vesicourateral reflex
75
Q

hydronephrosis dilation occurs .. (location)

A

proximally to the site of pathology

76
Q

hydronephrosis leads to … (appearance)

A

compression and possible atrophy of renal cortex and atrophy

77
Q

hydronephrosis - serum creatinine elevation?

A

only if obstruction is bilateral or if patient has only one kidney

78
Q

hallmark of nephritic syndrome

A

glumerular inflammation and bleeding

Renal (15 decks)

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