Lecture 5.2 - Renal Flashcards
What are some predisposing factors to a UTI?
–> Renal scarring
–> Compression during pregnancy
–> Urinary retention
–> Caliculi (stones)
–> Diabetes
Concerning in older population.
What populations are UTIs most common in?
Older men d/t enlarged prostate
Also common in nurses
What are some S/S of UTI?
–> Dysuria (painful)
–> Frequency (<2h)
–> Urgency
–> Suprapubic discomfort or pressure
–> Chills/fever and lower back pain might indicate upper UTI.
What might the urine of someone with a UTI look like?
Urine
–> Sediment
–> Hematuria
–> Cloudiness
How do UTI presentations differ in older adults?
More generalized
–> ABD discomfort instead of dysuria
–> Sudden onset delirium
How to test for UTI?
Dipstick analysis for
–> Nitrates
–> bacteremia
–> Elevated WBC
–> Leukocyte extrase
What is leukocyte extrase?
An enzyme found in WBCs that might indicate infection (Used in UTI dipstick)
After a positive UTI dipstick, what might a physician also want to perform?
Microscope analysis for bacteria in urine + midstream urine analysis
How are UTIs treated?
–> Sulfonamide antibiotics (most common)
–> Older adults respond to nitrofurantoin
–> Ciprofloxacin for chronic infections
What is pyelonephritis?
Inflammation of the renal parenchyma
–> Usually bacterial, not always
Where does acute pyelonephritis usually start?
Renal medulla and spreads to cortex.
What are the possible complications of recurrent pyelonephritis?
Scar tissue development which effects kidney function
Possible development of chronic pyelonephritis
What are the S/S of pyelonephritis?
–> Fatigue
–> Sudden onset fever
–> Flank pain
–> Cystitis
What is a KUB?
A kidney, ureter, and bladder ultrasound
What is cystitis?
Inflammation of the bladder
How long are antibiotics given for pyelonephritis?
14-21 days
What antibiotics are used for acute pyelonephritis?
Ampicillins, vancomycin, cipros, septra
What is septra?
Combination of sulfamethoxazole and trimethoprim
–> Used to treat pyelonephritis
Which demographics are most affected by kidney stones?
More common in men and those aged 20-55. More common in the summer months - likely due to dehydration
Which diagnostic tests are done when a person is suspected to have kidney stones?
Urinalysis
Urine culture
Pyelogram/KUD
X-ray
What is the main priority when treating someone with kidney stones?
Main priority is pain control
–> opiates (10-15 mg)
–> Toradol/Ketorolac is very helpful IM for this kind of pain (NSAIDS)
Combination therapy can be used too
What precaution should be taken in those with kidney stones while they urinate?
Ensure to strain urine to detect is stone has been passed spontaneously.
What is Lithotripsy?
Blasting of kidney stones with high energy shock waves
What dietary changes should be made for those with kidney stones?
At least 3L fluid a day
–> Dehydration contributes to caliculi formations, UTI
Large intakes of dairy or other high protein high calcium foods can contribute to the formation
What size of kidney stone is unlikely to pass spantaneously?
Larger than 4 mm are unlikely to pass through ureter
What percentage of people with have another kidney stone after the first incidence?
About half
What age group is most affected by kidney cancers?
50-70 years old