Pbl-6 UTI and kidney stone Flashcards
UTI risk factors
- hygiene
- sexual activity
- postmenopausal status
- catheters
- immunosuppression
- urinary tract abnormalities
- urinary retention
- prostate issues
Epidemiology of UTI
Most common occurring bacterial infection- 50% of women will have a UTI by 32 yo
Bactrim
Avoid if used within the last 3 months
Lower UTI S&S
dysuria- bacterial colony irritating the urinary epithelium
frequency- stimulation of urinary reflex
urgency-stimulation of urinary reflex
NO SYSTEMIC SIGNS
Upper UTI S&S
infection of the urinary tract above the bladder
dysuria, frequency, urgency, fever/chills (cytokines), flank pain/CVA tenderness (inflammation of the renal parenchyma and capsule)
N/V, constitutional symptoms
Sensitivity and Specificity of the urine dipstick
High for blood
high for protein
Culture Se and Sp
leukocyte esterase high Se and medium Sp
Nitrites high Sp low Se
3 clinical variables for dx
dysuria, leukocytes and nitrites present on dipstick
Prediction of UTI Se and Sp for 2 positive findings:
Se= 80.3% Sp= 53.7%
Value of urine cultures
detects and id’s the organism
takes 1-3 days
Nitrofurantoi
Not active in the blood but becomes active when processed in the kidney
DOESN’T work in upper UTI because there is not high enough concentrations
Risk factors for nephrolithiasis
hx of renal stones, reduced intake or increased water loss, low urine volume, high ion levels, low urinary pH, reduced levels of natural calculus inhibitors, infections, genetic defects, anatomical prob, certain drugs, gout, oxalate rich foods (spinach, chocolate and nuts), insulin resistance, prolonged immobilization, obesity, warm climates, Vit C suppl in men and estrogen sup in women
S&S with nephrolithiasis
SEVERE pain with radiation to low abdomen, N/V, dysuria, hematuria, urgency and frequency, fever/chills
Best imaging for stones?
- CT best Se and Sp- can detect stones as small as 1-2 cm
2. US
Most common Ab’s for UTI’s
- Bactrim- TMP-SMX
- Ciprofloxacin
- Nitrofurantoin
