PPNP2 finals Flashcards
what is acute kidney injury?
sudden ↓ kidney fx over hrs or days
RF of acute kidney injury
non-modifiable (age, DM, autoimmune diseases, cancers, kidney/ renal/ heart diseases)
modifiable (unctrlled HTN, meds ie DAN, contrast dye)
types of acute kidney injury
- Prerenal
↓ blood flow due to haemorrhage, burns, ascites etc - Intrarenal
Damage to kidney
Eg glomerulonephritis, toxins, prolonged ischemic injury - Postrenal
↓ outflow of urine from kidneys due to blockage
Which may be caused by tumours, strictures, enlarged prostate, kidney stones lodged in ureter
signs/ symptoms of acute kidney injury
- oliguria (↓ urine o/p (no foul-smelling)
cause: edema (peripheral/ pulmonary), HTN, increased weight, bounding pulse, JVD) - diuretic
cause: electrolyte imbalances (increased K+ - cardiac arrhythmias, PO42-, decreased Ca2+ - tetany), increased urea/ waste pdts concn in blood (anorexia, uremic encephalopathy)
treatment for AKI
goal: manage symptoms (fluid vol takes precedence over pain since it can result in pulmonary edema and cause hypoxia)
1. Replace Losartan (ARB) with Ca channel blocker Amlodipine (treat HTN)
2. Edema/ fluid retention → Furosemide (loop diuretics)
3. Hyperkalemia (IV Insulin, Oral sodium polystyrene sulfonate, IV Ca gluconate)
4. Pain → Acetaminophen (Avoid NSAIDs eg ibuprofen)
5. GERD (gastroesophageal reflux) → Cimetidine
what is CKD?
Slow, progressive ↓ in kidney fx (irreversible)
↓ GFR → < 100 ml/ min
RF of CKD
non-modifiable (age, genes)
modifiable (HTN, obesity, DM, smoking, meds ie DAN, diseases)
5 stage of CKD
- Normal kidney fx
- Due to the presence of the remaining nephrons → become larger to work harder - Kidney fx mildly ↓
- Moderate ↓↓
- Severe ↓↓↓
- Kidney fx completely lost → renal failure/ ESRD
progression of CKD
- kidneys lose ability to conc urine, causing polyuria, nocturia
- oliguria, causing edema etc
- diuretics (electrolyte imbalance, uremia, uremic encephalopathy, uremic frost, pericarditis)
treatment of CKD
goal: manage BP
1. ACE inhibitors (-pril)
2. ARBs (-sartan)
3. Na-glu cotransporter inhibitor (-flozin)
3. pain - paracet/ acetaminophen
4. diuretics - furosemide
SE of lisinopril
hypotension, dizziness
dry unproductive cough
angioedema
hyperkalemia
contraindications of ACE inhibitors/ ARBs
pregnancy, pts w renal failure
SE of candesartan
hypotension, dizziness
angioedema
hyperkalemia
(less severe than ACE inhibitors)
SE of canagliflozin
UTI
*need of monitoring serum creatinine within 4 weeks of therapy - small, expected increase 10-20%
treatment for cystitis
NAF (nitrofurantoin, amoxicillin-clavulanate, fosfomycin)
treatment for bacteriauria
NAF (nitrofurantoin, amoxicillin-clavulanate, fosfomycin)
treatment for pyelonephritis
amoxicillin-clavulanate, cefuroxime axetil
SE of nitrofurantoin
GI disturbances
brown urine
acute pneumonitis (resolved upon disc.)
SE of amoxicillin-clavulanate
GI disturbances
penicillin allergy
drug-drug interaction w MTX
SE of fosfomycin
well tolerated
SE of cefuroxime axetil
GI disturbances
allergy (less freq than amox-clav)
drug-drug interaction w antacids, H2 blockers, PPI & warfarin
treatment for recurrent UTI
trimethoprim, nitrofurantoin, amoxicillin-clav, post-menopausal women: topical estrogen cream
treatment for UTI in male
trimethoprim, quinolone
treatment for complicated lower UTI
trimethoprim, quinolone
treatment for prostatitis
trimethoprim, quinolone, amoxicillin-clav
treatment for UTI in pregnant women
trimethoprim, amoxicillin-clav
treatment for UTI in catheterised pts
- irrigation w antiseptic, antibacterial solns
- cleaning the urethra area w povidone-iodine
- prophylactic Abs in short-term catheterisation in the first 4-7 days
treatment for pt who has had recent sexual activity and contracted symptomatic bacteriuria
azythromycin or doxycyline
mgmt of pt undergg dialysis
- monitor for signs of hypotension
- IV fluids, trendelenburg position, supplemental O2, slow down ultrafiltration rate - monitor for signs of dialysis disequilbrium syndrome (restlessness, headache, nausea, vomiting. blurred vision, altered mental status, muscle cramps)
mgmt of post-dialysis pt
- report to HCP if feeling lightheaded, dizzy
- monitor for bleeding for at least 6h
- access site care
- if pt on long-term dialysis, administer hep b vaccine
signs/ symptoms of cystitis
- urine/ bacteriuria
- cloudy, foul-smelling urine
- haematuria - bladder - edema
- bladder fullness
- suprapubic pain
- increased urgency/ freq
signs/ symptoms of pyelonephritis
flank pain, fever, chills, nausea/ vomiting
signs/ symptoms of urethritis
dysuria
how do estrogen/ progesterone affect the chances of contracting UTI?
decreased estrogen due to menopause changes the vaginal flora, making it more susceptible
increased progesterone during pregnancy dilates ureter, causing urinary stasis, increasing the risk of contracting UTI
urge incontinence
overactive bladder → sudden urge to urinate, difficult to delay
overflow incontinence
pressure from bladder (too full) causes urine to leak out
- Caused by: problems w urinary retention eg spinal cord injuries or enlarged prostate
fxal incontinence
physical, cognitive or envtal problem
- Seen in pts w mobility problems, dementia
stress incontinence
- ↑ intra abdominal pressure eg sneezing, coughing, laughing, exercise etc
- Caused by weak pelvic floor muscles
1. Pregnancy & childbirth (esp multiple pregnancies)
2. Trauma by vaginal deliveries or instruments (women) or prostate cancer surgical treatment (men)
3. ↑ risk during menopause since ↓ estrogen causes atrophy of pelvic tissue
4. Bladder prolapse (aka bladder hernia; when bladder protrudes into vaginal space → compress)
complication of urinary incontinence
- skin breakdown
- UTI
- lower qty of life
RF of BPH
- age > 50y
- obesity
- fam hx
- hx of erectile dysfx (likely due to changing H as men age)
