Renal Flashcards
A patient presents with acute renal colic pain and hematuria. The patient denies nausea, vomiting, and dysuria. Serum creatinine level is 0.8 mg/dL. The patient is afebrile, and urinalysis is unremarkable. Imaging indicates a stone of 5 mm. What is the priority intervention for management of this patient?
A.Analgesia and hydration
B.Urologic consultation
C.Administration of tamsulosin 0.4 mg once daily
D.Initiation of antibiotics
Answer: A. Analgesia and hydration
This patient is presenting with nephrolithiasis. Most patients with a stone ≤5 mm can be treated conservatively at home with pain medication and hydration until the stone passes as long as they are able to tolerate adequate oral intake. The patient’s urine should be strained, and any stone that passes should be submitted for analysis. If patients experience uncontrollable pain or fever, hospitalization is often necessary. A urologic consultation is indicated for patients presenting with a stone >10 mm, urinary tract infection, acute kidney injury, anuria, and/or severe pain, nausea, or vomiting. A urinary tract infection is unlikely given that the patient is afebrile, and the urinalysis is unremarkable, so initiation of antibiotics is not indicated at this time. Tamsulosin, an alpha blocker, is indicated for patients with urethral stones >5 mm and ≤10 mm in diameter to facilitate stone passage.
An adult nonpregnant female patient presents with complaints of dysuria, urinary frequency, and urgency. Urinalysis is significant for pyuria and bacteriuria. Urine culture and susceptibility testing are pending. The patient’s vital signs are otherwise stable, and she denies chills, fever, or flank pain. The patient denies a history of any recent broad-spectrum antimicrobial use, travel, or healthcare exposures. Based on this presentation, which of the following antimicrobial regimens is indicated?
A.No antibiotics are indicated, only symptom management
B.Meropenem 1 g IV every 8 hours plus vancomycin 15 mg/kg IV every 12 hours
C.Trimethoprim-sulfamethoxazole (Bactrim) 160/800 mg PO BID for 3 days
D.Ceftriaxone 1 g IV once daily
Answer: C. Trimethoprim-sulfamethoxazole (Bactrim) 160/800 mg PO BID for 3 days
The patient is presenting with symptoms of acute simple cystitis, an acute infection that is confined to the bladder with no signs of systemic infection (e.g., chills, rigors, fatigue, flank pain, costovertebral angle tenderness). Often, diagnosis can be made based on the classic symptoms in adult nonpregnant female patients; however, a urinalysis and urine culture can confirm the presence of pyuria and bacteriuria. Initial empiric antimicrobial agents without risk factors for multidrug–resistant infection include: nitrofurantoin, trimethoprim-sulfamethoxazole,fosfomycin, and pivmecillinam. Of note, multidrug–resistant gram-negative urinary tract infections should be suspected in any patient with a history of a previous multidrug–resistant isolate; previous use of a fluoroquinolone, trimethoprim-sulfamethoxazole, or broad-spectrum beta-lactam; previous inpatient stay at a healthcare facility; and/or travel to areas with high rates of multidrug–resistant organisms. Antimicrobials are not indicated for patients presenting with bacteriuria without consistent urinary symptoms (asymptomatic bacteriuria). For hospitalized patients who are not critically ill or at risk for an infection with a multidrug–resistant gram-negative organism, ceftriaxone 1 g IV once daily is recommended. For critically ill patients or those with a urinary tract obstruction, meropenem plus vancomycin is recommended.
UTI decision score
Burning = 1
Leuks = 1
Nitrites = 1
0-1= perform culture before deciding the need for antibiotics . Treat if symptoms severe
2-3 = start antibiotics without waiting for culture
