Renal Flashcards
Definition of UTI
presence of a pure growth of >10^5 organisms per mL of fresh MSU, 1/3 women with symptoms of UTI have -ve MSU
List Lower UTI
Urethra (Urethritis)
Bladder (cystitis)
Prostate (Porstatitis)
List Upper UTI
Renal pelvis - Pyelonephritis
List the causative organisms of UTI
E.coli
Staph Saprophyticus
kelbsiella
Pseudomonas aeruginosa
List the risk factors for UTI
Increased bacterial inoculation chance - Sexual activity, incontinence
Binding of uropathogenic bacteria - increased spermicide use, decreased oestrogen, menopause
Decreased urine flow - Dehydration, tract obstruction
Bacterial growth - DM, immunosuppression, stones, catheter, tract malformation, pregnancy
Summarise epidemiology for UTI
Common
Majority in women
What are the presenting symptoms of UTI?
Cystitis: Frequency, Urgency, dysuria, haematuria, suprapubic pain
Prostatitis: Flu-like symptoms, Low backache, Few urinary symptoms, Swollen or tender prostate on PR
Acute Pyelonephritis: High fever, Rigors, Vomiting, Loin pain + tenderness, Oliguria
What are the signs of UTI
Fever Abdo/loin tenderness Foul smelling urine Distended bladder enlarged prostate
What investigations would you carry out for UTI?
Urine dipstick - leucocyte esterase + nitrites
Urine microscopy - leucocytes (infection)
MSU Culture - exclude diagnosis (pt no respond to abx)
Ultrasound - rule out obstruction
Bloods - FBC, U&E, CRP, Blood cultures (urosepsis)
Management plan for UTI
Uncomplicated Tx - Trimethoprin // Nitrofurantoin
Treat for 3-6 days, men may require longer course
Alternative treatments - Coamoxiclav//Cefalexin
Complications of UTI
Ascending infection leads to: pyelonephritis perinephric and intrarenal abscess Hydronephrosis // pyenophrosis AKI Sepsis
Summarise prognosis for UTI
GREAT prognosis with appropriate treatment
Define AKI
Abrupt loss of kidney function resulting in the retention of urea and other nitrogenous waste products and the dysregulation of extracellular volume and electrolytes
How is AKI classified
Pre-renal
Intrinsic renal
Post renal
List pre-renal causes of AKI
Hypovolaemia (haemorrhage, sever vomiting)
Heart Failure
Cirrhosis
Nephrotic Syndrome
Hypotension (Shock, sepsis, anaphylaxis)
Renal hypoperfusion (NSAIDs, ACEi, ARBs, RAS)
List intrinsic causes of AKI
glumerulonephritis, haemolytic uraemic syndrome Acute tubular necrosis Acute interstitial nephritis Vasculitides Eclampsia
List post-renal causes of AKI
(Obstruction) Calculi Urethral stricture Prostatic hypertrophy/malignancy bladder tumour
What are the risk factors for AKI
Age CKD comorbidities Sepsis Hypovolaemia Nephrotoxic medications Emergency SUrgery Diabetes mellitus
Summarise the epidemiology of AKI
15% of adults admitted to hospital develop AKI
Common in elderly
What are the presenting symptoms of AKI
oliguria/anuria
nausea/vomiting
dehydration
confusion
What are the signs of AKI
Hypertension distended bladder dehydration fluid overload Raised JVP pulmonary and peripheral oedema Pallor/rash/bruising (vascular disease)
Appropriate investigations for AKI
urinalysis (blood, leuc/nitrites -UTI, glucose, protein, osm)
Bloods (FBC, Blood film, U&Es, Clotting, CRP)
Immunology - immunoglobulins, ANA, complement
Ultrasound - post renal cause/hydronephrosis
Imaging - CXR(pulmonary oedema)/AXR(renal stones)
Management plan for AKI
Protect from hyperkalaemia
optimise fluid balance
stop nephrotoxic drugs
Consider for dialysis
refer to nephrology if intrinsic renal disease is suspected
Renal Replacement Therapy: Hyperkalaemia, Pulmonary Oedema, severe metabolic acidaemia, uraemic
List complications of AKI
pulmonary oedema Acidaemia Uraemia Hyperkalaemia Bleeding
Summarise the prognosis for AKI
Poor prognosis Age multiple organ failure Oliguria Hypotension CKD
AKI has an increased risk of developing CKD
