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CPR Test II > Renal Approach to hematuria, dysuria, and nocturia > Flashcards

Renal Approach to hematuria, dysuria, and nocturia Flashcards

1
Q

upper DDx of Hematuria

A 
Renal malignancy
Renal cysts
Urinary stones
Glomerulonephritis
UTI 
-pyelonephritis
-Cystitis
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2
Q

lower DDx of hematuria

A 
Bladder cancer
Bladder stone
Hemorrhagic cystitis (cyclosphamide)
BPH
Prostate cancer
Urethritis
Urethral trauma (urinary cather)
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3
Q

what is an uncomplicated UTI

A

acute cystitis or pyelonephritis in a non pregnant outpatient woman without any anatomic abnormalities or urinary instrumentation

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4
Q

what are complicated UTI and some examples

A

UTIs that are associated with factors increasing colonization and decreasing efficacy of therapy

  • Pregnancy
  • Urinary retention or obstruction
  • renal failure
  • renal transplant
  • Males
  • Anatomic abnormalities
  • Urinary catheter or urinary instrumentation
  • immunocomprimised

Some references include all pyelonephritis cases

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5
Q

what is definition of recurrent UTI

A

> 2 infections in six months or >3 infections in one year

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6
Q

what is the definition pf asymptomatic bacteriuria

A

Bacteriuria present on urine culture but no clinical UTI symptoms present in patient

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7
Q

what is definition of Catheter-associated UTI (CA-UTI)

A

UTI associated with placement of urinary catheter or within 48 hours of removal

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8
Q

what are the major risk factors for UTIs

A 
Female sex
Hx of UTI
Sexual activity
Condom/diaphragm/spermicide use
Vaginal infection
Indwelling urinary catheters
DM
Obesity 
Immunosuppression
Urinary tract abnormalities
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9
Q

what is the pathogenesis of UTIs

A

Uropathogenic bacteria colonizing the GI tract, perineium, or vagina inoculate the urethra and ascend into the bladder

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10
Q

Common UTI pathogens

A

Gram Negative:

  • E Coli
  • Klebsiella pneumonia
  • Proteus mirabillis
  • pseudomonas aeruginosa

Gram Positive:

  • Enterococcus species
  • Staphylococcus saprophyticus
  • Group B streptococcus
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11
Q

Classic presentation of cystitis

A

Dysuria
Urinary frequency
Urinary urgency

suprapubic abdominal pain
gross or microscopic hematuria

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12
Q

Classic presentation of Pyelonephritis

A 
Fever/chills/rigors
Flank pain
CVA tenderness on exam
Fatigue
Nausea/vomitting and anorexia
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13
Q

what is a common presentation of UTI in older adults

A

Altered mental status

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14
Q

what are some complications of UTIs

A 
Sepsis and septic shock
AKI
Perinephric abscess
Emphysematous pyelonephritis
Papillary necrosis
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15
Q

what are the diagnostic tools of UTIs

A

Urine dipstick

  • Leukocyte esterase
  • Nitrates
  • Blood
  • color is cloudy

Urinalysis with urine microscopy

  • Hematuria
  • pyuria
  • WBC cast
  • Bacteria present

Urine culture with sensitivities

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16
Q

what is seen on Urine culture with sensitivities to know a true UTI

A

True UTI have > 10,000 CFU (colony forming units/ml)

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17
Q

what is the treatment of Uncomplicated cystitis?

A

Nitrofurantoin
Trimethoprim-sulfamethoxazole DS
Fosfomycin

second line antibiotics

  • Fluoroquinolones
  • B-lactams
18
Q

what is the treatment of acute pyelonephritis or complicated UTI?

what is the treatment of asymptomatic bacteriuria?

A

if no hospitalization is required oral antibiotics
if hospitalization is required treat with IV antibiotics

no treatment is needed of asymptomatic bacteruria unless patient is pregnant

19
Q

how soon should Urinary catheters be removed?

A

AS SOON AS POSSIBLE

20
Q

what is prostatitis and what are the risk factors

A

infection of the prostate gland
-more common in young and middle aged men

risk factors:

  • functional or anatomical anomalies
  • Urinary tract instrumentation
  • UTIs
  • Diabetes
  • Smoking
  • HIV
21
Q

what are the typical bacteria in Prostatitis

A

Gram negative bacilli:

  • E.Coli
  • Klebsiella pneumonia
  • proteus mirabilis
  • pseudomonas aeruginosa

Gram positive cocci

  • entercococcus species
  • normal skin flora
22
Q

Classic presentation of acute bacterial prostitis

A

Patients typically appear acutely ill
-fever chills, malaise, N/V, and even signs of sepsis

Irritate voiding symptoms

Obstructive symptoms

suprapubic or perineal pain

23
Q

classic presentation of chronic bacterial prostatitis

A

Patients typically present with more subtle signs and symptoms compared to acute prostatitis

symptoms of recurrent UTIs

Obstructive symptoms

suprapubic or perineal pain

pain with ejaculation or blood in semen

24
Q

what is the diagnosis of acute or chronic prostatitis

A

Acute:

  • digital rectal exam
  • urinalysis and urine culture

Chronic prostatitis

  • digital rectal exam
  • urinalysis and urine culture
  • diagnostic standard is prostatic massage (4 glass test or 2 glass test
25
Q

What is the treatment of prostatitis and for how long?

A

Fluoroquinolones
Trimethoprim-Sulfamethoxazole

duration of antibiotics is 4-6 weeks

26
Q

what are the risk factors of BPH

A 
age
metabolic syndrome
Obesity
genetic susceptibility
excessive coffee or caffeine intake
27
Q

Pathogenesis of BPH

A

results from increased total number of stromal and glandular epithelial cells within the prostate

28
Q

pathogenesis of Lower urinary tract symptoms

A

Bladder outlet obstruction (BOO) from BPH

and detrusor muscle overactivity secondary to BOO

29
Q

Clinical presentation of BPH and LUTs

A

Storage symptoms:
-urinary frequency, urgency, nocturia, and urinary incontinence

Voiding symptoms
-slow urinary stream, straining to void, urinary intermittency (starting/stopping micturition), splitting of voiding stream, terminal dribbling

30
Q

Diagnosis of BPH

A 
Digital rectal exam
Urinalysis
BMP 
Prostate specific antigen
-often elevated in BPH

Post void residual U/S

31
Q

Pharmacologic Treatment of BPH

A

A1-blockers

  • tamsulosin, alfuzosin, doxazosin
  • improvement in 1-2 weeks

5a-reductase inhibitors

  • finasteride, dutasteride
  • improvement in 6-12 months

Anticholinergic agents

  • oxybutynin, tolterodine, fesoterodine, darifenacin
  • decrease detrusor muscle contraction

Phosphodiesterase 5-inhibitors

  • used mainly in erectile dysfunction and LUTs
  • tadalafil
32
Q

what is a surgical treatment for BPH

A

Transurethral resection of prostate (TURP)

simple prostatectomy

  • open
  • laparascopic
  • robotic-assisted
33
Q

what is the DDx of Nocturia

A 
Urinary incontinence
Diuretics 
BPH
UTIs
Primary polydipsia
Polyuria\-Diabetes insipidus
34
Q

what is the likelihood of getting a symptomatic stone recurrence at 1, 5, and 10 years

A

15% at 1 year

35% to 40% at 5 years

50% at 10 years

35
Q

what is the percentage of kidney stones that are calcium?

A

80%

36
Q

what are the classical symptoms of Nephrolithisis

A

Intermittent, severe flank pain that radiates to groin
Hematuria
-gross of microscopic
Gravel passage or visualized stone passage
nausea/vomitting

37
Q

What are complications of Nephrolithiasis

A

Hydronephrosis
can lead to AKI or CKD
recurrent urinary infections if stones become infected

38
Q

what are the diagnosis of nephrolithiasis

A

Non-contrast CT abdomen and pelvis
-renal stone protocol CT

can do:

  • Kidney Ureter bladder x ray
  • renal and bladder U/S
  • Urinalysis with microscopy
  • strain urine
  • Metabolic evaluation after stone
39
Q

what stones are radioopaque and what are radiolucent?

A

radiopaque: calcium oxalate/phosphate and struvite
(can see)

Radiolucent: uric acid and cystine:
(cant see)

40
Q 
stone shapes:
Cystine crystals?
Uric acid crystals?
Struvite? 
Calcium oxalate monohydrate?
Calcium oxalate dihydrate?
A

Cystine crystals = hexagonal crystal

Uric acid crystals = Rhombic plates or rosette shaped crystals

Struvite (MAP) = coffin lid crystal

Calcium oxalate monohydrate = dumbell-shaped crystals

Calcium oxalate dihydrate = envelope shaped crystal

41
Q

Medical therapy for Nephrolithiasis

A 
Fluids
Pain control
Anti nausea medication
Expulsive therapy (dilates ureter)
-alpha blocker
-calcium channel blocker (nifedipine)
42
Q

Surgical therapy for Nephrolithiasis

A
  • Extracorporeal sock wave lithotripsy
  • ureteroscopy with basket stone extraction
  • percutaneous nephrolithotomy (PUL) or open nephrolithotomy

CPR Test II (6 decks)

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