Renal disease

Question 1

name of UTI in…
bladder
urethra
kidneys

Answer 1

cystitis
urethritis
pyelonephritis

Question 2

3 categories of differential diagnosis

Answer 2

Intra-abdominal: appendicitis, pancreatitis, cholecystitis

Pregnancy-related: preterm labour, chorioamnioitis, placental abruption

Genital tract infections/ Ovarian cysts

Question 3

Why is it recommended to offer MSU at booking?

Answer 3

Asymptomatic bacteriuria (ABU) occurs in 2-10% of pregnant women and asymptomatic.
ABU associated with premature birth, low birth weight

Question 4

S+S of cystitis

Answer 4

• dysuria
• haematuria
• increased frequency and urgency of micturition
• suprapubic pain
• offensive smell
• cloudy, concentrated urine
• pyrexia

Question 5

Cystitis diagnosis

Answer 5

culture from an MSU or CSU.
nitrates in urinalysis and/or symptoms is sufficient to start treatment

Question 6

Cystitis treatment/management

Answer 6

• Abx: don’t need to wait for MSU report, start on S+S and adjust after
• Encourage oral hydration
• Advise on perineal hygiene
• Empty bladder after intercourse
• Treat further S+S to prevent pyelonephritis
• test of cure after Abx treatment

Question 7

What is Pyelonephritis?

Answer 7

Sudden severe inflammation of kidneys. Their ability to reabsorb sodium affected, leading to oedema and decreased urine output.

Question 8

S+S of pyelonephritis

Answer 8

• pyrexia
• rigours
• tachycardia
• nausea + vomiting –> dehydration
• loin pain
• guarding
• dysuria and frequency. of micturition
• urine often cloudy, acidic and has an offensive smell

Question 9

Pyelonephritis complications

Answer 9

• miscarriage and preterm birth
• maternal pyrexia –> septicaemia and death
• IUGR and fetal hypoxia –> due to reduced maternal plasma volume leading to poor placental perfusion
• Pain may prevent recognition of preterm labour

Question 10

Pyelonephritis management

Answer 10

admission for rest, observation and treatment
- sepsis 6 protocol
- CTG –> risk of fatal hypoxia. stillbirth, preterm birth
- IV Abx within the hour
- fluids –> avoid urinary stasis and dehydration
- fluid balance –> assess renal function
- bloods –> CRP, lactate, BVG, blood cultures
- VTE assessment –> pyrexia and immobility
- 4hrly obs of temp, pulse, BP, RR

Question 11

Acute kidney injury / acute renal failure

Answer 11

acute deterioration in renal function (reduced GFR and raised serum creatinine)
+
diminished urine output (< 25-30 ml/hr)