renal/genitourinary Flashcards
mtg of cystitis
Lower UTI
- nitrofurantoin 100mg BID x 5 days
-trimethoprim-sulfamethoxazole x 3 days
-fosfomycin 3 gm PO x 1
what does nitrate indicate or not on dipstick
presence of nitrate is very specific ( negative ) but not very sensitive (postive) test
- doesn’t mean you have one if present but with out you most likely do not
what does esterase indicate or not on dipstick
very sensitive (postive) but not very specific (negative)
- if present pretty postive you have , but doesn’t mean you don’t if not present
mtg of upper uti
Cipro x 7 days
levofloxacin
ceftriaxone 1gm IV x 14 days
RIFLE Class
R- risk
I- injury
F- failure
L- loss
E- end stage kidney disease
pt has UO less than 0.5ml/kg/hour x 6 hours and SCR elevated x 1.5 what is this
kidney risk
pt has Scr elevated x 3 what rifle class is this
failure
UO < 0.3ml/kg/hour x 24 hour or anuria x 12 hours
pt has Scr x 2 what is this
kidney injury
UO < 0.5 ml/kg/hr x 12 hours
complete loss of kidney function x 4 weeks
kidney loss
what is end stage kidney disease per RIFLE
complete loss of kidney function > 3 months
examples of pre-renal kidney injury
and mtg
outside kidney
shock, dehydration, cardiac failure, burns, diarrhea, vasodilation/sepsis
expand intravascular volume
examples of intra-renal injury and mtg
Acute Tubular Necrosis (ATN)
affect renal cortex or medulla
allergic disorders, obstruction of renal vessel (embolism/thrombosis)
nephrotoxic agents (most common)
mismatched blood transfusion
maintain renal perfusion, stop nephrotoxic drugs, dialysis
examples of post Renal injury
and mtg
urine flow obstruction
BPH, tumor, calculi, diabetic neuropathy
remove source of obstruction - check foley, renal US, CT scan
pre-renal disease labs
BUN/Cr ratio: >20:1
urine sodium <20
specific gravity >1.015
normal/few hyaline casts
FEN < 1
FEN of intrarenal/post renal
> 3
most common cause of intrinsic renal injury
nephrotoxic drugs
what does radiation of pain downward to the groin mean when you have a stone
stone has passed to lower third of the ureter - testicular pain may also occur
tx for nephrolithiasis
morphine/hydromorphone
toreador
metoclopramide
black box warning for metoclopramide
EPS -extrapyramidal symptoms
tardive dyskinesia
male presents with complaints of dysuria and s/s of BPH - what do you order first
UA
what OTC herbal agent may help with BPH
saw palmetto
what medications should you avoid with BPH
benadryl
sudafed
oxymetazoline spray
SSRIs
A patient presents with asymptomatic bacteriuria - how do you treat
you don’t unless they are pregnant, going under urologic intervention or perhaps rental transplant
most common conical illness for adults over 65 y/o
UTI
