Renal ID Flashcards
Renal Abscess
An abscess that is confined to the kidney and is either caused by an intrinsic infection or a septic infection
Renal Abscess S/S
Fever/chills
Abd pain
Weight loss
Dysuria/hematuria/malaise
Renal abscess dx
WBC’s, bacteria, hematuria in urine
Leukocytosis
CT scan will diagnose **
Renal abscess tx
IV Abx
Percutaneous drainage
Acute pyelonephritis
Affects renal cortex while sparing glomeruli and vessels
Usually E. coli
What is seen in the urine for pyelo?
White cell casts
Pathognomonic
Emphysematous Pyelonephritis
Life-threatening necrotizing infection of the kidneys characterized by gas formation within or around the kidneys.
Majority of pts have poorly controlled DM or are immunocompromised
High mortality rate w/o tx
Acute Pyelo s/s
Shaking chills
High fever
arthralgias / myalgias
Flank pain, CVA tenderness
What will CT show with acute pyelo?
May show hydronephrosis and attenuation.
Diagnostic procedure of choice
Acute pyelo tx
Severe cases may require admission
May need a cath
IV Ampicillan until; 24 hrs after fever drops
PO Cipro, Ofloxacin, Bactrim for 21 days
White cell casts are pathognomonic for?
Pyelonephritis
Chronic Pyelo
Caused by renal injury induced by recurrent or persistent renal infxn
Occurs in pt’s with anatomical abnormalities
Most commonly vesicoureteral reflux (VUR)]Can lead to ESRD
Vesicoureteral Reflux (VUR)
Retrograde flow of urine from the bladder to the upper urinary tract.
One of the most common pediatric urinary problems
VUR indicence
10 of kids get it.
70 of pediatric UTI’s have VUR
Female > male
Genetc predisposition
Primary VUR
Congenital deficiency in the longitudinal muscle fibers ureterovesicular junction. Greatly narrows it.
Secondary VUR
Bladder outlet obstruction at the posterior urethral valve or stenosis.
Neurogenic bladder
VUR presentation
Infant: Failure to thrive, nonspecific
Older kids: flank pain, abd pain, fever
Prenatally: abd swelling, diagnosed with U/S
Chronic Pyelo findings
Coarse, Asymmetric corticomedullary scarring
Thyroidization of kidney
Eosinophillic casts
TEA
TEA = ?
Thyridization of kidney
Eosinophillic Casts
Asymmetric Scarring
Chronic Pyelo
Chronic pyelo S/S
Fever
Lethargy
N/V
Flank pain, dysuria
Stage 1 and 2 chronic pyelo tx
Amoxacillin Bactrim Septra Nitrofurantoin Continue until puberty, when it is generally outgrown
Stage 3 and 4 chronic pyelo tx
Surgery (reimplant ureters)
ACE, ARB for HTN
Eliminate UTI’s
Xanthogranulomatous Pyelonephritis (XPN)
An unusual variant of pyelonephritis that is usually a complication of obstruction induced by infected renal stones.
Usually involved massive destruction of the kidney requiring nephrectomy.
XPN displays neoplasm like properties of local tissue invasion and destruction.
Referred to as a pseudotumor
XPN presentation
Common in middle aged women Females > Males 4:1 Flank pain Fever, malaise, anorexia, weight loss Flank mass
In children, how does XPN present?
It can be local or the entire kidney.
Same S/S as adults
growth retardation
Cystitis
Bladder infection most commonly due to E. Coli and occasionally from enterococci.
Typically ascends form the urethra
Rare in men
Cystitis S/S
Irritative voiding (frequency, urgency, dysuria)
Suprapubic discomfort
Hematuria
May appear following intercourse in women.
Cystitis Urinalysis
Pyuria, bacteriuria, hematuria
Urine culture positive for causative organism
Cystitis Tx
Uncomplicated: Flouro and nitrofurantoin
Bactrim and septra can be ineffective
Urethritis
Inflammation of urethra caused by STD
Gonococcal Urethritis
Non gonococcal urethritis
Gonococcal urethritis
Caused by gonorrhea (80% of cases)
Non-gonoccal urethritis
Caused by chlamydia, ureaplasma, mycoplasma, trich.
Post-traumatic urethritis
happens in 2 - 20% of post-cath patients. 10x more likely to occur with latex than silicone.
Urethritis S/S
Usually occur 4 days to 2 weeks post contact.
Urethral discharge
Dysuria, itching
Heaviness in genitals
All patients with urethritis should be tested for?
Gonorrhea and Chlamydia
Urethritis Tx
ALL patients must be treated, even if asymptomatic.
Zithromax, flouroquinolones, doxy
IM rocephin
Prostatitis
Inflammation or infection of the prostate
Acute bacterial
Chronic bacterial
nonbacterial
Acute bacterial prostatitis
Usually caused by gram- rods, E. coli, pseudomonas.
Acute prostatitis S/S
Perineal, sacral, suprapubic pain
Fever
irritative voiding
Very painful prostate on exam.
Acute prostatitis Tx
May require hospitalization
IV ampicillin, aminoglycosides
PO quinolones for 4-6 weeks
Chronic prostatitis
May evolve form acute
gram- rods
Chronic Prostatitis S/S
Irritative voiding
Low back and perineal pain
Physical exam of prostate is often unremarkable
generally have normal UA
Chronic proatatitis Tx
Septra has best cure rate (6-12 weeks)
NSAIDS, hot sitz bath
Nonbacterial Prostatitis
Diagnosis of exclusion
S/S identical to chronic
treat for myco, chamydia
Epididymitis
Inflammation of infection of the epididymis
Younger males: STD
Older males: gram- rods
Epididymitis S/S
Scrotal pain along spermatic cord
Symptoms may follow, trauma, sexual activity
Fever, scrotal swelling
Prostate may be tender
Epididymitis Tx
Bed rest, scrotal elevation
Abx for 10-21 days
Treat sexual partners
