Renal ID

Question 1

Renal Abscess

Answer 1

An abscess that is confined to the kidney and is either caused by an intrinsic infection or a septic infection

Question 2

Renal Abscess S/S

Answer 2

Fever/chills
Abd pain
Weight loss
Dysuria/hematuria/malaise

Question 3

Renal abscess dx

Answer 3

WBC’s, bacteria, hematuria in urine
Leukocytosis
CT scan will diagnose **

Question 4

Renal abscess tx

Answer 4

IV Abx

Percutaneous drainage

Question 5

Acute pyelonephritis

Answer 5

Affects renal cortex while sparing glomeruli and vessels

Usually E. coli

Question 6

What is seen in the urine for pyelo?

Answer 6

White cell casts

Pathognomonic

Question 7

Emphysematous Pyelonephritis

Answer 7

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

Question 8

Acute Pyelo s/s

Answer 8

Shaking chills
High fever
arthralgias / myalgias
Flank pain, CVA tenderness

Question 9

What will CT show with acute pyelo?

Answer 9

May show hydronephrosis and attenuation.

Diagnostic procedure of choice

Question 10

Acute pyelo tx

Answer 10

Severe cases may require admission
May need a cath
IV Ampicillan until; 24 hrs after fever drops
PO Cipro, Ofloxacin, Bactrim for 21 days

Question 11

White cell casts are pathognomonic for?

Answer 11

Pyelonephritis

Question 12

Chronic Pyelo

Answer 12

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

Question 13

Vesicoureteral Reflux (VUR)

Answer 13

Retrograde flow of urine from the bladder to the upper urinary tract.
One of the most common pediatric urinary problems

Question 14

VUR indicence

Answer 14

10 of kids get it.
70 of pediatric UTI’s have VUR
Female > male
Genetc predisposition

Question 15

Primary VUR

Answer 15

Congenital deficiency in the longitudinal muscle fibers ureterovesicular junction. Greatly narrows it.

Question 16

Secondary VUR

Answer 16

Bladder outlet obstruction at the posterior urethral valve or stenosis.
Neurogenic bladder

Question 17

VUR presentation

Answer 17

Infant: Failure to thrive, nonspecific
Older kids: flank pain, abd pain, fever
Prenatally: abd swelling, diagnosed with U/S

Question 18

Chronic Pyelo findings

Answer 18

Coarse, Asymmetric corticomedullary scarring
Thyroidization of kidney
Eosinophillic casts
TEA

Question 19

TEA = ?

Answer 19

Thyridization of kidney
Eosinophillic Casts
Asymmetric Scarring
Chronic Pyelo

Question 20

Chronic pyelo S/S

Answer 20

Fever
Lethargy
N/V
Flank pain, dysuria

Question 21

Stage 1 and 2 chronic pyelo tx

Answer 21

Amoxacillin
Bactrim
Septra
Nitrofurantoin
Continue until puberty, when it is generally outgrown

Question 22

Stage 3 and 4 chronic pyelo tx

Answer 22

Surgery (reimplant ureters)
ACE, ARB for HTN
Eliminate UTI’s

Question 23

Xanthogranulomatous Pyelonephritis (XPN)

Answer 23

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.

Question 24

XPN displays neoplasm like properties of local tissue invasion and destruction.

Answer 24

Referred to as a pseudotumor

Question 25

XPN presentation

Answer 25

``` Common in middle aged women Females > Males 4:1 Flank pain Fever, malaise, anorexia, weight loss Flank mass ```

Question 26

In children, how does XPN present?

Answer 26

It can be local or the entire kidney. Same S/S as adults growth retardation

Question 27

Cystitis

Answer 27

Bladder infection most commonly due to E. Coli and occasionally from enterococci. Typically ascends form the urethra Rare in men

Question 28

Cystitis S/S

Answer 28

Irritative voiding (frequency, urgency, dysuria) Suprapubic discomfort Hematuria May appear following intercourse in women.

Question 29

Cystitis Urinalysis

Answer 29

Pyuria, bacteriuria, hematuria | Urine culture positive for causative organism

Question 30

Cystitis Tx

Answer 30

Uncomplicated: Flouro and nitrofurantoin | Bactrim and septra can be ineffective

Question 31

Urethritis

Answer 31

Inflammation of urethra caused by STD Gonococcal Urethritis Non gonococcal urethritis

Question 32

Gonococcal urethritis

Answer 32

Caused by gonorrhea (80% of cases)

Question 33

Non-gonoccal urethritis

Answer 33

Caused by chlamydia, ureaplasma, mycoplasma, trich.

Question 34

Post-traumatic urethritis

Answer 34

happens in 2 - 20% of post-cath patients. 10x more likely to occur with latex than silicone.

Question 35

Urethritis S/S

Answer 35

Usually occur 4 days to 2 weeks post contact. Urethral discharge Dysuria, itching Heaviness in genitals

Question 36

All patients with urethritis should be tested for?

Answer 36

Gonorrhea and Chlamydia

Question 37

Urethritis Tx

Answer 37

ALL patients must be treated, even if asymptomatic. Zithromax, flouroquinolones, doxy IM rocephin

Question 38

Prostatitis

Answer 38

Inflammation or infection of the prostate Acute bacterial Chronic bacterial nonbacterial

Question 39

Acute bacterial prostatitis

Answer 39

Usually caused by gram- rods, E. coli, pseudomonas.

Question 40

Acute prostatitis S/S

Answer 40

Perineal, sacral, suprapubic pain Fever irritative voiding Very painful prostate on exam.

Question 41

Acute prostatitis Tx

Answer 41

May require hospitalization IV ampicillin, aminoglycosides PO quinolones for 4-6 weeks

Question 42

Chronic prostatitis

Answer 42

May evolve form acute | gram- rods

Question 43

Chronic Prostatitis S/S

Answer 43

Irritative voiding Low back and perineal pain Physical exam of prostate is often unremarkable generally have normal UA

Question 44

Chronic proatatitis Tx

Answer 44

Septra has best cure rate (6-12 weeks) | NSAIDS, hot sitz bath

Question 45

Nonbacterial Prostatitis

Answer 45

Diagnosis of exclusion S/S identical to chronic treat for myco, chamydia

Question 46

Epididymitis

Answer 46

Inflammation of infection of the epididymis Younger males: STD Older males: gram- rods

Question 47

Epididymitis S/S

Answer 47

Scrotal pain along spermatic cord Symptoms may follow, trauma, sexual activity Fever, scrotal swelling Prostate may be tender

Question 48

Epididymitis Tx

Answer 48

Bed rest, scrotal elevation Abx for 10-21 days Treat sexual partners