Renal ID Flashcards
Renal abscess – Diagnosis
UA – WBC’s, bacteria, hematuria
CBC –Leukocytosis
Ultrasound – 1st choice!
CT scan – diagnostic modality of choice, with contrast
Acute Pyelonephritis
Bacteria infection can result from hematogenous spread or from ascending infection (usually due to predisposing condition)
Usually: E. coli
Also: Proteus, Klebsiella, and Enterobacter.
THINK WBC CASTS
Emphysematous pyelonephritis
life-threatening necrotizing infection of the kidneys characterized by gas formation within or surrounding the kidneys.
The majority of patients have poorly controlled DM, or immunocompromised or have associated urinary tract obstruction
w/o tx= sepsis and carries a high mortality rate.
Acute pyelonephritis common Abx
I.V. – Ampicillan
P.O. – Ciprofloxin, Ofloxacin, Bactrim DS
Vesicoureteral reflux (VUR)
Retrograde flow of urine from the bladder to the upper urinary tract.
Normally the ureter has antireflux action by
1- actively by trigonal muscle contraction
2- passively by flap valve mechanism
VUR Clinical presentation
UTI :
In newborn: usually non specific manifestation such as failure to thrive, difficult feeding, or lethargy.
Older children: flank pain or abdominal pain , fever.
Prenatally diagnosed by US with abdominal swelling (late finding)
Chronic Pyelonephritis and TEA
T - Thyroidization
E - Eosinophilic Casts
A - Assymetric Scarring
Stages 1 and 2 VUR TX.
This is reflux of urine to the ureter or renal pelvis without ureteral dilatation.
Medical therapy with ABO’s (Amoxicillan, Bactrim, Septra, Nitrofurantoin)
Continue ABO’s until puberty (most children will outgrow reflux by puberty) or until reflux resolves
Stage 3 and 4 VUR (severe reflux) TX.
Surgery and medical therapies are equally effective
Or prophylactic Abx for life
URETHRITIS
GU – caused by N. Gonorrhoea (80% of cases)
NGU – caused Chlymadia, Ureaplasma, Mycoplasma, Trichomonas and rarely
Lymphogranuloma venereum
Herpes genitalis
Syphilis
Acute bacterial Prostatitis
Usually caused by gram-negative rods, esp E. coli, pseudomonas
Most likely routes of infection includes ascent up the urethra and reflux of infected urine into the prostatic duct.
PROSTATITIS/Chronic Tx
Septra has the best cure rate, quinolones, erythromycin, cephalexin also used
Optimal duration of therapy is 6-12 weeks
NSAIDS and hot sitz baths may provide symptomatic relief
PROSTATITIS/Acute Tx
Hospitalization may be required
I.V. antibiotics (ampicillan and aminoglycosides) until afebrile for 24-48 hours
PO antibiotics (quinolones) are used for 4-6 weeks
Follow-up urine culture should be obtained after therapy is completed to ensure eradication
