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Nephrology > Renal ID > Flashcards

Renal ID Flashcards

1
Q

Renal Abcess:

  1. Confined where?
  2. Caused by what? 2
A
  1. Abscess that is confined to the kidney and is
  2. caused either by
    - bacteria from an infection traveling to the kidneys through the bloodstream or
    - by a urinary tract infection traveling to the kidney and then spreading to the kidney tissue.
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2
Q

Renal Abscess: Unusual to occur but will generally happen as a result of common problems such as?
8

A
  1. Kidney inflammation
  2. Vesicoureteral reflux
  3. Multiple skin abscesses
  4. Diabetes mellitus (autonomic nephropathy)
  5. Nephrolithiasis
  6. IVDA
  7. Pregnancy
  8. Neurogenic bladder
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3
Q

Renal abscess symptoms:

7

A
  1. Fever
  2. Chills
  3. Abdominal pain
  4. Weight loss
  5. Dysuria
  6. Hematuria
  7. Malaise

Kids like to vomit with renal absesses

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4
Q

Renal abscess – Diagnosis

7

A
  1. UA
  2. CBC
  3. Xray
  4. Ultrasound
  5. CT scan- dont usually want to use die
  6. – Sed rate and CRP
  7. DOnt be afraid to get blood cultures early because you may need them later
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5
Q

What will you find in the following in a renal abcess:

  1. UA 3
  2. CBC
  3. Xray- Whats the down side to this?
  4. Ultrasound?
  5. CT scan?
A
  1. – WBC’s, bacteria, hematuria
  2. –Leukocytosis
  3. – small abscesses may be difficult to recognize
  4. – more helpful than xray. INITIAL TEST!
  5. – diagnostic procedure of CHOICE/96% accurate in diagnosing renal abscess.
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6
Q

Renal abscess – Treatment

3

A
  1. I.V. antibiotics covering causative organism
  2. Open drainage in the past
  3. Percutaneous drainage is now the more common method
    - amp with aminoglycosides
    - (amp and gent)
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7
Q

Renal abcess prognosis?

2

A
  1. Low recurrence rate if underlying cause treated, ex: kidney stones, reflux
  2. Diabetes mellitus and advanced renal abscesses may lead to serious disease or death
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8
Q

Acute Pyelonephritis

  1. Affects what and spares what?
  2. What is characteristic of this?
  3. Bacteria infection can result from hematogenous spread or from ascending infection (usually due to predisposing condition)
A
    • Affects cortex with
    • sparing of glomeruli and vessels.
  2. White cell casts in urine are pathognomonic (always think this if you see casts)
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9
Q

What kind of bacteria causes Acute Pyelonephritis usually:

  1. Most common?
  2. Others? 3
A
  1. Usually: E. coli

2. Also: Proteus, Klebsiella, and Enterobacter.

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10
Q
  1. Acute Pyelonephritis general prognosis?
  2. If coexistent renal disease is present what may result?
  3. Inadequate therapy could result in what?
A
  1. Healthy Adults usually recover complete renal function.
  2. If coexistent renal disease is present, scarring or chronic pyelonephritis may result.
  3. Inadequate therapy could result in abscess formation
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11
Q

Acute pyelonephritis:
1. Emphysematous pyelonephritis is what?

  1. The majority of these pts will have what?
  2. If they dont what will they have? 2
  3. Without early therapeutic intervention this condition becomes rapidly progressive, generalizes to what?
  4. What is the prognosis?
A
  1. life-threatening necrotizing infection of the kidneys characterized by gas formation within or surrounding the kidneys.
  2. poorly controlled DM
  3. Non DM patients are usually immunocompromised or have associated urinary tract obstruction due to lithiasis.
  4. fulminant sepsis
  5. carries a high mortality rate.
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12
Q

Acute pyelonephritis Symptoms

5

A
  1. Shaking chills
  2. High fever
  3. Arthralgias
  4. Myalgias
  5. Flank pain with CVA tenderness
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13
Q

What are two situations that cause neurogenic bladder?

A
  1. pregnancy

2. MS

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14
Q

Acute pyelonephritis
Diagnosis?
5

A
  1. UA
  2. CBC
  3. Blood culture may also be positive
  4. Ultrasound
  5. CT scan
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15
Q 
Acute pyelonephritis
Diagnosis what will be seen on the following:
1. UA? 3
2. CBC? 1
3. Ultrasound? 1
4. CT scan? 2
A
  1. WBC’s, bacteria, hematuria
  2. Leukocytosis with left shift
  3. may show hydronephrosis from a stone or other source of obstruction
  4. diagnostic procedure of choice – may show hydronephrosis and attenuation caused by inflammation/infection.
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16
Q

Acute pyelonephritis
treatment:
1. Severe or complicating factors may require what?
2. What may be necessary in the case of urinary retention?
3. What may be required if there is ureteral obstruction?

  1. What are required to determine antimicrobial sensitivity?
A
  1. hospital admission
  2. Catheterization
  3. Nephrostomy drainage
  4. Blood and/or urine cultures
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17
Q

Acute pyelonephritis
1. Treatment: Common antibiotics used? 4

  1. How long are they given?
  2. Follow-up treatment includes?
  3. Patients at high risk of recurring urinary tract and kidney infections are?
A
    • I.V. – Ampicillan
    • P.O. – Ciprofloxin, Ofloxacin, Bactrim DS
  2. Antibiotics are given for 21 days.
  3. re-culturing urine several weeks after drug therapy is finished to rule-out re-infection.
  4. –indwelling catheters – require long-term follow up.
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18
Q
  1. Chronic pyelonephritis is caused by?
  2. Occurs almost exclusively in patients with major anatomical anomalies such as? 4 (most commonly?)
  3. 30-40% of young children with UTI’s have what?
A
  1. Caused by renal injury induced by recurrent or persistent renal infection
    • Urinary tract obstruction
    • Struvite calculi
    • Renal dysplasia
    • Vesicoureteral reflux (VUR) – most commonly
  3. VUR
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19
Q

Definition of VUR?

Normally the ureter has antireflux action by? 2

It is one of the most common problems encountered by pediatric urologist.

A
  1. Retrograde flow of urine from the bladder to the upper urinary tract.

1- actively by trigonal muscle contraction
2- passively by flap valve mechanism

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20
Q
  1. 70% of infants presenting a with UTI have what?
  2. More in what gender?
  3. Who is it more serious?
  4. Genetic predisposition is positive in up to what percent of pts?
A
  1. VUR
  2. Female >male.
  3. Usually male has higher grade VUR than females.
  4. 40%.
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21
Q

Primary etiology of VUR?

2

A
  1. Congenital deficiency in the longitudinal muscle fibers in ureterovesical junction
  2. Altering the normal ratio of length: width from 5: 1 down to 1.4 :1
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22
Q

Secondary etiology of VUR?

2

A
  1. Bladder outlet obstruction at the posterior uretheral valve or stenosis
  2. Functional obstruction eg. Neurogenic and non neurogenic bladder dysfunction
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23
Q 
VUR Clinical presentation
UTI:
1. In a newborn?
2. Older children?
3. Prenatally?
A
  1. In newborn: usually non specific manifestation such as failure to thrive, difficult feeding, or lethargy.
  2. Older children: flank pain or abdominal pain , fever.
  3. Prenatally diagnosed by US with abdominal swelling (late finding)
24
Q

VUR Workup

  1. Urinalysis? 2
  2. Standard VCUG and US are required in? 3
A
  1. (for significant colony count)
    >100,000 count in mid-stream sample
    >10,000 in catheterized or aspirated urine sample
  2. 1- child less than 5 yr with UTI
    2- any male child with a UTI
    3- febrile UTI
25
Q

Prognosis of VUR

Resolves spontaneously before adolescence in: 5

A
  1. 90% of Gr. 1 reflux
  2. 80% of Gr. 2
  3. 50% of Gr. 3
  4. 10% of Gr. 4
  5. 0 in Grade 5 reflux
26
Q
  1. Kidney is most susceptible to what?
  2. Scars develop less frequently after what age?
  3. VUR and scarring lead to what? 2
A
  1. scarring in the first year of life and at the time of first upper tract infection.
  2. 5
  3. VUR and scarring lead to
    - hypertension,
    - progressive renal insufficiency and failure.
27
Q
  1. Chronic pyelonephritis
    is associated with what?
  2. May occur in utero with what?
  3. UTI’s also induce renal injury, which heals with what?
  4. Infection without reflux is less likely to do what?
A
  1. Associated with progressive renal scarring, which can lead to ESRD
  2. renal dysplasia, although dysplasia may also be caused by obstruction
  3. scar formation.
  4. produce injury
28
Q

Chronic Pyelonephritis

  1. What does the scarring look like?
  2. What happens to the kidney?
  3. WHat are seen in the tubules?
  4. Whats the acronym to remember this? 4
A
  1. Coarse, asymmetric corticomedullary scarring.
  2. Thyroidization of the Kidney (filled with colliod casts)
  3. Eosinophilic casts seen in tubules
  4. Chronic Pye and
    T - Thyroidization
    E - Eosinophilic Casts
    A - Assymetric Scarring
29
Q

Symtpoms of Chronic pyelonephritis?

5

A
  1. Fever
  2. Lethargy
  3. Nausea and vomiting
  4. Flank pain or dysuria
  5. Some children may present with failure to thrive
30
Q

Diagnosis of chronic pyelonephritis?

3

A
  1. UA
  2. Urine Culture
  3. Imaging-IVP
31
Q

Diagnosis of chronic pyelonephritis:

  1. What will the UA show? 3
  2. What will the imagaing show?4
  3. Why would we not rely on the urine culture?
A
  1. UA –
    - WBCs,
    - bacteria,
    - hematuria.
  2. Imaging – IVP
    - caliceal dilatation and
    - blunting with cortical scars.
    - Ureteral dilatation and
    - reduced renal size may also be evident
  3. Urine culture will usually isolate bacteria, although a negative culture does not exclude diagnosis as patient has most likely been on antibiotics.
32
Q

Chronic pyelonephritis: Other imagaing you may want to do?

3

A
  1. Voiding cystourethrogram (VCUG) may document reflux of urine to the renal pelvis and ureteral dilatation
  2. Cystoscopy images show evidence of reflux at the ureteral orifices.
  3. Renal sonogram may show calculi
33
Q

Chronic pyelonephritis

  1. Stages 1 and 2 VUR is what?
  2. Treatment? 4
  3. How long should we continue this therapy? 2
A
  1. This is reflux of urine to the ureter or renal pelvis without ureteral dilatation.
  2. Medical therapy with ABO’s
    - Amoxicillan,
    - Bactrim,
    - Septra,
    - Nitrofurantoin
  3. Continue ABO’s
    - until puberty (most children will outgrow reflux by puberty) or
    - until reflux resolves
34
Q

Chronic pyelonephritis
Stage 3 and 4 VUR (severe reflux)
treatment?

A

Surgery and medical therapies are equally effective

35
Q

Chronic pyelonephritis
Stage 3 and 4 VUR (severe reflux)
treatment: Indications for surgery include?
3

What does the surgery involve?

A
  1. Medical noncompliance with formation of new scars
  2. Persistent reflux after puberty in women
  3. Breakthrough infections in patients who are compliant

Surgery involves the reimplantation of the ureters .

36
Q

Chronic pyelonephritis
Treatment:
1.______ _______ restriction should be advised to prevent progressive renal injury
2. Aggressive ____ _______ is beneficial to slow the progression of renal failure. 3.__________ are particularly beneficial

  1. Careful follow-up and monitoring for pregnant women with prompt tx for UTI’s to prevent what? 3
  2. Routine screening is recommended for who?
A
  1. Dietary protein
  2. BP control
  3. ACE’s/ARB’s
  4. renal failure,
    preeclampsia
    miscarriages
  5. siblings of patients with VUR
37
Q
  1. What is Xanthogranulomatous pyelonephritis (XPN)?

2. Describe the prognosis?

A
  1. is an unusual variant of chronic pyelonephritis that, in two-thirds of cases, is a complication of obstruction induced by infected renal stones.
  2. Affected patients usually have massive destruction of the kidney requiring nephrectomy.
38
Q

XPN:

  1. The disease process shares many characteristics with a true neoplasm, in terms of its what? 2
  2. Associated problems?
  3. Unliateral or Bilateral?
A
    • radiographic appearance and
    • ability to involve adjacent structures or organs.
  2. Patients are often immunocompromised in some manner.
  3. Although most cases of XPN are unilateral, bilateral disease has been reported.
39
Q

XPN is more common in what gender and appears most commonly in what decades of life?

What is there usually a history of?

A

XPN is 4 times more common in women than men, and is usually noted in the fifth and sixth decades of life.

There is usually a history of recurrent urinary tract infections.

40
Q

Chronic pyelonephritis/XPN

displays what kind of properties and is capable of what?

A

XPN displays neoplasm-like properties

capable of local tissue invasion and destruction, and has been referred to as a pseudotumor.

41
Q

Chronic pyelonephritis/XPN
The clinical picture is somewhat different in adults and children.

Children: The typical presenting features include what? 4

A
  1. Flank pain.
  2. Fever, malaise
  3. Weight loss, anorexia
  4. A palpable flank mass may be present, which may be tender or demonstrate CVA tenderness.
42
Q

Chronic pyelonephritis/XPN: There are two different presentations in children. What are they?

A
  1. The most common form affects boys and girls equally and involves the entire kidney.
  2. The other form, which is more frequent in girls, is localized and may mimic a tumor.
43
Q

Chronic pyelonephritis/XPN
The presenting features include:
3

Approx. 1/2 of children will have what?

A
  1. Flank and abdominal pain.
  2. Fever.
  3. Growth and weight retardation.

a palpable abdominal mass.

44
Q

Chronic pyelonephritis/XPN
Examination of the urine confirms the presence of urinary tract infection:
1. Urinalysis reveals? 2

  1. Urine culture?
A
  1. Pyuria and bacteriuria.

2. Typically positive for gram-negative organisms (E coli, Proteus, Klebsiella, etc.)

45
Q

Chronic pyelonephritis/XPN

  1. Which bacteria is rarely involved?
  2. How often are the urine cultures sterile?
  3. Why might you need combination antimicrobial therapy?
A
  1. Staphylococcus aureus is rarely involved.
  2. The urine cultures are sterile in 25 percent of cases.
  3. Occasionally, different organisms may be isolated from urine and from the removed kidney, and combination antimicrobial therapy may be needed.
46
Q

Chronic pyelonephritis/XPN
Blood tests reveal nonspecific abnormalities including:
4

A
  1. *Anemia
  2. Increased ESR.
  3. *Abnormal results in liver function tests are found in 50% of patients, and occasionally associated with hepatomegaly.
    The cause of the liver abnormalities is not known, but results return to normal after treatment .
    • Creatinine levels prior to nephrectomy may be abnormal, but removal of the nonfunctioning XPN kidney is not excepted to alter baseline renal function.
  5. Anemia
  6. ESR
  7. Liver function tests
  8. Creatinine before the nephrectomy
47
Q

Chronic pyelonephritis/XPN
1. XPN is associated with what kind of damage to the kidney?

  1. Treatment is therefore what?
  2. Patients with a localized form (usually children) or with bilateral disease can be treated with what?
A
  1. virtually complete destruction of the kidney.
  2. surgical
    (after an initial course of antimicrobials to control the local infection)
    and consists of nephrectomy, in which all the involved tissue is removed and any fistulas closed.
  3. partial nephrectomy.
48
Q
  1. What is cystitis?

2. Most common bacteria involved? 2

A
  1. Infection of the bladder most commonly due to
    • coliform bacteria (usually E. coli) and occasionally from
    • gram-positive bacteria (enterococci)
49
Q

Cystitis route of infection?

Viral cystitis is due to?
seen mostly in who?

A

Route of infection is typically ascending from the urethra

Viral cystitis due to adenovirus is sometimes seen in children but is rare in adults

50
Q

Symptoms of cystitis?
3

Symptoms in women may often appear when?

A
  1. Irritative voiding (frequency, urgency, dysuria)
  2. Suprapubic discomfort is common
  3. Hematuria

following sexual intercourse

51
Q

Physical exam on cystitis may reveal what?

A
  1. suprapubic tenderness,

but examination is often unremarkable.

Systemic toxicity is absent

52
Q
  1. Workup for cystitis?

2. Lab work and imaging are warranted only if the following are suspected? 3

A
  1. Urinalysis
    • Pyelonephritis,
    • recurrent infections
    • anatomic abnormalities are suspected.
53
Q

What will the UA show on cystitis?
3

What will most likely be positive but not essential for the diagnosis?

A
  1. Pyuria,
  2. bacteriuria and
  3. varying degrees of hematuria

Urine culture is positive for the causative organism, but colony counts > 10,000 are not essential for the diagnosis

54
Q

Cystitis in men is rare and implies a pathological process such as:
3

A
  1. Infected lithiasis
  2. Prostatitis
  3. Chronic urinary retention requiring further work up
55
Q

Treatment:
Uncomplicated cystitis
1. Meds? 3 (2 drugs of choice)
2. Length of treatment?

A
    • Fluroquinolones and
    • nitrofurantoin are treatment of choice
    • Bactrim and Septra can be ineffective in a significant number of patients because of the emergence of resistant organisms. As of 2010, its use is limited to patients where the resistance rate is low
  2. Short-term (1-3 days)

Nephrology (15 decks)

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