Renal Infectious Disease Flashcards
Symptoms of renal abscess
fever, abdominal pain, weight loss, dysuria, hematuria
Diagnostic procedure of choice for renal abscess
CT scan
Treatment for renal abcess
IV abx and percutaneous drainage
What does acute pyelonephritis affect?
cortex with sparing of glomeruli and vessels
What are white cell casts in urine pathognomonic for?
acute pyelonephritis
What bacteria are most commonly implicated in acute pyelonephritis?
e. coli, proteus, klebsiella, enterobacter
What is emphysematous pyelonephritis?
life-threatening necrotizing infection of the kidneys characterized by gas formation within or surrounding the kidneys
Risk factors for emphysematous pyelonephritis
DM, immunocompromised, or urinary tract obstruction due to lithiasis
Symptoms of acute pyelonephritis
high fever, arthralgias, myalgias, flank pain w/CVA tenderness
What might a CT scan show for acute pyelonephritis?
hydronephrosis and attenuation caused by inflammation/infection
Common abx for acute pyelonephritis
IV ampicillin. PO-cipro, oxfloacin, Bactrim DS for 21 days.
How long should IV abx be cont’d?
for 24hrs after fever has resolved and then you can switch to PO
T/F chronic pyelonephritis occurs almost exclusively in patients with normal kidneys
false, occurs with major anatomical anomalies
What is one of the most common problems encountered by pediatric urologists?
Vesicoureteral reflux (VUR)
What percent of infants presenting with UTI have VUR?
70%
Etiology of primary VUR
deficiency in the longitudinal muscle fibers in ureterovesical junction
Etiology of secondary VUR
Bladder outlet obstruction at the posterior uretheral valve or stenosis. Functional obstruction (Neurogenic and non neurogenic bladder dysfunction)
How do newborns present with VUR?
failure to thrive, difficult feeding, or lethargy
What is required for a child < 5yrs w/UTI, male childe w/UTI, or febrile UTI?
Standard VCUG and US
What percent of gr. 1 reflux spontaneously resolve before adolescence?
90%
Characteristics of chronic pyelonephritis
asymmetric corticomedullary scarring, thyroidization of the kidney, eosinophilic casts in tubules
symptoms of chronic pyelonephritis
fever, lethargy, N/V, flank pain, dysuria
How does IVP establish diagnosis of chronic pyelonephritis?
reveal caliceal dilatation and blunting with cortical scars.
Tx of chronic pyelonephritis due to stage 1 and 2 VUR
ABX (Amoxicillan, Bactrim, Septra, Nitrofurantoin) until puberty or until reflux resolves
Tx of chronic pyelonephritis due to stage 3 and 4 VUR
Surgery involving the reimplantation of the ureters
What is xanthogranulamtous pyelonephritis?
variant of chronic pyelonephritis that, in two-thirds of cases, is a complication of obstruction induced by infected renal stones.
What is the outcome for most patients with XPN?
massive destruction of the kidney requiring nephrectomy
T/F XPN is sometimes referred to as pseudotumor
true
Signs/Symptoms of XPN
flank pain, fever, weight lose, palpable flank mass with or without CVA tenderness
Treatment for XPN
nephrectomy
What is cystitis most commonly due to?
coliform bacteria (usually E. coli) and occasionally from gram-positive bacteria (enterococci)
symptoms of cystitis
irritative voiding, suprpubic discomfort, hematuria
Tx of choice for uncomplicated cystitis
Fluroquinolones and nitrofurantoin for 1-3 days
What percent of urethritis is caused by n. gonorrhea?
80%
symptoms of urethritis
discharge, dysuria, itching, heaviness in genitals (males)
What work-up should be performed for all patients presenting with urethritis?
full STD work-up
Tx for urethritis
Zithromax, fluroquinolones, doxycycline orally or if compliance is questionable, IM Rocephin
what usually causes acute/chronic bacterial prostatitis?
gram-negative rods, esp E. coli, pseudomonas
symptoms of acute prostatitis?
Perineal, sacral, or suprapubic pain
Fever, irritative voiding, urinary retention
What do you need to be careful of with an acute prostate exam?
careful exam must be performed as vigorous manipulation can cause septicemia
Tx for acute prostatitis
I.V. antibiotics (ampicillan and aminoglycosides). PO antibiotics (quinolones) are used for 4-6 weeks
Difference between acute and chronic prostatitis
Physical exam of the prostate is often unremarkable and UA is normal in chronic prostatitis
What is necessary to make diagnosis of chronic prostatitis?
Culture of post-prostatic massage urine specimen
Tx fo chronic prostatitis
Septra has the best cure rate, quinolones, erythromycin, cephalexin also used
6-12 wks
What is the most common of the prostatitis syndromes?
nonbacterial prostatitis
Symptoms of nonbacterial prostatitis
identical to chronic but no history of UTI
Bugs that contribute to the STD forms of epidiymitis
chlamydia or N. gonorrhoea
What is non STD form of epididymitis associated with?
UTI’s and prostatitis and result from gram-neg rods
What medication is associated with self-limited epidiymitis?
amiodarone
symptoms of epididymitis
scrotal pain/swelling, fever, enlarged/tender mass, tender prostate
Tx for epididymtitis
Bed rest with scrotal elevation in the acute phase
ABO therapy is directed at causative organism for 10-21 days
