Renal infectious Dz Flashcards
Renal Abcess
- what is this?
- may occur as a result of what common problems?
What: abscess confined to the kidney and is caused either by bacteria from an infection traveling to the kidneys through the blood stream or by UTI traveling to the kidney and then spreading to the kidney tissue.
Result of:
- Kidney inflammation
- Vesicoureteral reflux
- Multiple Skin abscesses
- DM
- Nephrolithiasis
- IVDA
- Pregnancy
- pyelonephritis
- Neurogenic Bladder
Renal Abcess Sx, Dx
- fever
- chills
- abd pain
- weight loss
- dysuria
- hematuria
- malaise
Dx:
-UA: WBC, bacteria, hemturia
- UC
- CBC: leukocytosis
- Xray: small abcesses may be difficult to recognize
- Ultrasound; may be more helpful than xray
- CT scan: diagnostic procedure of choice, 96% accurate in renal abscess dx
- Sed rate & CRP
Renal Abscess
- common bugs
- Treatment
- Prognosis
Bugs: e.coli, enterobacteria
Tx:
-IV abx (ampicillin w/ aminoglycosides)
- used to do I&D now percutaneous drainage is most common.
- if no response to tx need to have nephrectomy.
Prognosis:
-low recurrence with underlying cause treated. e.g kidney stones, reflux
-DM and advanced renal abscesses may lead to serious dz or death
Acute Pyelonephritis
-affects what part of the kidney?
- what is a pathognomonic finding in the urine?
- caused by?
- prognosis
Affects the cortex of the kidney, spares the glomeruli and vessels.
- Pathognomonic finding in urine is WBC casts**
- Cause: bacteria infection either from hematogenous spread or from ascending infection, usually e.coli. May be proteus, klebsiella, staph, and enterobacter.
Prognosis:
-healthy adults usually recover complete renal function, inadequate therapy could result in abscess formation
Emphysematous Pyelonephritis:
- what is this?
- who gets this most commonly?
- prognosis
WHat; life-threatening necrotizing infection of kidneys characterized by gas formation within or surrounding the kidneys.
-MC in those with poorly controlled DM, otherwise they are immunocompromised in some way.
Prognosis:
-w/o early tx, rapidly progressive, generalizes to fulminant sepsis and carries a high mortality rate.
Acute Pyelonephritis:
- sx
- dx
Sx:
- shaking chills
- high fever
- arthralgias
- myalgias
- flank pain w/ CVA tenderness
- Urgency, frequency
- N/V/D in peds.
Dx:
-UA: WBC, bacteria, hematuria
- CBC: leukocytosis w/ left shift
- Blood cultures may be positive
- urine culture
- US; may show hydronephrosis from a stone or other source of obstruction
- CT; diagnostic procedure of choice, DONT use dye.
Acute Pyelonephritis:
-Tx
- may require hospitalization
- catheterization may be necessary in case of urinary retention
- nephrostomy drainage may be required if there is ureteral obstruction
-Blood/urine culture to determine ABX.
ABX: I.V Ampicillin, PO Ciprofloxacin, Ofloxacin, Bactrim DS.
abx are given for 21 days
continue IV abx for 24hrs after fever resolves, then move to PO abx, follow up w/ urine cultures
Chronic Pyelonephritis:
- causes
- prognosis
Cause: renal injury induced by reucurrent or persistent renal infection, occurs almost exclusively in pts with major anatomic anomalies..
- Urinary Tract Obstruction
- Struvite Calculi
- Renal dysplaise
- Vesicoureteral reflux*
- Chronic UTI
Prognosis;
-may lead to ESRD
Chronic Pyelonephritis:
- describe the changes made to the kidney
- sx
Chronic Pye TEA
T: thyroidization of kidney
E: Eosinophilic casts
A: Asymmetric scarring; course asymmetric corticomedullary scarring
Sx:
- fever
- lethargy
- N/V
- Flank pain or dysuria
- some children failure to thrive*
Chronic Pyelonephritis:
-diagnosis
Dx:
- UA: WBC, bacteria, hematuria
- UC: isolates bacteria
- imagining:
- IVP-helps establish dx b/c reveals caliceal dilation and blunting with cortical scars.
- -Voiding Cystourethrogram; document reflux of urine
- -Cystoscopy; shows evidence of reflux at the ureteral orfices
- -US may show calculi
Tx general Chronic Pyelonephritis
- eliminate recurrent UTI & correct underlying problem wither its anatomic or functional
- dietary protein restriction in those with progressive renal injury
- BP control; ACEI/ARB
- follow up screening/monitoring
Vesicoureteral reflux:
- what is this?
- cause
- gender, age
- clinical presentation
What: retrograde flow of urine from bladder to upper urinary tract.
Cause: Primary: dysfunction of trigonal muscle contraction
Secondary: obstruction or stenosis of flap valve mechanism.
Most common in females, children
Presentation:
Newborn: failure to thrive, difficult feeding, lethargy
Older children: flank/abd pain, fever
Prenatally: dx by US w/ abdominal swelling
Vesicoureteral Reflux:
- Work up
- prognosis
Work up:
- UA
- US & VCUG required in:
1. child less than 5yrs w/ UTI
2. any male child
3. febrile UTI
Prognosis
-usually resolves spontaneoulsy before adolescence, except for Grade IV and V.
-scarring leads to HTN and renal insufficiency/failure
Vesicoureteral Relfux:
- describe stages
- Tx
Stages 1 & 2:
-refllux of urine to the ureter or pelvis without ureteral dilation
Stage 3 & 4: reflux of urine to the ureter or pelvis with ureteral dilation and scarring.
Tx:
Stage 1 &2:
-Abx until puberty or resolve. (Amoxicillan, bactrim, septra, nitrofurantoin)
Stage 3&4:
-medical therapy (Abx)
- surgery if medical noncompliance with formation of new scars, persistent reflux after puberty in women, breakthrough infections in pts who are compliant w/ abx
- surgery involves reimplantation of the ureters.
Xanthogranulomatous pyelonephritis (XPN)
- what is this?
- characteristics of this
- most common in which gender, age
What: complication of obstruction induced by infected renal stones.
-has neoplasm like properties capable of local tissue invasion and destruction, referred to as a pseudotumor.
most common in women, 5th & 6th decade of life
