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Adult Health > Renal/Urinary > Flashcards

Renal/Urinary Flashcards

1
Q

Urinary Tract Infection (UTI): General Considerations

A
  • most common bacterial infection in all age groups
  • usually caused by a single, gram-negative bacteria (E.coli most common)
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2
Q

Urinary Tract Infection (UTI): What is it?

A

Infection of one or more structures of the urinary system
- kidney
- bladder
- urethra

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3
Q

Urinary Tract Infection (UTI): Risk Factors

A
  • females (due to shorter urethras)
  • contraceptives (oral and diaphragms)
  • immunocompromise
  • sexual activity
  • aging (relaxed pelvic support, BPH, prostatitis)
  • pregnancy
  • cognitive impairment
  • use of spermicide
  • dysfunctional voiding pattern
  • hx of UTIs
  • structural abnormalities
  • chronic constipation in children
  • DM
  • procedures (Foley, surgery)
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4
Q

Urinary Tract Infection (UTI): Symptoms

A
  • dysuria, frequency, urgency, hesitancy
  • males may have slow urinary stream or dribbling of urine
  • occasional hematuria
  • occasionally, low back pain or lower abd pain (suprapubic)
  • sensation of incomplete bladder emptying
  • usually, no GI complaints
  • no vaginal or urethral discharge
  • temp less than 100F or no fever
  • normal bowel sounds
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5
Q

What is a strong indicator that a person has a UTI?

A

There is a 60-90% probability of UTI when dysuria, frequency, fever, and back pain are present

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6
Q

Urinary Tract Infection (UTI): Differentials for Women

A
  1. Vulvovaginitis
  2. Pelvic inflammatory disease
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7
Q

Urinary Tract Infection (UTI): Differentials for Men

A
  1. Urethritis
  2. Prostatitis
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8
Q

Urinary Tract Infection (UTI): Diagnostic Studies

A
  1. Urinalysis (WBCs present, positive leukocyte esterase, positive nitrites, bacterial count > 100,000 CFU/mL of urine)
  2. Culture and sensitivity
  3. Abd ultrasound
  4. Post-void residual testing
  5. Cystoscopy
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9
Q

Urinary Tract Infection (UTI): Prevention

A
  1. hydration
  2. empty bladder frequently
  3. void before and after intercourse
  4. estrogen therapy in postmenopausal women
  5. avoidance of spermicidal products
  6. good perineal hygiene
  7. removal and avoidance of urinary catheters as soon as reasonably possible
  8. antibiotic prophylaxis for recurrent UTIs
  9. circumcision
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10
Q

Urinary Tract Infection (UTI): Standard Treatment

A
  1. Trimethoprim/sulfamethoxazole (Bactrim) 160/800 mg PO BID for 3 days
  2. Nitrofurantoin 100 mg BID for 5 days
  3. Fosfomycin 3 mg single-dose
  4. Fluoroquinolones reserved for resistant infections
  5. PCN and cephalosporins are good first choices in pregnancy (avoid sulfa drugs and quinolones)
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11
Q

Urinary Tract Infection (UTI): Red Flags

A
  • Unusual presentation and/or non-response to standard treatments = referral
  • Gross hematuria without evidence of acute UTI indication of malignancy until proven otherwise
  • Hemodynamically unstable, severely dehydrated, or unable to tolerate oral meds require hospitalization
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12
Q

Interstitial Cystitis: What is it?

A
  • a chronic, irritable, and painful inflammation of the bladder due to unknown etiology
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13
Q

Interstitial Cystitis: General Considerations

A
  • most commonly affects women between the ages of 30-50
  • not life-threatening but causes poor quality of life
  • considered a chronic pain syndrome
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14
Q

Interstitial Cystitis: Symptoms

A

Characterized by pain with bladder filling that is relieved by emptying and is often associated with urgency, frequency, and nocturia

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15
Q

Interstitial Cystitis: Diagnosis

A

A diagnosis of exclusion - must have a negative urine culture and cytology and no other obvious causes

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16
Q

Interstitial Cystitis: Treatment Options

A
  • No cure
  • Hydrodistension of the bladder (can help for about 3-6 months)
  • Amitriptyline 10-75 mg per day PO
  • Nifedipine 30-60 mg/day PO or other CCBs
  • Pentosan polysulfate sodium (Elmiron)
  • Intravesical instillation of dimethyl sulfoxide and heparin
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17
Q

Acute Pyelonephritis: What is it?

A

Bacterial infection of the soft tissue of the renal parenchyma and pelvis or other portion of upper urinary tract

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18
Q

Acute Pyelonephritis: What causes it?

A

Most cases caused by an ascending infection from the bladder and the organism is usually E. coli

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19
Q

Acute Pyelonephritis: Symptoms

A
  • sudden onset of fever and chills
  • pronounced CVA tenderness
  • irritative voiding symptoms (dysuria, frequency, urgency)
  • nausea, vomiting, diarrhea
  • tachycardia
    ** Older adults (fever, mental status changes)
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20
Q

Acute Pyelonephritis: Diagnostic Studies

A
  1. UA (shows WBCs frequently in clumps, white cell clasts, proteinuria, and RBCs)
  2. Urine culture shows colony count greater than 100,000 and the offending organism
  3. Urinary tract imaging/blood cultures
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21
Q

Acute Pyelonephritis: Treatment

A
  1. Antipyretics
  2. Antibiotics
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22
Q

Acute Pyelonephritis: Antibiotic Treatment

A

First Line:
1. ceftriaxone IM 1g once OR
2. ciprofloxacin 400 mg IV once OR
3. gentamicin 5 mg/kg IV once

Then:
1. ciprofloxacin 500 mg PO BID x 7 days OR
2. levofloxacin 750 mg PO QD x 5 days OR
3. trimethoprim/sulfamethoxazole 160/800 mg PO BID x 14 days

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23
Q

Urethritis: What is it?

A

An inflammation of the urethra

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24
Q

Urethritis: General Considerations

A
  • gonococcal vs nongonoccocal vs nonspecific
  • Nongonococcal urethritis is the most common STD in men
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25
Q

Urethritis: Causes of Nongonoccocal urethritis

A
  • chlamydia
  • herpes simplex virus
  • trichomonas vaginalis
  • haemophilus influenzae
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26
Q

Urethritis: Symptoms

A
  • usually develops in 7-14 days (range 2-35)
  • painful urination
  • urethral discharge (may be profuse and prurulent, or scanty)
  • suprapubic discomfort
  • frequency and urgency
  • fever
  • most women are asymptomatic
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27
Q

Urethritis: Diagnostic Studies

A
  • Endocervical/vaginal swabs (women)
  • urethral swabs (men)
  • UA
  • gram stain of discharge
  • culture of discharge
  • urine culture
  • NAAT
  • should also test for gonorrhea and chlamydia
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28
Q

Urethritis: Treatment

A
  1. Treat initially for gonorrhea and chlamydia
    - ceftriaxone 500 mg IM for those <150kg or 1 g IM for those > 150 kg in a single dose AND
    - azithromycin 1 g PO single dose (pregnant) OR
    - doxycycline 100 mg PO BID x 7 days (nonpregnant)
  2. For nongonococcal urethritis
    - azithromycin 1 g PO in a single dose OR
    - doxycycline 100 mg PO BID x 7 days
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29
Q

Urolithiasis/Nephrolithiasis: What is it?

A
  • stones in the urinary tract that result from crystallized material in the urinary system
  • urolithiasis: stones in the urinary system
  • nephrolithiasis: stones in the kidney
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30
Q

Urolithiasis/Nephrolithiasis: Five Most Common type of Urinary Stones

A
  1. Calcium oxalate
  2. Calcium phosphate
  3. Struvite
  4. Uric acid
  5. Cystine
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31
Q

Urolithiasis/Nephrolithiasis: Causes

A
  • certain medications
  • dehydration
  • diet high in animal protein and salt
  • sedentary lifestyle/obesity
  • HTN
  • insulin resistance
32
Q

Urolithiasis/Nephrolithiasis: Symptoms

A
  • usually sudden onset
  • severe, agonizing pain (abdominal/flank, renal colic, testicular)
  • hematuria
  • patient in constant motion, no comfort
  • nausea with or without vomiting
  • diaphoresis
  • tachycardia
33
Q

Urolithiasis/Nephrolithiasis: Prevention and Screening

A
  • fluid intake of 3 L per day if appropriate
  • increase fruit and vegetable consumption
  • if prone to calcium stones, restrict animal protein, sodium, dairy products, and other oxalate-rich foods
  • if prone to uric acid stones, alkalinization of urine may prevent formation
34
Q

Urolithiasis/Nephrolithiasis: Diagnosis

A
  1. UA - hematuria nearly 100%; if pH < 5.5 means uric acid, if pH > 7.5 means struvite
  2. Chemistries: calcium, phosphorus, electrolytes, uric acid, BUN, creatinine
  3. Helical non-contrast CT scans (GOLD STANDARD)
  4. KUB/Renal ultrasound (will not identify uric acid stones, small stones, or stones overlapping a bony prominence)
35
Q

Urolithiasis/Nephrolithiasis: Pharmacological Management

A
  1. Pain management (ibuprofen, hydrocodone, morphine, meperidine, ketorolac IM then PO)
  2. Oral corticosteroids (prednisone)
  3. Antiemetics as needed (ondansetron)
  4. Alpha-adrenergic blockers (tamsulosin)
36
Q

Urolithiasis/Nephrolithiasis: Non-Pharmacologic Management

A
  1. Surgical intervention (ureteroscopic stone extraction)
  2. Extracorporeal shock wave lithotripsy (SWL)
37
Q

Asymptomatic Bacteriuria: What is it?

A

Significant bacterial count (at least 100,000 cfu/mL) in urine of a patient who has no other symptoms

38
Q

Asymptomatic Bacteriuria: Risk Factors

A
  1. Females
  2. Elderly
  3. Perimenopausal status
  4. Pregnancy
  5. Structural abnormalities
  6. Foley
  7. Spinal cord injury
  8. Sexual activity
39
Q

Asymptomatic Bacteriuria: Etiology

A

Most commonly caused by gram negative bacteria, such as E. coli

40
Q

Asymptomatic Bacteriuria: Diagnostic Studies

A
  • Screening of all pregnant women should be done in the first trimester or at the initial prenatal visit
  • UA: two consecutive midstream voided specimens that are positive for WBCs
  • Women: two urine cultures showing at least a single pathogen present at > 100,000 CFU/mL
  • Men and Foley patients: one positive culture of 100,000 CFU/mL
  • Urine culture
41
Q

Asymptomatic Bacteriuria: Treatment

A

Treatment is controversial, but evidence-based guidelines recommend treatment for women who are pregnant and patient who are immunocompromised or undergoing urologic intervention/surgery

42
Q

Hematuria: What is it?

A

The presence of RBCs in the urine
- may be microscopic or gross
- with or without pain

43
Q

Hematuria: Etiology

A
  • infection
  • renal calculi, tumors, trauma, polycystic renal disease, neoplasm
  • inflammation or infection of bladder or prostate, stones, and in patients with malignancy or BPH
  • medications (ASA, anticoagulants)
  • coagulopathies (Sickle Cell Disease)
  • strenuous exercise
  • menstruation
44
Q

Hematuria: Diagnostics

A
  • UA, C&S (shows RBCs and RBC casts)
  • CT Scan
  • PT, PTT, INR, Sed rate, CBC, BUN, Creatinine, eGFR, CMP
45
Q

Hematuria: Treatment

A
  • therapy directed at underlying cause
  • refer to urology or nephrology
46
Q

Urinary Incontinence: Types

A
  1. Urge
  2. Stress
  3. Overflow
  4. Functional
  5. Mixed
47
Q

Conditions that Mimic Urge Incontinece

A

** DIAPPERS (transient causes)
D - dementia/delirium
I - infection
A - atrophic vaginitis
P - pharmaceuticals
P - psychological conditions
E - excess urinary output
R - restricted mobility
S - stool impaction

48
Q

Urge Incontinence: Etiology

A

** Detrusor instability
1. UTI
2. Chronic cystitis
3. Dementia
4. Parkinson’s disease
5. Aging
6. Stroke
7. Irradiation of bladder

49
Q

Stress Incontinence: Etiology

A

** Sphincter Incompetence
1. Aging
2. Pelvic floor muscle weakness
3. Estrogen deficiency
4. Perineal trauma
5. Prostatic/pelvic surgery
6. Sneezing
7. Coughing
8. Laughing
9. Exertion or effort

50
Q

Overflow Incontinence: Etiology

A
  1. Urinary leakage from overdistended bladder
  2. Incomplete emptying
  3. Impaired detrusor contractility
  4. Bladder outlet obstruction
  5. Prostatic enlargement
51
Q

Functional Incontinence: Etiology

A
  1. Severe mental illness
  2. Sedating medications
  3. Physical or mental disability
52
Q

What is Mixed Incontinence?

A

Stress incontinence coexisting with urge incontinence

53
Q

Urinary Incontinence: Diagnostic Tests

A
  1. Voiding diary for 3-7 days
  2. UA (normal, unless underlying condition present)
  3. PSA (if elevated, rule out infection, inflammation, and malignancy)
  4. Bladder sonogram with post void residual volume (If PVR greater than 150 mL, then investigate for abnormality)
  5. Voiding cystourethrogram
  6. For men: perform digital rectal exam to assess for BPH
54
Q

Urinary Incontinence: Management

A
  1. anticholinergics (oxybutynin, tolterodine, trospium)
  2. beta-adrenergic agonists (mirabegron/mybetriq)
  3. voiding diary
  4. avoid caffeine and alcohol
  5. limit use of diuretics
  6. eliminate constipation
  7. bladder training
  8. Kegel exercises
  9. external collection catheters
  10. pessaries for prolapsed uterus
  11. intermittent catheterization
  12. smoking cessation
  13. weight loss
  14. surgery
55
Q

Acute Kidney Injury (AKI): What is it?

A

An abrupt decrease in kidney function that encompasses both injury (structural damage) and impairment (loss of function)

56
Q

Acute Kidney Injury (AKI): 3 Main Causes

A
  1. Prerenal
  2. Intrinsic
  3. Postrenal
57
Q

Causes of Prerenal AKI

A
  1. Hypotension
  2. HF
  3. Vasocontriction/vasodilation
  4. Hemorrhage
  5. Sepsis
  6. Diuretics
  7. MI/PE
  8. Dehydration
58
Q

Causes of Intrinsic AKI

A
  1. Systemic illness
  2. Autoimmune disease
  3. Medications
  4. Infections
  5. Ischemia
  6. Rhabdomyolysis
  7. Contrast dye
  8. HTN
  9. Thombosis
  10. Tumor lysis
  11. Malignancy
59
Q

Causes of Postrenal AKI

A
  1. BPH
  2. Nephrolithiasis
  3. Autonomic bladder dysfunction
  4. Tumors
  5. Thrombosis
60
Q

Glomerulonephritis: What is it?

A
  • Renal dysfunction resulting from inflammation in the glomerular capillaries
  • onset may be abrupt or insidious
  • may be reversible or progressive
  • 3rd leading cause of ESRD
61
Q

Glomerulonephritis: Symptoms

A
  1. May be asymptomatic
  2. Edema
  3. HTN
  4. “Foamy” urine
  5. Hematuria
  6. Azotemia
  7. Renal insufficiency
  8. Pyuria
62
Q

Glomerulonephritis: Diagnostic Studies

A
  1. Renal biopsy (GOLD STANDARD)
  2. Renal ultrasound
  3. CT
  4. CMP, GFR, CBC, UA, Sed rate, ESR, CRP, ANA
63
Q

Glomerulonephritis: Management

A
  1. BP Management
  2. Proteinuria (ACE inhibitors or ARBs)
  3. Control DM
  4. Treat HLD
  5. Diuretics
  6. Anticoagulation may be needed in the presence of nephrotic syndrome
  7. Avoid nephrotoxic meds like NSAIDs
64
Q

Glomerulonephritis: Consultation and Referral

A

Refer to nephrology if:
- progressive proteinuria
- albumin to creatinine ratio greater than 300
- rapid decline in GFR
- presence of urinary sediment/casts
- resistance HTN
- hereditary kidney disease
- nephrotic syndrome
- unknown etiology

65
Q

Chronic Kidney Disease (CKD): General Considerations

A
  • affects at least 14% of Americans
  • 70% of cases are caused by DM or HTN
  • serum creatinine may stay WNL until a large amount of kidney function is lost
  • stages 1-4 are usually asymptomatic
  • stage 5 indicates ESKD and requires dialysis, transplant, or palliative care
66
Q

Chronic Kidney Disease (CKD): Symptoms

A
  1. Uremic syndrome: fatigue, nausea, anorexia, a metallic taste, halitosis
  2. Neurologic symptoms: memory impairment, insomnia, restless legs, twitching
  3. Generalized pruritis
  4. Decreased libido, menstrual irregularities, impotence, anovulation
  5. Medication toxicity
  6. CVD symptoms: HTN, overload, edema
67
Q

Chronic Kidney Disease (CKD): Diagnostic Studies

A
  1. UA
  2. GFR
  3. BUN/creatinine
  4. electrolytes
  5. 24-hour urine creatinine
  6. PTH
  7. Vitamin D
  8. Uric acid
  9. Serum albumin
  10. LFT
  11. CBC
68
Q

Chronic Kidney Disease (CKD): Management

A
  1. Treatment of underlying condition
  2. Discontinue nephrotoxic meds
  3. ACEs and ARBs
  4. Allopurinol
  5. EPO stimulating agents
  6. Ferrous sulfate
  7. Correction of electrolytes
  8. Anti-emetics
  9. Anti-pruritics
69
Q

Acute Tubular Necrosis: General Considerations

A
  • Ischemia can come from anything that prevents the blood from getting to the kidneys, like a hemorrhage or shock
70
Q

Acute Tubular Necrosis: Nephrotoxic Meds

A
  • gentamycin
  • tobramycin
  • vancomycin
  • amphotericn B
  • IV contrast media
71
Q

Acute Tubular Necrosis: Endogenous Nephrotoxins

A
  • Myoglobin (rhabdomyolysis)
  • Transfusion reactions
72
Q

Acute Tubular Necrosis: Symptoms

A
  • “coca cola” type urine
  • similar symptoms of UTI
73
Q

Acute Tubular Necrosis: Diagnostic Studies

A
  1. UA
  2. Renal ultrasound
  3. CT
74
Q

Acute Tubular Necrosis: Treatment

A
  • Aimed at the cause
  • treatment of electrolyte, acid-base, and volume imbalances
75
Q

Acute Tubular Necrosis: Course and Prognosis

A

Divided into 3 Phases:
1. Initial injury
2. Maintenance phase (oliguric or non-oliguric, with the non-oliguric phase having better outcomes); lasts 1-3 weeks
3. Recovery phase
** As with AKI, dialysis will likely be required for a short time

76
Q
A

Adult Health (14 decks)

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