Renal/Urinary Flashcards
Urinary Tract Infection (UTI): General Considerations
- most common bacterial infection in all age groups
- usually caused by a single, gram-negative bacteria (E.coli most common)
Urinary Tract Infection (UTI): What is it?
Infection of one or more structures of the urinary system
- kidney
- bladder
- urethra
Urinary Tract Infection (UTI): Risk Factors
- 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)
Urinary Tract Infection (UTI): Symptoms
- 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
What is a strong indicator that a person has a UTI?
There is a 60-90% probability of UTI when dysuria, frequency, fever, and back pain are present
Urinary Tract Infection (UTI): Differentials for Women
- Vulvovaginitis
- Pelvic inflammatory disease
Urinary Tract Infection (UTI): Differentials for Men
- Urethritis
- Prostatitis
Urinary Tract Infection (UTI): Diagnostic Studies
- Urinalysis (WBCs present, positive leukocyte esterase, positive nitrites, bacterial count > 100,000 CFU/mL of urine)
- Culture and sensitivity
- Abd ultrasound
- Post-void residual testing
- Cystoscopy
Urinary Tract Infection (UTI): Prevention
- hydration
- empty bladder frequently
- void before and after intercourse
- estrogen therapy in postmenopausal women
- avoidance of spermicidal products
- good perineal hygiene
- removal and avoidance of urinary catheters as soon as reasonably possible
- antibiotic prophylaxis for recurrent UTIs
- circumcision
Urinary Tract Infection (UTI): Standard Treatment
- Trimethoprim/sulfamethoxazole (Bactrim) 160/800 mg PO BID for 3 days
- Nitrofurantoin 100 mg BID for 5 days
- Fosfomycin 3 mg single-dose
- Fluoroquinolones reserved for resistant infections
- PCN and cephalosporins are good first choices in pregnancy (avoid sulfa drugs and quinolones)
Urinary Tract Infection (UTI): Red Flags
- 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
Interstitial Cystitis: What is it?
- a chronic, irritable, and painful inflammation of the bladder due to unknown etiology
Interstitial Cystitis: General Considerations
- most commonly affects women between the ages of 30-50
- not life-threatening but causes poor quality of life
- considered a chronic pain syndrome
Interstitial Cystitis: Symptoms
Characterized by pain with bladder filling that is relieved by emptying and is often associated with urgency, frequency, and nocturia
Interstitial Cystitis: Diagnosis
A diagnosis of exclusion - must have a negative urine culture and cytology and no other obvious causes
Interstitial Cystitis: Treatment Options
- 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
Acute Pyelonephritis: What is it?
Bacterial infection of the soft tissue of the renal parenchyma and pelvis or other portion of upper urinary tract
Acute Pyelonephritis: What causes it?
Most cases caused by an ascending infection from the bladder and the organism is usually E. coli
Acute Pyelonephritis: Symptoms
- 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)
Acute Pyelonephritis: Diagnostic Studies
- UA (shows WBCs frequently in clumps, white cell clasts, proteinuria, and RBCs)
- Urine culture shows colony count greater than 100,000 and the offending organism
- Urinary tract imaging/blood cultures
Acute Pyelonephritis: Treatment
- Antipyretics
- Antibiotics
Acute Pyelonephritis: Antibiotic Treatment
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
Urethritis: What is it?
An inflammation of the urethra
Urethritis: General Considerations
- gonococcal vs nongonoccocal vs nonspecific
- Nongonococcal urethritis is the most common STD in men
Urethritis: Causes of Nongonoccocal urethritis
- chlamydia
- herpes simplex virus
- trichomonas vaginalis
- haemophilus influenzae
Urethritis: Symptoms
- 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
Urethritis: Diagnostic Studies
- 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
Urethritis: Treatment
- 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) - For nongonococcal urethritis
- azithromycin 1 g PO in a single dose OR
- doxycycline 100 mg PO BID x 7 days
Urolithiasis/Nephrolithiasis: What is it?
- 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
Urolithiasis/Nephrolithiasis: Five Most Common type of Urinary Stones
- Calcium oxalate
- Calcium phosphate
- Struvite
- Uric acid
- Cystine