Renal & Urinary Tract Disorders in Pregnancy CH 28

Question 1

Asymptomatic Bacteriuria, what is it

Answer 1

presence of actively multiplying bacteria in the urinary tract, excluding the distal urethra, without any obvious symptoms

Question 2

risk factors for asymptomatic bacteriuria

Answer 2

low socioeconomic status, parity, age, sexual practice, diabetes and sickle cell

Question 3

causative organism for asymptomatic bacteriuria

Answer 3

E COLI!, but can be caused by klebsiella-enterobacter-serratia group, staphylococcus aureus, enterococcus, group B strep, and proteus

Question 4

asymptomatic bacteriuria clinical findings

Answer 4

isolation of microorganisms with a colony count >10^5 organisms per milliliter of urine in a clean catch in a women who has no symptoms of UTI.

Question 5

Complications of asymptomatic bacteriuria

Answer 5

pyelonephritis if untreated

Question 6

Complications of asymptomatic bacteriuria in pregnant patient; how to prevent

Answer 6

Increased stasis of urine and higher risk for infection due to anatomic dilation in renal system. Screen all pregnant patients and treat promptly to prevent UTI. Also associated with preterm delivery, fetal loss, and preeclampsia

Question 7

Screening pregnant patients for asymptomatic bacteriuria

Answer 7

Screen at each prenatal visit, do urinalysis and culture if proteinuria is present. Screen those with sickle cell (and trait) every 4 weeks.

Question 8

Treatment for asymptomatic bacteriuria

Answer 8

sulfonamide, nitrofurantoin or a cephalosporin if pathogen is e coli. Repeat urine culture in 1-2 weeks. DONT give nitrofurantoin to mothers with glucose 6 phosphatase deficiency. NO sulfa drugs in late pregnancy (hyperbilirubinemia). No tertacyclines (cause dental staining) or trimethoprim (folic acid antagonist, messes with organogenesis)

Question 9

When to give suppressive therapy for asymptomatic bacteriuria

Answer 9

when bacteriuria persists after 2 or more courses of therapy, give Nitrofurantoin at bedtime for duration of pregnancy

Question 10

Acute cystitis, what is it

Answer 10

urine culture demonstrating bacteria in urine in a patient symptomatic for UTI. uncommon in preganancy

Question 11

Clinical findings of acute cystitis

Answer 11

urinary frequency, urgency, dysuria, suprapubic discomfort. urine may look cloudy and malodourous and should be cultured to confirm diagnosis and identify antibiotic sensitivities. needs colony count of >10^3

Question 12

acute cystitis treatment

Answer 12

sulfonamide, nitrofurantoin or a cephalosporin. Repeat urine culture 1-2 weeks after treatment. If UTI persists after 2 or more courses of therapy, give Nitrofurantoin at bedtime for duration of pregnancy

Question 13

Acute pyelonephritis, what is it

Answer 13

one of the most common causes of hospitalization in pregnancy, presence of bacteria in urine culture

Question 14

Acute pyelonephritis prevention

Answer 14

screening for and treating asymptomatic bacteruria

Question 15

clinical findings of Acute pyelonephritis

Answer 15

fever, shaking, chills, CVA tenderness, flank pain, nausea, vomitiing, headache, increased urinary frequency, dysuria. Pyuria and WBCs on urinalysis

Question 16

complications of Acute pyelonephritis

Answer 16

fever, bacterial endotoxemia, endotoxic shock, renal insufficiency, anemia, leukocytosis, thrombocytopenia, elevated fibrin split product levels, preterm labor, prematurity, fetal death, intrauterine growth restriction. associated with pulmonary dysfunction

Question 17

treatment of Acute pyelonephritis

Answer 17

hospitalize, treat hypovolemia, give tylenol for fever. wait until getting cultures to choose antibiotics. monitor respirations and urine output. usually give cephalosporin (cefazolin) or ceftriaxone for 14 days. add gentamicin if there is resistance. use US of kidney and urinary tract if no improvement

Question 18

relapse

Answer 18

recurrent infection from same species and type specific strain of organism present before treatment. represents a treatment failure

Question 19

reinfection

Answer 19

recurrent infection due to a different strain of bacteria after successful treatment of initial infection, occurring > 3 weeks after completion of therapy

Question 20

Urinary calculi causes

Answer 20

chronic UTI, hyperparathyroidism, gout, obstructive uropathy

Question 21

urinary calculi clinical findings

Answer 21

abdominal or back pain that radiates to groin, fever, nausea, vomiting, hematuria

Question 22

physiologic hydroureter of pregnancy

Answer 22

more prominent on the right. increases likelihood that pregnant patient will spontaneously pass her stone

Question 23

clinical diagnosis of urinary calculi

Answer 23

confirmed by US exam of urinary tract. if inconclusive you may use MRI or CT

Question 24

Complications of urinary calculi

Answer 24

increased risk for preterm delivery

Question 25

urinary calculi treatment (basic, medication)

Answer 25

hospital admission, hydration, urine culture and gram stain for appropriate antibiotic therapy, correction of electrolyte imbalance and systemic analgesia (possible opiods, severe pain may need epidural). Most stones pass spontaneously due to dilated urinary tract.

Question 26

Surgical intervention for urinary calculi

Answer 26

ureteral stenting, transuretheral cystoscopic stone extraction, nephrostomy drainage, or open surgery. Done by urologist for unremitting pain, sepsis, or infection unresponsive to antibiotic therapy. Shock wave lithotripsy contraindicated

Question 27

Acute renal failure definition

Answer 27

sudden impairment in kidney function that leads to retention of waste products (urea) and abnormal fluid and electrolyte balance. occurs infrequently in pregnancy but carries high mortality rate

Question 28

acute renal failure causes

Answer 28

most cases caused by acute hypovolemia associated with OB hemorrhage (placenta previa, placental abruption, postpartum hemorrhage). preeclampsia, sepsis.

Question 29

Acute renal failure prevention

Answer 29

volume replacement to maintain adequate urine output. Proper management of high risk OB conditions (eclampsia, abruptio placentae, chorioamnionitis), ready blood availability, and avoidance of nephrotoxic antibiotics.

Question 30

Acute renal failure clinical findings

Answer 30

urine output <400 mL in 24 hours or an increase in serum creatinine (at least 1.5 fold). BUN concentration are usually increased.

Question 31

Oliguric phase

Answer 31

urine output drops to <30 ml/h, with accumulation of BUN and potassium. pt becomes acidotic with the increase in hydrogen and loss of bicarb

Question 32

Diuretic phase

Answer 32

large volumes of dilute urine are passed with loss of electrolytes due to absence of function of renal tubules.

Question 33

Recovery phase

Answer 33

tubular function returns to normal, volume and composition of urine normalize

Question 34

Acute renal failure clinical manifestations and complications

Answer 34

anorexia, nausea and vomiting, lethargy, cardiac arrhythmia, anemia, renal or extrarenal infection, thrombocytopenia, metabolic acidosis, and electrolyte imbalance

Question 35

Electrolyte imbalances in acute renal failure

Answer 35

hyperkalemia, hyponatremia, hypermagnesemia, hyperphosphatemia, hypocalcemia

Question 36

Complications of acute renal failure

Answer 36

pregnancy loss, low birth weight , premature labor, and still birth.