Renal/Urology Flashcards
☆How to take history & do examination in UTI cases?
- Urinalysis
- Dipstick Test:
-Leukocyte esterase: Indicates the presence of white blood cells (WBCs), suggesting infection.
- Nitrites: Indicates the presence of bacteria that convert nitrates to nitrites (e.g., E. coli).
- Hematuria: Presence of blood in the urine.
- Proteinuria: Presence of protein in the urine.
- pH: The acidity of the urine can give clues about the type of bacteria.
- Urine Microscopy
- Microscopic Examination:
- (WBCs): Elevated levels indicate infection.
Red Blood Cells (RBCs): Presence may indicate infection or other pathology.
- Bacteria: Direct visualization of bacteria.
- Urine Culture and Sensitivity
- Urine Culture:
- Identifies the specific bacterial pathogen causing the infection.
- Colony Count: A significant growth (usually >10^5 colony-forming units/mL) confirms infection.
- Sensitivity Testing:
- Determines the antibiotic sensitivity pattern of the isolated organism to guide appropriate antibiotic therapy.
- Blood Tests (if systemic symptoms are present)
- (CBC):
-Blood Cultures:
- If there are signs of sepsis or systemic infection.
- Imaging (if complications are suspected or recurrent UTIs)
- Ultrasound:
- To check for structural abnormalities, stones, or obstructions in the urinary tract.
- CT Scan:
- Detailed imaging to detect any complicated UTI, such as abscesses, stones, or anatomical abnormalities.
- Intravenous Pyelogram (IVP):
- An X-ray exam of the urinary tract, used less frequently due to advancements in other imaging techniques.
- Additional Tests for Specific Situations
- Cystoscopy:
- Direct visualization of the bladder and urethra, used if there are recurrent UTIs or suspicion of bladder pathology.
- Voiding Cystourethrogram (VCUG):
- To assess for vesicoureteral reflux, particularly in children or patients with recurrent UTIs.
Procedure for Collecting a Urine Sample
- Midstream Clean-Catch
- Catheterization:
- May be used if the patient is unable to provide a clean-catch sample or if contamination is a concern.
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1. symptoms:
*Urine symptoms:
- Dysuria
- Frequency
- Urgency
- Nocturia
- Hematuria
- Cloudy or foul-smelling urine
- Pain:
- Suprapubic pain
- Flank pain (suggesting upper UTI or pyelonephritis)
*Others:
- Fever, chills, or malaise
- Onset and Duration
-When did the symptoms start?
- Have they been constant or intermittent?
- Have the symptoms worsened, improved, or stayed the same over time? - Past Medical History
- Previous UTIs:
- How many UTIs have you had in the past?
- When was your last UTI?
- What treatment was given, and was it effective?
- Chronic conditions:
- Diabetes
- Kidney disease
- Immunocompromised state
- Any history of urological surgeries or abnormalities
- Medications
- Current medications:
- Are you taking any antibiotics currently?
- Are you on any immunosuppressive drugs?
- Allergies:
- especially to antibiotics
- Sexual History
- Are you sexually active?
- Have you had new sexual partners recently?
- Do you use contraceptives? Which type?
- Have you noticed any vaginal or penile discharge? - Social History
- Hygiene practices:
- Fluid intake:
- How much water do you drink daily?
- Recent travels:
- Have you traveled recently? If so, where?
- Family History of UTIs
- Associated Symptoms
- Nausea or vomiting
- Back pain
- Fatigue - Physical Examination
- look for signs of:
- Fever
- Costovertebral angle tenderness (for pyelonephritis)
- Suprapubic tenderness
History:
Urine: Urgency, frequency, dysuria, foul-smelling urine
Pain: suprapubic pain , and lower back pain.
General: fever
Vaginal: vaginal discharge, vulval pain or pruritus,vaginal irritation , or dyspareunia are all suggestive features
Ask about
-medical, surgical and family histories
-Current medications
-menstrual cycles, last menstrual period
E/X: Check suprapubic and costovertebral-angle tenderness
In pediatrics: signs of dehydration or hemodynamic unstability
☆what are the investigations done for UTI?
1-Urinalysis with dipstick testing is useful for confirmation ( pyuria, +ve nitrites & leukocyte esterase )
Urinalysis (of UTI patient) eg.
Appearance: turbid
Color: dark yellow
pH:7.4 (normal 4.5-7.8)
WBC: 55/hpf (normal: <5)
RBC: 3/hpf (normal: <3)
Cell casts: none
Crystals: none
Glucose: none
Protein: 5 mg/dL (normal: <20)
Nitrites: positive
Leukocyte esterase: positive
2-Urine cultures are not routinely required. Neither are imaging studies of the urinary tract or a CBC indicated in uncomplicated UTI
Cultures should also be performed if :
1-symptoms persist after 48 to 72 hours of antibiotic therapy
2-symptoms reoccur after treatment.
3-complicated UTIs
Imaging in pediatrics:
renal and bladder ultrasonography is mandatory following the first episode of UTl in children < 2 years children > 3 years only if there is no response to treatment within 48 hours.
voiding cystourethrography is only indicated if ultrasonography reveals abnormalities of the urinary tract.
Treatment of Adult UTI?
Phenazopyridine: is a urinary tract analgesic
1-Nitrofurantoin : ( 1st choice )
- Macrocrystals (Macrodantin, Furadantin, and equivalents) = regular release
Give: 50-100 mg ×6h ×7 days ( or for 3 days after obtaining sterile urine )
- Monohydrate/macrocrystals (Macrobid and equivalents) = Dual release
Give : 100 mg ×12hr ×7 days ( or for 3 days after obtaining sterile urine )
Prophylaxis:
Regular release: 50 to 100 mg orally once a day at bedtime
2- trimethoprim/sulfamethoxazole (TMP/SMX)
( Bactrim, Septra, Cotrim, cotrimoxazole, Sulfatrim )
Dosage: 80mg/400mg or 160mg/800mg
-1 DS tab or 2 regular-strength tabs ×12hr x 5days
- Prophylaxis :use regular-strength tablet once/twice per week
3-fosfomycin ( Monurol )
Give 3 g PO once
Multi-drug resistant UTI: 2-3 g PO every 2-3 days for 3 doses
Preparation: Dissolve 1 packet (3 g) in 3-4 oz water
Not used in pediatrics
