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STEP 2 Cardio + Renal > Renal. UTI (08-03) > Flashcards

Renal. UTI (08-03) Flashcards

1
Q

FA. what is the way of UT infection?

A

Ascending

Urethra –> prostate (prostitis) –> bladder (cystitis) –> kidney (pyelonephritis) –> systemis (urosepsis)

Due to this ascention these infections share common microbiologic profiles.

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2
Q

FA. Cystitis presentation?

A

Dysuria, frequency, urgency, suprapubic pain, WBC in urine (BUT NOT WBC CASTS).

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3
Q

FA. fundamental Pyelonephritis symtoms?

A

CVA tenderness, flank pain
hematuria, WBC CASTS
Systemic symptoms: fever, chills

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4
Q

FA. Uncomplicated UTI criteria.

A

Lower UTI is acute, simple cystitis (symptoms in other card) in otherwise healthy, nonpregnant woman who has not failed a/b therapy

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5
Q

FA. Uncomplicated UTI treatment.

A

TMP-SMX for 3 days
Nitrofurantoin for 5-7 days - only for cystitis, if suspected pyelo, when clearance < 60 ml/min or complicated UTI, dont use nitrof.

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6
Q

FA. Uncomplicated UTI. When culturing?

A

ONLY when treatment failed

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7
Q

UW. Uncomplicated UTI. when avoid TMP-SMX?

A

When locaql resistance > 20 proc.

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8
Q

UW. Uncomplicated UTI. What single shot drug?

A

Fosfomycin single dose

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9
Q

UW. Uncomplicated UTI. When fluoroquinolones?

A

Only when previously mentioned options cannot be used (TMP-SMX, nitrof, fosfomycin)

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10
Q

FA. Complicated UTI. criteria? summarized

A

summarized: one that does not meet criteria for uncomplicated.

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11
Q

FA. Complicated UTI. criteria detailed.

A

Symptoms same as in uncomplicated.
Everything depends on populations which are at higher risk for complexity.

pregnant
patient with comorbidities (such as diabetes),
infants and toddlers, and male sex;

immu­nocompromise or stents or urinary catheters, as well as those with recurrent or refractory UTls

A complicated UTI would also be any patient with systemic symptoms of UTI that might suggest pyelo­ nephritis.

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12
Q

FA. Complicated UTI. treatment? stable

A

fluroqui­nolones, third-/fourth-generation cephalosporins,
or TMP-SMX
Peroral is hemodinamically stable and can be treated outpatient

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13
Q

FA. Complicated UTI. treatment? unstable

A

Unstable hemodynamic - iv a/bs

IV third-/fourth-generation cephalosporins
typically given, or fluroquinolones

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14
Q

UW. Complicated UTI. treatment?

A

Fluoroquinolines (5-14 days)
extended spectrum eg ampic-sulbactam for more severe

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15
Q

UW. Complicated UTI. sampling

A

Obtain prior treatment and adjust ab if needed

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16
Q

UW. Uncomplicated UTI. nitrofurantoin complication HY?

A

Nitrofurantoin induced pulmonary injury 3-9days after drug + rashes + eosinophilia + lung findings

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17
Q

UW. Complicated UTI. what ab dont use and what use instead in pregnancy?

A

dont use fluoroquinolones
considercefpodoxime, cephalexin, amoxiclave, fosmomycin

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18
Q

UW complicated UTI in cases?

A

DM, pregnancy, renal failure, indwellin cath, urinary procedure (eg cystoscopy), urinary tract obstruction, immunosupression and hospital acquired.

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19
Q

FA. pregnancy UTI.
what is routinely performed and why in pregnant?

A

Urinalysis is routinely performed to screen for asymptomatic bacteriuria

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20
Q

FA. pregnancy UTI. increased risk for what?

A

patients are at increased risk for pyelonephritis and urosepsis

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21
Q

FA. pregnancy UTI.
asymptomatic bacteriuria treatment?

A

normally does not require treatment;
BUT, due to increased risk for com­ plications, pregnant women with asymptomatic bacteria are treated with either nitrofurantoin
or amoxicillin

Treatment of cystitis and pyelonephritis would be as for
treatment of complicated UTI

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22
Q

FA. pregnancy UTI.
asymptomatic bacteriuria. what to do after treatment?

A

follow-up culture to confirm
resolution

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23
Q

FA. pregnancy UTI. cystitis treatment?

A

as for complicated UTI.
But dont give fluoroquinolones in pregnancy, choose other drug

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24
Q

UW. pyeolonephritis. treatment outpatient?

A

Fluoroquinolones (ciprofloxacin, levofloxacin)

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25
Q

UW. pyeolonephritis. treatment inpatient?

A

iv ab’s

fluoroquinolone, aminoglycoside+/- ampicillin

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26
Q

UW. pyeolonephritis. sampling?

A

obtain prior abs and adjust abs as needed

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27
Q

FA. prophylaxis for UTI. what patients?

A

Recurrent UTls (two or more infections in 6 months or three or more infections
in 1 year);

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28
Q

FA. prophylaxis for UTI.
What are methods? 3

A

behavioral modifications are first line and include i fluid intake (promoting urinary flow so that microbes cannot as easily ascend the urinary tract),

postcoital voiding/stoppage of spermicide use,

and vaginal estrogen in postmenopausal females

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29
Q

FA. what is recurrent UTI. criteria?

A

two or more infections in 6 months
or
three or more infections in 1 year

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30
Q

FA. prophylaxis for UTI.
what if behavioral is not effective?

A

Antibiotic prophylaxis (TMP-SMX or nitrofurantoin) after inter­course, first sign(s) of symptoms;

the physician can prescribe antibiotics at a low dose for 3-6 months or continuously

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31
Q

FA. Bladder pain syndrome (BPS) + UTI mimics.
what is other name for BPS?

A

Interstitial cystitis = bladder pain syndrome

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32
Q

FA. Bladder pain syndrome + UTI mimics.

What symptoms?

A

CHRONIC suprapubic pain/discomfort, dysuria, frequency, dys­pareunia, pelvic pain, relief after voiding that lasts
>6 weeks without an underlying medical cause;

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33
Q

FA. Bladder pain syndrome + UTI mimics.
in what patients?

A

classi­cally in women with psychiatric disease (analogous to fibromyalgia, IBS)

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34
Q

FA. Bladder pain syndrome + UTI mimics. treatment?

A

!!!!First-line treatment: Avoid dietary triggers

Amitriptyline, pain management (phenazopyridine or methenamine), bladder hydrodistention

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35
Q

FA. what is UTI mimics? what diseases? 3

A

Bladder pain syndrome

hemorrhagic cystitis (after cyclophosphamide)

bladder irritation from radiation therapy to pelvis

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36
Q

FA. common UTI bugs. Mneumonic

A

SEEKS PP

Serratia
E.Coli
Enterobacter
Klebs. pneumonia
Staph. saprophyticus
Pseudomonas
Proteus mirabilis

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37
Q

FA. UTI m/os.
Leading cause?

A

E Coli

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38
Q

FA. UTI m/os. leading second cause, esp.in sexually active females?

A

Staph. saprophyticus

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39
Q

FA. UTI m/os. third leading cause?

A

Klebs. pneumonia

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40
Q

FA. UTI m/os. healthcare associated and drug resistant. red pigment

A

Serratia marcescens

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41
Q

FA. UTI m/os. healthcare associated and drug resistant? 2 mo/s

A

Enterococcus
pseudomonas aeruginosa

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42
Q

FA. UTI m/os. produces urease, assoc. with struvite stones

A

Proteus mirabilis

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43
Q

FA. UTI m/os.
diagnostic markers? 2

A

Leukocyte esterase = evidence of WBC activity

Nitrite test - reduction of urinary nitrates by GRAM NEGATIVE m/os.

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44
Q

FA. UTI in what patients more common?

A

in females (shorters urethras colonized by fecal microbiota)

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45
Q

FA. UTI. risk factors?

A

Obstructio (stones, enlarged protate), kidney surgery, catheter, congenital malformations (vesicoureteral reflux), DM, pregnancy

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46
Q

FA. What symptoms absent in uncomplicated UTI/ simple cystitis?

A

systemic such fever

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47
Q

FA. uncomplicated UTI/ simple cystitis triad?

A

frequency, suprapubic pain, dysuria (burning)

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48
Q

FA. uncomplicated UTI/ simple cystitis.
Diagnostics?

A

Clinical diagnosis is sufficient

49
Q

FA. uncomplicated UTI/ simple cystitis. First line abs? 2

A

TMP-SMX (3d) or nitrofurantoin (5-7d)

50
Q

FA. uncomplicated UTI/ simple cystitis. drugs for pain relief? 2

A

Pentosan (relieves cystitis pain)
Phenazopyridine (relieves urinary tract pain)

51
Q

FA. Complicated UTI form - pyelonephritis.
what specific symtoms?

A

systemic (fever, chills, tachy)
CVA tenderness + flank pain

52
Q

FA. Complicated UTI form - pyelonephritis.
Algo.
if suspect it, what further steps?

A

Collect urine +/- blood culture –> then urinalysis

53
Q

FA. Complicated UTI form - pyelonephritis.
Algo.
If Urinalysis normal - unlikely pielonephritis

IF Urinalysis shows WBC –> likely pielonephritis. whats next? 3 groups of patients

A

High complication risk –> Imaging (CT, US) to assess for anatomic causes eg abscess

Hemodinamically stable, can tolerate p/os –> outpatient oral theraphy
ALL OTHER PATIENTS –> iv therapy

54
Q

FA. Complicated UTI form - pyelonephritis.
3 main steps?

A

Cultures - prior ab
Urinalysis - same as in cystitis + WBC CASTS
Imaging (US, CT) - for pts who have high risk of complications

55
Q

FA. Complicated UTI form - pyelonephritis.
what examines imaging?3

A

anatomic causes+abscess formation+emphysematous pyelonephritis

56
Q

FA. Complicated UTI form - pyelonephritis. algo

what if iv treatment fails?

A

do Imaging

57
Q

FA. Complicated UTI form - pyelonephritis.

Complications?3

A

Abscesses
Emphysematous pyelonephritis
Chronic pyelonephritis

58
Q

FA. Complicated UTI form - pyelonephritis.
Abscesses. where forms? 2

A

In the renal parenchyma and/or perirenal fat (perinephric abscess)

59
Q

FA. Complicated UTI form - pyelonephritis.
Abscesses. when do we suspect? symptoms

A

persistent fever + abdominal pain despite ab treatment

60
Q

FA. Complicated UTI form - pyelonephritis.
Abscesses. what to do to evaluate?

A

CT/UG –> diagnose abscess –> drainage (all perinephric, > 5cm renal) + continue abs

61
Q

FA. Complicated UTI form - pyelonephritis.
Emphysematous pyelonephritis. what causes and in what patients?

A

gas producing bacteria.

In DM or immunocompromise

62
Q

UW. Dipstic proteinuria (albumin). trace?

A

15-30 mg/dl

63
Q

UW. Dipstic proteinuria (albumin). +1

A

30-100 mg/dl

64
Q

UW. Dipstic proteinuria (albumin). +2

A

100-300 mg/dl

65
Q

UW. Dipstic proteinuria (albumin). +3

A

300-1000mg/dl

66
Q

UW. Dipstic proteinuria (albumin). +4

A

> 1000 mg/dl

67
Q

FA. Chronic pyelonephritis. causes?

A

recurrent pyelonephritis (in children with vesicouretheral reflux)

Obstruction in adults (stones, BPH, cervical carcinoma)

68
Q

FA. Chronic pyelonephritis. anatomic changes?

A

blunted calyces + corticomedullary scarring of the kidneys (on imaging)

69
Q

FA. Chronic pyelonephritis.

what is imaging characteristic for vesicouretheral reflux?

A

seen upper/lower pole scarring

70
Q

FA. Chronic pyelonephritis.
Pathologic findings?

A

Interstitial fibrosis and thyroidization of kidney (athrophic tubules filled with eosinophilic proteaceous materials)

71
Q

FA. Chronic pyelonephritis.
what is xantogranulomatous pyelonephritis?

A

severe form of chronic pyelonephritis.

72
Q

FA. Chronic pyelonephritis.
xantogranulomatous pyelonephritis. causes?

A

infected kidney stone obstruction

73
Q

FA. Chronic pyelonephritis.
xantogranulomatous pyelonephritis. seen on imaging?

A

infected kidney stone obstruction –> granulomatous inflammation –> multiple, dar round areas on CT (Bear Paw sign)

74
Q

FA. key fact abs.

Nitrofurantoin and fosfomycin only achieve therapeutic concentrations where?

A

bladder + urine

they do not penetrate renal parenchyma, so they should be used only to treat cystitis, NOT PYELONEPHRITIS

75
Q

FA. Complicated UTI form - pyelonephritis. treatment HD stable, peroral. abs?

A

Outpatient

Fluoroquinolones or 3-4th generation cephalosporin or TMP-SMX 7-14d.

76
Q

FA. Complicated UTI form - pyelonephritis. treatment HD unstable, critically ill, urinary obstruction. iv, abs?

A

inpatient

ceftriaxone, ampicillin-sulbaktam, piptaz, fluoroquinolones

guided by culture and sensitivity patterns

77
Q

UW. Bladder pain syndrome = interstitis cystitis.

epidemiology? 3

A

women

1.assoc. with psychiatric disorder

2.pain disorders - fibromyalgia, irritable bowel syndrome)

  1. history of UTI
78
Q

UW. Bladder pain syndrome = interstitis cystitis. clinical presentation?3

A

bladder pain exacerbated with filling, exercise, sexual intercourse, alchohol, prolonged sitting.

Relief with voiding

incr. urinary frequency, urgency

Dyspareunia

aka Lower urinary tract symtoms

79
Q

UW. Bladder pain syndrome = interstitis cystitis.

diagnosis? 2

A

CLINICAL DIAGNOSIS

bladder pain with no other cause >= 6 weeks

normal urinalysis

80
Q

UW. Bladder pain syndrome = interstitis cystitis. treatment? main idea

A

not curative, focus on improving quality of life

81
Q

UW. Bladder pain syndrome = interstitis cystitis. conservative treatment? first line

A

FIRST LINE - behavioral modification, avoidance of triggers, physical therapy

82
Q

UW. Bladder pain syndrome = interstitis cystitis. treatment drugs?

A

amitriptyline (for refractory), pentosan polysulfate sodium

analgetics for acute exacerbations

83
Q

FA. protatitis - form of complicated UTI.

how ascends infection?

A

infection from urethra + reflux of infected urine –> prostate (acute or chronic prostatitis)

84
Q

FA. protatitis - form of complicated UTI.

pathogens - predominant UTI. most common e coli.

85
Q

FA. protatitis - form of complicated UTI.

acute in what patients?

A

young < 40 yo males

high-risk sexual behaviour incr. risk of n. gonorea or c. trachomatis

86
Q

FA. protatitis - form of complicated UTI.

chronic in what patients?

A

older males 40-70 y/o.
may result from acute prostatitis

87
Q

FA. protatitis - form of complicated UTI.

Acute - symptoms?

A

ill appearance

systemic
+ prostatitis symptoms (perineal pain, low back pain, defecation pain
+ irritative urinary symptoms (dysuria)
+ frequency
+ urgency

–> urinary retention.

88
Q

FA. protatitis - form of complicated UTI.

Acute - DRE?

A

exquisitely tender + boggy prostate

Prostate massage should be avoided as ir can cause bacteremia.

its clinical diagnosis, so DRE can be even skipped

89
Q

FA. protatitis - form of complicated UTI.

Chronic - symptoms?

A

patient does not appear ill

less symptomatic, fever usually absent.

Prostatitis symptoms - dull, poorly localized pain in lower back+ perineal+scrotal+ suprapubic

+ recurrent urinary symtoms (dysuria, frequency, urgency, obstructive symptoms, ED +/- bloody semen) with repeated isolation of the same m/o/.

90
Q

FA. protatitis - form of complicated UTI.

DRE in chronic?

A

Enlarged, non-tender

91
Q

FA. protatitis - form of complicated UTI.

How confirmed acute?

A

urinalysis (Sheets of WBC + bacteria)
+
urine culture (e coli).

92
Q

FA. protatitis - form of complicated UTI.
Acute. in what patients obtain blood culture?

A

in very ill or HD unstable

93
Q

FA. protatitis - form of complicated UTI.

Chronic. suggested by what lab?

A

WBC in prostatic secretions

94
Q

FA. protatitis - form of complicated UTI.
Chronic. when positive urine culture?

A

positive - in chronic bacterial prostatitis

negative - in chronic nonbacterial prostatitis.

95
Q

FA. protatitis - form of complicated UTI.
Chronic. what test used to determine location?

A

four glass

96
Q

FA. protatitis - form of complicated UTI.
Chronic. diagn. first glass?

A

initial urine = urethra sample

97
Q

FA. protatitis - form of complicated UTI.
Chronic. diagn. second glass?

A

midstream urine = bladder sample

98
Q

FA. protatitis - form of complicated UTI.
Chronic. diagn. third glass?

A

prostatic massage - prostate sample

99
Q

FA. protatitis - form of complicated UTI.
Chronic. diagn. glass?

A

after prostatic massage - another prostatic sample

100
Q

FA. protatitis - form of complicated UTI.
Chronic. alternatevely can be used 2 glass test - atitinka 4 glass paskutinius du zingsnius, kur meginys is prostatos

101
Q

FA. protatitis - form of complicated UTI.
Acute - treatment 2. severe?

A

hospitalization + iv abs (fluoroquinolones +/- 3th-4th gen. cephalosporins)

102
Q

FA. protatitis - form of complicated UTI.
Acute - treatment. mild?

A

outpatient TMP-SMX or fluoroquinolones (ciprofloxacin or levofloxacin) for 4-6 weeks to achieve therapeutic levels in prostate.

103
Q

FA. protatitis - form of complicated UTI.
Acute - mild. what treatment if men in high-risk sexual activity?

A

consider N gonorrhoe and C trachomatis coverage (ceftriaxone + azitromycin or doxycyline)

104
Q

FA. protatitis - form of complicated UTI.
Chronic prostatitis –> treatment?

A

TMP-SMX or fluoroquinolone (ciprof or levofluoc) for 6-8 weeks –> to achieve therapeutic levels in prostate.
Treatment is difficul, UTI recurrences are common.

105
Q

UW. use fluoroquinolones. what adverse may occur?

A

Tendinopathy.

esp. achilles. also in rotator cuff, biceps, thumb, hand

C/P: pain and/or tenderness 2-6 cm above the posterior calcaneous in achilles tendinopathy.

106
Q

UW. Recurrent UTI table.

Definition? 2

A

> = 2 infections in 6 months

> =3 infections in 1 year

107
Q

UW. Recurrent UTI table. risk factors? 4

A

history of cystitis at =< 15 y/o

spermicide use

new sexual partner

Postmenopausal status

108
Q

UW. Recurrent UTI table. evaluation?2

A

urinalysis
urine culture

109
Q

UW. Recurrent UTI table. prevention?3

A

Behavioral modification

Postcoital or daily ab prophylaxis

Topical vaginal estrogen for postmenopausal patients

110
Q

UW. Recurrent UTI table. what ab is choice to prevent?

111
Q

UW. UTI

After 48 hours of symptomatic improvement, most hospitalized patients (complicated
UTI) can be transitioned to culture-guided oral antimicrobials.

112
Q

UW. Renal abscess.
Risk factors. 5

A

Pyelonephritis, complicated UTI.

Renal calculi

DM

Anatomic abnormality (tumor, PKD)

Pregnancy

113
Q

UW. Renal abscess.
Clinical? 3

1 ryskus yra

A

Fever, chills
Flank/abdominal pain

NO IMPROVEMENT ADTER 48-72h of broad spectrum antibiotics

114
Q

UW. Renal abscess.
diagnosis. 2

A

Renal UG
CT scan of abdomen

115
Q

UW. Renal abscess.
treatment? 2

A

I/v ab
+/- drainage

116
Q

UW acute pyelonepf.

117
Q

UW acute pyelonepf.
Uncomplicated 4 facts:population, mo, abs

A

otherwise healthy, nonpregnant

Ecoli

ORAL FLUOROQUINOLONES (preff), tmp-smx

I/v abs if VOMITING, elderly, septic

118
Q

UW acute pyelonepf.
complicated. 3 facts: patiets, incr risk for what and treatment?

A

DM!!!!, urinary obstruction, renal failure, immunosupression, hospital acquired

incr. risk of abs resistance/treatmetn failure

I/V!!! fluoroquinolones, AMG, extended spectrum beta lactam/cephalosporin

STEP 2 Cardio + Renal (35 decks)

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