RENAL-UTI Flashcards
Complicated UTI
Children Elderly Fever Flank Pain Men Prenancy Comorbidities-DM, IMC REcurrent Indwelling cathter Recent ABX SX more than 7D
What is the most common route and org of UTI (Cysitis)?
E.coli from:Travel to urethral, colonize in vaginal introitus.
Stimulate host response
Improper wiping
Sex inc, new partnerns
Spermicide change vaginal flora
Protectin- uterovesical close, urine pH high
Male- long urehtra, prostate secretions
Pt at ED for kidney stones, d/t neuogenic atonic bladder with a catheter. What is she at risk for?
UTI
Other factors:
Sexual active, BPH, Reflux (kids-bladder to kidney), DM
Fluid sits around grows
PT 28 y/o non pregnant. LMP 4/1/19, Acute c/o burning urinatin, frequency, urgencey. PE-tender supropubic pain, hematuria, Temp 100.1.
Uncomplicated UTI
PT 78 y/o F non pregnant. c/o frequency, urgency. PE-tender supropubic pain, incontinence. Temp 98.9
Post menopause
Geriatric
complicated UTI
PT 28 y/o gradual onset non pregnant. LMP 4/1/19, c/o burning urination, no frequency, urgency. PE-tender suprapubic pain, hematuria, Temp 100.1.
R/o STI
D/c, ordo, pruritis, dysparurena
New partner
Chlamydia
PT 28 y/o non pregnant. LMP 4/1/19, c/o burning urination, no frequency, urgency. LAB- pyuria, hematuria, nitries. WBC cast
UTI Urinalys
Not always indicated
Pt dilute specimne
Pyridium-color change
A Pt has a recurrent complicated, irregular symptoms of UTI not improving with TX? What is next
Urine culture
>100K indentifies org
50K ecoli, 50K Staph-NO, contamin
+Culutre via Lab to TX
PT 28 y/o non pregnant. LMP 4/1/19, Acute c/o burning urination, frequency, urgency. PE-tender suprapubic pain, hematuria, Temp 100.1. What is initail step and tx?
UA- check nitrites
UPT
Urine GC/Chlamydia if noted
TX-empircally Nitrofuranoin SMP-TMX Pyridium- 200x3d dysuria (don't' mask pain) Hydation
F/u offer STI, Pt education
PT 78 y/o F non pregnant. c/o frequency, urgency. PE-tender supropubic pain, incontinence. Temp 98.9. What step are next and tX
Complicate
UA and micro
Urine GC/Chlam
TX-
FQ (NON PREGNANT)or
Ceftriaxone (preg ok) (inpatine IM or IV)
7-10dys
If no better
UA culture
Imaging
F/U 2d-improvement
Recurrent Risk FActors
RElapse, Reinfection Genentic Sex Diaphragm use Urinary incont cystocele Residual vol. Vagin atrophy Early UTI in child Preventio Probiotics, tx other iss
Prophalysis
antimicrobial prophalxix
>2 w/in 6m
>3 w/in 12m
Macrobid-Nitro*
Small does daily or Post sex
With probiotics
Post meno- vaginal estrogen cream
ADR- GI disturbance or candidiasis
A M PT has had 7 UTI in one year the keep reoccuring? WHat is next?
Urology Referral
Structure
Persisten hematuria
Males
IF complicated, reucrrent what do you labs and what TX?
*Urine culture
Vag swab
Tx empiracally with another ABX until culutre comes back. Sulfa or FQ
Pt c/o gradual discomfort, dysurain, freq help discomfort, urg, bladder pain. Feel better after mictriction, nocutrua, No fever, no flank, no d/c, no n/v. 2-4/yr. Labs NEG- UA hematuria, -C&SUS, CT
PE-Normal, mild vag tender and bladde
Interstitial cystisis
Bladder Pain Syndrome
3-6% W
40s
Assoc w/ IBS, Vulvodynia, fibro. Anxiety, depr, sex dys. LBP. Took awhile to fig. out was not infections
Cause- Mast cell, Abnormal Permeability k+ l/t MSK activation
LIkely no one did UA prior.
DX- no critieria. PHM, no etiology, UA, C&S in all
Hematura- urine cytology (not needed, HUNNER LESIONS, mast cells)
TX- supportive and Psycho. Tx comorbidities. Symptom manage- avoid irritant caffeine. PT pelvic floor. Analgesics
2nd- amitriptyline, heparinaoid, Anihistamines
