Urinary / Renal Flashcards
UTI symptoms.
Increased urinary frequency, dysuria, suprapubic pain, odorous urine, slight hematuria
Pyelonephritis
Signs of UTI, and fever, chills, flank pain, CVA tenderness, N/V
Refer and admit
UTI Labs
Leukocyte esterase and nitrites positive and patient has symptoms
WBC in urine, some RBCs may be present
Casts = kidney involvement
UTI Treatment
Not pregnant:
Nitrofurantoin ER 100 mg bid for 5 days (CrCl must >30 mL/min)
TMP-SMZ DS 1 tab bid for 3 days for women and 7 days for men
Fosfomycin pwd 3 g single dose
Pregnant:
Cephalexin, PCN, Ampicillin, Augmentin
Avoid Nitrofurantoin or TMP-SMZ after 36 weeks
Follow up in 48 hours, if symptoms return after 2-3 weeks then consider treatment for resistant bacteria
Urethritis
Men have mild dysuria and pruritis at penis distal end, discharge, usually gonorrhea
Women have vaginal discharge, bleeding, pyuria
For men, check prostrate and for women do pelvic exam
Recurrent v. Relapse v. Reinfection UTI
Recurrent = 3 times in one year, or twice in 6 months Relapse = infection not eradicated by first treatment Reinfection = Recurrence due to new bacteria growth
Complicated UTI
Males
Pyuria (6-10 neutrophils) with positive blood or urine culture
Structural or functional abnormality of the urinary tract
Diabetes
Immuno-compromised
Pregnant
Asymptomatic Bacteruremia
Colony count 100,000 and no symptoms
Do not treat unless patient is pregnant or symptomatic, post-menopause women may need estrogen cream
Hematuria Tips
Consider:
Blood at start of stream = urethral dysfunction
Blood at end of steam = cancer
Blood cycling or mixes = endometriosis, cancer
New onset of Nocturia
Diabets polyuria bladder irritation stimulant use incomplete emptying prostate
Outpatient treatment for pyelonephritis
Fluids
Antiemetics
Acetameinophen
Ceftiaxone 500-1000mg once IM
Cipro PO or Levofloxacin PO oi TMP-SMZ PO
Return in 48 hours and repeat urine culture
Urethritis Treament
Presumed STI - rarely is cause of irritants or estrogen deficiency Treat combo (gonorrhea and chlymdia) Ceftriaxone 250mg once and Azithromycin 1 gram once
Urinary Calculi
Mineral desposits from microscopic crystals in loop of henle
Risks - obesity, poor diet, low socioeconomic, history
Types of Calculi
Calcium Oxalate (75+%) - radiopaque Calcium Phosphate (5%) - radiopaque Struvite (5-15%) - Radiopacity Uric Acid (5-10%) - radiolucent Cystine (1%) - radiopacity
Uric acid stones more common id diabetic, gout, metabolic syndrome
Kidney stone symptoms
Renal or uretral colic pain often raidates to opposite side abdomen or groin N/V Hematuria, dysuria Fever, shills, vague abd complaints
Usually sudden onset, flank or lower abd pain
KUB imaging or CT scan
