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ICM -- Nephrology > Urinary Tract -- Krathwohl > Flashcards

Urinary Tract -- Krathwohl Flashcards

1
Q

A complicated UTI is…

A

at risk of failing treatment or of severe disease for some reason

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2
Q

Common reasons for a complicated UTI

A

Diabetes, Pregnancy, Structural Abnormalities, Indwelling Catheters, UT Obstruction, Immunosuppression, Drug Resistant Organisms

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3
Q

Which men get UTIs?

A

Children
Elderly w/ anatomical abormalities
Uncircumcised, catheters

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4
Q

Pyelonephritis symptoms

A

Fever over 38, Chills, Flank Pain, CVA tenderness, Nausea

Dysuria, Frequency, Urgency, Hematuria

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5
Q

Most E Coli are still sensitive to…

A

Augmentin, Cephalexin, Fosfomycin

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6
Q

Important components of UTI

A

Classic symptoms in young woman is usually sufficient

Urinalysis – Pyuria (over 5 WBC), Pos Leukocyte Esterase, Nitrate Test

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7
Q

Role of urine culture in diagnosis of UTI

A

Helps determine causative organism, but doesn’t prove infection. Could be an asymptomatic bacteriuria

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8
Q

What do you need to see in Urine Culture to decide anything

A

24 hours
Usually requires 10^5 CFU
Any E Coli is significant

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9
Q

How does vaginitis present differently from UTI

A

Usually no change in frequency or urgency

Think Candida, trichamonas

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10
Q

How does urethritis present differently from UTI

A

No bacteria

Think GC, Chlamydia, and HSV

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11
Q

First line agents for Cystitis

A

Nitrofurantoin

Trimethoprim-sulfamethoxazole (Bactrim)

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12
Q

Treatment meds for Pyelonephritis

A

Mild – Oral Cipro, Levofloxacin

Severe – Cefriaxone, Piperacillin-tazobactam, meropenem

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13
Q

How long do you treat cystitis? pyelonephritis?

A

Cystitis – 3-5 days

Pyelonephritis – 10-14 days

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14
Q

In a complicated UTI patient that isn’t responding, you should…

A

CT for stones, obsruction, infarction, abscess

US as a backup

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15
Q

Important details on renal and perinephric abscess

A

Usually arises from extension or pyelonephritis, but can come from steph in bacteremia. Perinephric abscess occupies the space btw the renal capsule and Gerota’s fascia.

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16
Q

How to treat renal abscess

A

Usually needs percutaneous drainage
Call urology if any stone is present
Broad spectrum ABs until cultures

17
Q

Calcium oxalate crystals look like…

A

Envelope or Dumbbell

18
Q

Uric Acid crystals ususally look like..

A

Pleomorphic

19
Q

Cystine stones usually look like…

A

Hexagonal Shape

20
Q

Magnesium ammonium phosphate stones (struvite) usually look like…

A

Coffin Lids

21
Q

Imaging best for kidney stones

A

Non-contrast CT is best

US is acceptable, but less sensitive

22
Q

Therapy for kidney stones

A

Usually just pain meds and hydration
Consult if appears septic, anuria, ARF
Alpha blockers (tamsulosin)

23
Q

Significant sizes of stone

A

Stones under 5 mm usually pass spontaneously

Stones over 1cm usually won’t pass

24
Q

Biochemical risks for kidney stone occurance

A

Hypercalciuria
Hyperoxaluria
Hypocitraturia
High Urine pH

25
Q

Two diseases most associated with stone formation

A

Primary hyperparathyroidism

Infections with Proteus (urea splitting organims)

26
Q

For patients with high urine calcium, treat with

A

Hydrochlorothiazide

Low Protein Diet

27
Q

In hypocituria you can raise urinary citrate by

A

Alkalinizing the plasma with K Citrate or K Bicarb

28
Q

Treatment for hyperoxaluria

A

Calcium Carbonate

Binds Oxalate in the intestine in the intestine to prevent urinary excretion

29
Q

Risk factors for RCC

A

Men, 60-80 yo

Smoking, Heavy Aspirin Use, Hep C

30
Q

Classic Symptoms of RCC

A

Flank Pain, Hematuria, Palpable Abdominal Mass

Usually discovered incidently on CT

31
Q

Less classic RCC symptoms

A

Clots in the bloody urine
Scrotal Varicoceles
IVC invovlement lowers extremity edema

32
Q

Paraneoplastic symptoms associated with RCC

A

Anemia, FUO, Hypercalcemia

Cachexia, Erythrocytosis, Amyloidosis.

33
Q

Diagnosis of RCC is typically made via

A

CT scan
Watch out for cysts – can hide cancer
Usually OK if cyst is round with sharp borders + no echoes

34
Q

How to treat RCC

A

Surgery is localized

No established for advanced, but consider IL2, IFNa, and antiangiogenic therapy

ICM -- Nephrology (9 decks)

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