Uro/Endo week: core conditions (UTI, acute kidney injury, CKD, prostate disorders) Flashcards
Define acute kidney injury
Abrupt sustained rise in serum urea and creatinine (1.5x)
Usually (not always) reversible or self-limiting
Causes of pre-renal AKI
Prolonged hypovolemia leading to fall in GFR
- V n D
- burns
- sepsis
- heart failure
- liver cirrhosis
- drugs that impair renal autoregulation (ACE inhibitors, NSAIDs)
Causes of renal AKI
- Intrinsic renal disease
- Drugs (nephrotic eg aminoglycoside a/b - gentamycin, IV contrast, ACE i, NSAIDs, diuretics)
Causes of post-renal AKI
-urinary tract obstruction (both tracts)
- Liminal - stones, clots
- Mural - malignancy, bph, stricture
- Extrinsic compression = malignancy around pelvis
Symptoms of AKI
- Fatigue
- Nausea
- Confusion
- Dehydration
- Reduced urine output
2 definitions of chronic kidney disease
- Impaired renal function for >3 months due to abnormal kidney structure/damage
- eGFR <60 for 3 months with or without kidney disease/damage
Evidence of impaired renal function
- proteinuria
- haematuria
- anatomical abnormality
Pathology of CKD
Fibrosis of remaining tubules, glomeruli, small blood vessels.
Leads to progressive renal scarring, loss of renal function
Causes of CKD
- Hypertension/ atherosclerotic reno-vascular disease
- Diabetes
- Intrinsic renal disease
- Schistosomiasis (due to ureterovesical stricture causing urinary tract obstruction)
Most common overall cause of UTI
E Coli
UTI bacteria that promotes kidney stone growth
Proteus mirabilis
Most common cause of UTI in young sexually active females
Staph saprophyticus
Most common bacterial cause of haematogenous pyelonephritis
Staph aureus
Predisposing factors that cause UTI
- urine flow obstruction (calculi/ urethral stricture)
- vesico-ureteral reflux (congenital abnormality, bladder overdistension)
- female
- sex
- diabetes
- elderly, immunocompromised
Symptoms of urethritis
Burning with urination
Symptoms of cystitis
- Pelvic pressure
- Urge incontinence
- Lower abdomen discomfort
- Frequent urination
- Painful urination (dysuria)
- Blood in urine
Symptoms of acute pyelonephritis
- Upper back and side (flank) pain
- High fever
- Shaking and chills
- Nausea
- Vomiting
Who should be treated for cystitis?
For how long?
- all symptomatic patients (duration differs)
- asymptomatic pregnant women (1-2 weeks)
- children (1-2 weeks)
- non pregnant women (3 days)
Who should not be treated for asymptomatic cystitis
Elderly
Antibiotics for UTI
Which must be cautioned in pregnancy
- trimethoprim
- nitrofurantoin
- ciprofloxacin
- amoxicillin
- cefuroxime
- gentamycin
Cautioned in pregnancy
- ciprofloxacin (avoid in all trimester)
- trimethoprim (avoid 1st trim)
- nitrofurantoin (avoid 3rd trim)
Which components of urine dipstick test, when positive, point to UTI
Which is more sensitive?
- nitrite (more sensitive)
- leukocyte esterase
What in a midstream urine sample indicates a UTI
Positive nitrites and leucocyte esterase
