urological problems and the kidney Flashcards
what is nephrolithiasis ?
formation or the disease of stones in the kidneys
what are the risk factors for developing urinary stones ?
male
white
obese
diabetic
what are the conditions associated with urinary stone disease ?
primary hypertension
sarcoidosis
CF
what is the nature of the pain associated with urinary stones ?
acute colicky flank pain radiating to the groin
what are the required workup for urinary stones ?
rule out medication induced stones
CT can be used
MRI if the patient is pregnant
urine culture to identify the type of stone
what are the different types of urine stones/crystals ?
calcium oxalate calcium phosphate uric acid struvite cystine
what are the associated conditions with calcium oxalate crystals ?
hypercalciuria
what are the associated conditions with calcium phosphate crystals ?
distal renal tubular acidosis
what are the associated conditions with uric acid crystals?
hyperurecemia
gout
DM
obesity
what are the associated conditions with struvite crystals ?
alkaline crystals due to chronic urinary tract infection
what are the associated conditions with cystine crystals ?
cystinuria
what is the most important intervention when it comes to treatment of renal stones ?
markedly increase fluid intake
what can be given in cases of hypercalciuria ?
thiazide diuretics
what can be given in cases of hyperuricosuria ?
allopurinol or potassium citrate
what can be given for hypocitraturia ?
potassium citrate
what size of stones should pass spontaneously ?
less than 4 mm
when is urological intervention required ?
evidence of :
- infection
- acute kidney injury
- intractable nausea or pain
- stones that fail to pass
what are the urological intervention options ?
shock wave lithotripsy
percutaneous nephrolithotomy
rigid and flexible ureteroscopy
which urological intervention can be used for proximal ureteric stones ?
shock wave lithotripsy
when is percutaneous nephrolithotomy indicated ?
anatomic abnormalities such as horse shoe kidney
what is the treatment of choice for middle and distal ureteric stones ?
rigid and flexible uterescopy
what are the classifications of UTIs in adults ?
asymptomatic bacteriuria acute uncomplicated cystitis in females recurrent cystitis in females acute uncomplicated pyelonephritis in females complicated UTI
what is asymptomatic bacteriuria ?
presence of uropathogens without any evidence of systemic infection
which group of people are at a much higher risk at acquiring acute uncomplicated cystitis ?
sexually active women mostly between the ages of 15-45 y/o
what is the most common causative organism of uncomplicated UTI ?
e.coli
staph aureus
who is at risk of a complicated UTI ?
- post menopausal women
- males
- patients with structural or functional abnormalities of the urinary tract
- catheters in situ
- patients with comorbidities ( DM)
what may asymptomatic bacteriuria in young children indicate ?
underlying vesicoureteral reflux
what is the clinical picture of uncomplicated cystitis in females ?
acute onset of dysuria
frequency
suprapubic pain or new urine incontinence
what are the differential diagnosis of uncomplicated cystitis in females ?
vaginitis
urethritis
what are the investigations for uncomplicated cystitis ?
urine analysis :
heamturia common inn UTI but not vaginitis/urethritis
bacteruria required for a definitive diagnosis
urine cultures are not indicated
in a case of suspected uncomplicated cystitis if the urine analysis showed negative for pyuria what would that suggest ?
strongly suggests an alternative diagnosis
what must be considered if there is a recurrence of attacks within 1 to 2 weeks in recurrent acute cystitis?
consider infection with ab-resistant antibiotic
obtain urine culture
treat according to culture
if there is recurrence within 2 weeks to 6 months of initial infection what is the next best step in management ?
use a different antibiotic
if recurrence occurs after 6 months of the initial infection what is the next best thing to do ?
use the same antibiotic
what is the clinical presentation of pyelonephritis ?
fever chills
costophrenic angle pain
nausea and vomiting
pyuria is almost always present
what investigations should be done in cases of pyelonephritis ?
urine cultures
what is the most important factor in the development of catheter associated bacteriuria ?
the duration of the catheterization
what are the complications of long term catheterization ?
bacteremia
antibiotic resistance flora
cystitis/pyelonephritis
catheter obstruction
what is the clinical picture of catheter associated bacteriuria ?
asymptomatic
when do we give antibiotics in UTI ?
only in symptomatic cases to avoid antibiotic resistant bacteria
what can we do to reduce the incidence of symptomatic UTI in patients with spinal cord injury ?
hydrophilic-coated catheter
what is the pathogenesis of prostatitis ?
reflux of infected urine from the urethra into the prostatic duct
what is the treatment fro prostatitis ?
fluoroquinolone
what should the broad spectrum ab given in UTI cover ?
staph aureus
what is emphysematous pyelonephritis ?
fulimant
necrotizing
life threatening form of acute pyelonephritis
how should the efficacy of treatment be evaluated ?
urine culture
