UTI Flashcards
Lower UTI cause
cystitis, dysuria, frequency syndrome,
upper UTI cause
pyelonephritis, Renal abcess etc
S and S of lower UTI
DYSURIA is the key symptom frequency nocturia urercy HEMATURIA OCCURS IN 40-60%
s and s labs
UA- pyuria >10wbc
nitrate on dipstic is specific but not sensitive (shows when they dont have it less than when they do)
esterace detection by dipstic is sensative but not specific (if have it, most likely they have UTI
management of lower UTI
3 day therapy
bactrim, cipro, or augmentin
during pregnanacy- amoxil, macrobid, keflex for 7 to 10 days
upper UTI sx
FLANK PAIN
FEVER AND CHILLS
N/V
mental stauts change in the elderly
Upper UTI - ESR
seen with pyelonephritis,
Management of upper UTI
14 day vs 6 week course
bactrim, cipro, augmentin or aminoglycosides, (gentor torbra)
pts with puelonephritis with N and V should be hospatilized
Renal insufficiency
decrease in renal funciton resulting in a decrease in GFR and reduction in clearence of slutes, GFR goes down with age
Causes of Renal Insufficiency
hypertensive nephrosclerosis
glomerulonephritisdiabetic neuropathy
inerstitial nephritis
polycystic kidney disease
Renal insufficiency symptoms
asymptomatic till late
systemic changes are not evided untill overall renal function is less than 20 to 25% of normal
acute kidney injury
BUN 7 to 20 mg/dL (2.5 to 7.1 mmol/L) is increased out of proportion to serum creat 0.84 to 1.21 milligrams per deciliter
caused by obstruction or acute tubular necrosis
reversible with proper therapy
chronic kidney injury
steady increase in BUN and creat ration 10:1 (normal is 10:1)
can slow prgress but damage is irreversable
stages of renal failure
diminishde renal reserve: 50% ephro loss creat doubles
renal insufficiency: 75% nephron loss mild azotemia present
ESRD: 90% nephron damage, azotemai and metabolic alterations
critera for dialysis
Acidosis or azotemia Electrolytes Intoxication Oliguria Uremia-urine in the blood
acute kidney injury management
find the cause and intervene to prevent permanent damage
chronic kidney damage management
diiuretics to reduce volume monitor and treat metabolic acidosis monitor electrolytes- hypercalcemia aceI to reduce renal vasoconstriction treat anemia- treat azotemia with HD
Acute renal failure pre-renal causes
outside kidney
caused by conditions that impair perfusion
(shock, hypovolemia, dehydratioon)
BY definition acute renal failure is only pre-renal if it is reversed by fixing the hypoperfusion,
NO DAMAGE TO RENAL TUBULES
Intrarenal (intrinsic or in the kidney)
diseases that effect the renal cortex, or medula such as hyersensitivity drug reactions, renal embolism or thrombus, most common cause is nephrotoxic drugs, mismatched blood transfusion.
results in nephron damage acute tubular necrosis
post renal below kidney
urine flow obstruction
mechanical: tumor bph or stones
functional - neurogenic bladder or diabetic neuropathy
pre-renal labs
serum BUN to Creat Ratio: over 10:1 Urine sodium: less than 20mmol.dl Specific Gravity: over 1.015 sediment: normal or few casts Fractional excretion of sodium: less than 1
expand intravascular volume consider dopamine
intra renal labs
serum BUN to Creat Ratio: 10:1 Urine sodium: over 40mmol/dl Specific Gravity: less than 1.015 sediment: granular white casts Fractional excretion of sodium: over 3
stop nephrotoxic drugs, RRT
post renal labs
serum BUN to Creat Ratio: 10:1 Urine sodium: usually over 40mmol/dl Specific Gravity: less than 1.015 sediment: normal Fractional excretion of sodium: usually over 3
remove obstruction, CT renal ultrasound
Renal calculi types
calcium 80%- frequently familial, more common in men, over 30 years of age
uric acid: more common in men, associated with gout
struvite- mainly in women, result for UTI’s knwn as mag ammonium phosphate stones, can fill the renal pelvicce and calyces
cystine stones-only amino acid tht becomes insouble in urine - tough to manage
kidney stone S and S
usually pain and bleeding
acute colic like flank pain usually seen with increasing intensity
radiation of pain down to the groin indicates that the stone has passed the lower third of the uriter
stone in the ureter witin the bladder causes frequency urgency and dysuria
kidney stone labs,
crystas in urine,
ct should be performed
ab x-ray my be diagnostic as most stones are radiopaque
Kidney stone management
morpehne, toradol and reglan,
obstructing outflow, or infection removal is indicated
larger fragments can be dc’d by cystoscopy
BPH definition
progressive, condition characterized by enlargment of the prostate gland, in me greater than 50
BPH urinary flow
starting and stopping
PSA values- over 4ng/ml, abnormal age specific ranges,
almost 40% of patients with prostate ca have a normal psa
40-49 less than 2.5
50-9 less than 3.5
60 to 69 less than 4.5
70 to 79 less than 6.5
BPH and alpha blockers
terazocin (hytrin) prazocin (minipress), tamsulsin (flomax) to relax bladder muscles.
alpha reductase inhibitors- finasteride (proscar) avodart to shrink the prostate
surgery if symptoms persit (turp)
BPH avoid
benedryl, sudafed afrin and SSRI’s diuretics and narcotic pain relivers
cockroft-gault equation:
creatine clearance ml/min
140 minus years in age x body weight in KG
divided by
72x serum creat in mg/dl
in females multiply the result by .85
normal creatinine clearence in adults Gero
males les than 40 107-139 ml/min or 1.8-2.3 ml per sec
females less than 40 87-107 ml/min or 1.5 to 1.8 ml per sec
