UTIs & Nephro Flashcards
3 cardinal symptoms of a UTI
Dysuria
Frequency (not POLYuria, more times not more amount)
Urgency
Red flags leading you to believe it’s not just a UTI? (ddx)
Gross/painless hematuria (cancer)
Discharge (STI) - males w/ urethritis may have discharge
Colicky/radiating flank pain (kidney stones)
5 bacteria commonly causing UTIs + bacterial classifications
E coli (80%; gram neg bacilli, enterobacteriaceae) Staph saprophyticus (2nd most common in sexually active women; graph + cocci, coagulase negative) Klebsiella pneumonia (GN baccili, enterobacteriaceae) Proteus mirabilis (GN baccili, enterobacteriaceae) Enterococci (GP cocci)
Name 5 things that can cause bladder stasis, increasing risk of UTI
1) Benign prostatic hyperplasia
2) Vesicoureteral reflux
3) Urinary bladder diverticulum
4) Neurogenic bladder (flaccid or spastic)
5) Urinary tract calculi
Delineate upper vs lower UTI
Upper = ureters or pyelonephritis Lower = cystitis (most common), urethritis, prostatitis
WHat makes a UTI “complicated”?
Pt is…
- male
- immunocompromised
- pregnant or postmenopausal female
- child
- predisposing factors (DM, medical devises, Hx, resistance)
Nocosomial UTIs are commonly caused by ____ and must appear ___ after admission
Indwelling catheters
>48 hours post-admission
Recurrent UTI is defined as..
3+ per year or 2+ in 6 months
what additional symptoms are typical of an upper UTI?
Fever
Flank pain
Nausea/vomiting
Fatigue/malaise
Best initial test for UTI = ?
What are you looking for?
Urinalysis: Pyuria, leukocyte esterase Bacteriuria, nitrites (E coli convert nitrates), urease Leukocyte casts (upper UTI) Hematuria, proteinuria
Name 4 types of imaging for UTIs. Are they always indicated?
Generally not indicated unless persistent Sx on ABs, recurrences, suspected obstruction, severe illness
1) CT scan (first line)
2) U/S (esp young children); can determine PVRV
3) Voiding cystourethrogram (VCUG): radioactive dye into bladder via catheter –> serial x-rays during voiding (reflux, strictures)
4) IV pyelogram (dye into arm vein –> X-rays of urinary tract, highlights obstructions)
Define interstitial cystitis. AKA? Diagnosis?
AKA painful bladder syndrome
chronic non-infectious cystitis of unknown etiology, more common in women
- diagnosis of exclusion but inflamm patches can be present
When should you treat asymptomatic bacteriuria
Pregnanct women
Pt undergoing endourological procedures w/ possible mucosal trauma
Renal transplant recipients
What is phenazopyridine (pyridium) and how is it used in UTIs?
Urinary analgesic, can be used for up to 3 days (warning: symptom-masking)
Do you need a post-treatment culture for UTI?
No, not if Sx resolve
Antibiotic treatment for uncomplicated lower UTI (1st/2nd line)
First line: Nitrofurantoin (5 days) OR TMP-SMX (3 days), fosfomycin (single dose)
2nd line: aminopenicillin + B-lactamase inhib, oral cephalosporines
Antibiotic treatment for complicated lower UTI
In men must penetrate prostate tissue (e.g. fluoroquinolones or TMP-SMX, not fosfomycin/nitrofurantoin)
Fluoroquinolones PO or IV (ciprofloxacin, levofloxacin)
Beta-lactams: 2nd or 3rd gen cephalosporins (e.g. ceftriaxone); ampicillin/sulbactam
TMP-SMX & nitrofurantoin are both what class of AB?
Anti-metabolites
___ should be considered for recurrent UTIs in postmenopausal women
Topical estrogen
If very recurrent UTIs can try…
chemoprophylaxis
Should pregnant women be screened for UTI?
Yes, in the first trimester!
Always treat even if asymptomatic (pyelo risk)
Most UTIs in children <1yr are…
Pyelonephritis!
Infant w/ bacteriuria + fever with no explanation =
Voiding symptoms + no fever + bacteriuria =
Pyelonephritis
Cystitis (common in girls >2yo)
Hydronephrosis =
dilation of ureter/kidney due to distal obstruction of urine outflow
In a male patient w/ recurrent acute urinary Sx, consider…
possible chronic bacterial prostatitis, consider urology consult
How does calcitriol affect Ca/Phosphate balance in bone, GI, kidney, blood
Active vitamin D Bone --> enhance mineralization if sufficient Ca, enhance resorption if low Ca GI --> more Ca & PO4 absorption Renal --> more Ca & PO4 resabsorption Blood: increase serum Ca & PO4
How does PTH affect Ca/Phosphate balance in bone, kidney, blood
Bone –> reabsorption
Kidney –> Ca absorption, PO4 excretion
Blood —> increase Ca, decrease PO4
3 forms of vit D from food version to active version + sites of activation
Cholecalciferol –> liver –> calcidiol –> kidney –> calcitriol
At the early stages of CKD there is no hyperphosphatemia. Why?
Because PTH secretion increases renal excretion (but once you reach GFR stage 4-5, kidneys can’t keep up with excretion)
How does calcitonin affect Ca/Phosphate balance in bone, GI, kidney, blood
Bone –> reduced resorption
GI –> reduced Ca absorption
Renal –> reduced Ca & PO4 reabsorption (excretion)
Blood –> reduced Ca & PO4
Indications for renal replacement therapy
AEIOU + G Metabolic Acidosis <7.1 Electrolytes: refractory hyperkalemia/hypercalcemia Toxic ingestion/poisoning Fluid overload Uremia GFR <10 or <15 + diabetes
GFR staging in CKD
G1 = 90+ G2 = 60-89 G3 = 30-59 G4 = 15-29 G5 <15 (kidney failure)
Albuminuria categories CKD
A1 < 3 (ACR, mg/mmol) (normal)
A2 = 3-29 (microalbuminuria)
A3 = 30+ (macroalbuminuria)
Why might CKD cause anemia?
EPO synthesized in kidneys
Main electrolyte changes in CKD?
High K
Low Ca
High PO4
Blood sugars in CKD?
Hypoglycemia can occur due to significantly decreased insulin clearance
____ are the most common types of incontinence in female patients
___ in male patients
Stress/mixed in female
Urge in male
5 neurological causes of incontinence
MS Spinal injury Normal-pressure hydrocephalus Dementia Delirium
Complications of incontinence
Depression/psychosocial distress
Dermatitis, skin infections, sores
UTIs
Antibiotics for UTI during pregnancy
Cephalexin (1st gen PO cephalosporin)
Nitrofurantoin (avoid during T1/term)
TMP/SMX (avoid during T1/term)
