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Preclerkship > UTIs & Nephro > Flashcards

UTIs & Nephro Flashcards

1
Q

3 cardinal symptoms of a UTI

A

Dysuria
Frequency (not POLYuria, more times not more amount)
Urgency

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2
Q

Red flags leading you to believe it’s not just a UTI? (ddx)

A

Gross/painless hematuria (cancer)
Discharge (STI) - males w/ urethritis may have discharge
Colicky/radiating flank pain (kidney stones)

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3
Q

5 bacteria commonly causing UTIs + bacterial classifications

A 
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)
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4
Q

Name 5 things that can cause bladder stasis, increasing risk of UTI

A

1) Benign prostatic hyperplasia
2) Vesicoureteral reflux
3) Urinary bladder diverticulum
4) Neurogenic bladder (flaccid or spastic)
5) Urinary tract calculi

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5
Q

Delineate upper vs lower UTI

A 
Upper = ureters or pyelonephritis
Lower = cystitis (most common), urethritis, prostatitis
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6
Q

WHat makes a UTI “complicated”?

A

Pt is…

  • male
  • immunocompromised
  • pregnant or postmenopausal female
  • child
  • predisposing factors (DM, medical devises, Hx, resistance)
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7
Q

Nocosomial UTIs are commonly caused by ____ and must appear ___ after admission

A

Indwelling catheters

>48 hours post-admission

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8
Q

Recurrent UTI is defined as..

A

3+ per year or 2+ in 6 months

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9
Q

what additional symptoms are typical of an upper UTI?

A

Fever
Flank pain
Nausea/vomiting
Fatigue/malaise

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10
Q

Best initial test for UTI = ?

What are you looking for?

A 
Urinalysis:
Pyuria, leukocyte esterase
Bacteriuria, nitrites (E coli convert nitrates), urease
Leukocyte casts (upper UTI)
Hematuria, proteinuria
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11
Q

Name 4 types of imaging for UTIs. Are they always indicated?

A

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)

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12
Q

Define interstitial cystitis. AKA? Diagnosis?

A

AKA painful bladder syndrome
chronic non-infectious cystitis of unknown etiology, more common in women
- diagnosis of exclusion but inflamm patches can be present

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13
Q

When should you treat asymptomatic bacteriuria

A

Pregnanct women
Pt undergoing endourological procedures w/ possible mucosal trauma
Renal transplant recipients

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14
Q

What is phenazopyridine (pyridium) and how is it used in UTIs?

A

Urinary analgesic, can be used for up to 3 days (warning: symptom-masking)

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15
Q

Do you need a post-treatment culture for UTI?

A

No, not if Sx resolve

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16
Q

Antibiotic treatment for uncomplicated lower UTI (1st/2nd line)

A

First line: Nitrofurantoin (5 days) OR TMP-SMX (3 days), fosfomycin (single dose)
2nd line: aminopenicillin + B-lactamase inhib, oral cephalosporines

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17
Q

Antibiotic treatment for complicated lower UTI

A

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

18
Q

TMP-SMX & nitrofurantoin are both what class of AB?

A

Anti-metabolites

19
Q

___ should be considered for recurrent UTIs in postmenopausal women

A

Topical estrogen

20
Q

If very recurrent UTIs can try…

A

chemoprophylaxis

21
Q

Should pregnant women be screened for UTI?

A

Yes, in the first trimester!

Always treat even if asymptomatic (pyelo risk)

22
Q

Most UTIs in children <1yr are…

A

Pyelonephritis!

23
Q

Infant w/ bacteriuria + fever with no explanation =

Voiding symptoms + no fever + bacteriuria =

A

Pyelonephritis

Cystitis (common in girls >2yo)

24
Q

Hydronephrosis =

A

dilation of ureter/kidney due to distal obstruction of urine outflow

25
Q

In a male patient w/ recurrent acute urinary Sx, consider…

A

possible chronic bacterial prostatitis, consider urology consult

26
Q

How does calcitriol affect Ca/Phosphate balance in bone, GI, kidney, blood

A 
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
27
Q

How does PTH affect Ca/Phosphate balance in bone, kidney, blood

A

Bone –> reabsorption
Kidney –> Ca absorption, PO4 excretion
Blood —> increase Ca, decrease PO4

28
Q

3 forms of vit D from food version to active version + sites of activation

A

Cholecalciferol –> liver –> calcidiol –> kidney –> calcitriol

29
Q

At the early stages of CKD there is no hyperphosphatemia. Why?

A

Because PTH secretion increases renal excretion (but once you reach GFR stage 4-5, kidneys can’t keep up with excretion)

30
Q

How does calcitonin affect Ca/Phosphate balance in bone, GI, kidney, blood

A

Bone –> reduced resorption
GI –> reduced Ca absorption
Renal –> reduced Ca & PO4 reabsorption (excretion)
Blood –> reduced Ca & PO4

31
Q

Indications for renal replacement therapy

A 
AEIOU + G
Metabolic Acidosis <7.1
Electrolytes: refractory hyperkalemia/hypercalcemia
Toxic ingestion/poisoning
Fluid overload
Uremia 
GFR <10 or <15 + diabetes
32
Q

GFR staging in CKD

A 
G1 = 90+
G2 = 60-89
G3 = 30-59
G4 = 15-29
G5 <15 (kidney failure)
33
Q

Albuminuria categories CKD

A

A1 < 3 (ACR, mg/mmol) (normal)
A2 = 3-29 (microalbuminuria)
A3 = 30+ (macroalbuminuria)

34
Q

Why might CKD cause anemia?

A

EPO synthesized in kidneys

35
Q

Main electrolyte changes in CKD?

A

High K
Low Ca
High PO4

36
Q

Blood sugars in CKD?

A

Hypoglycemia can occur due to significantly decreased insulin clearance

37
Q

____ are the most common types of incontinence in female patients
___ in male patients

A

Stress/mixed in female

Urge in male

38
Q

5 neurological causes of incontinence

A 
MS
Spinal injury
Normal-pressure hydrocephalus
Dementia
Delirium
39
Q

Complications of incontinence

A

Depression/psychosocial distress
Dermatitis, skin infections, sores
UTIs

40
Q

Antibiotics for UTI during pregnancy

A

Cephalexin (1st gen PO cephalosporin)
Nitrofurantoin (avoid during T1/term)
TMP/SMX (avoid during T1/term)

Preclerkship (25 decks)

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