Renal/Genitourinary disorders Flashcards
Urinary Tract Infections (UTI)
Inflammation and infection involving the kidneys, ureters, bladder and/or urethra.
Can be lower (bladder and urethra) or upper UTI (kidney and ureters)
Can be complicated (Occurs with defects in urinary tract or in individuals with other health problems) or uncomplicted (occurs in normal working urinary tract)
Most common causitive organism is E-Coli
S/S of lower UTI
Involving bladder and urethra.
Dysuria is the key symptom (remember, “it hurts to pee” is either a UTI or STD)
Frequency
Nocturia
Urgency
Hematuria
Lab/Diagnosits of lower UTI
Urinalysis usually shows pyuria WBC>10
Presence of nitrates by dipstick is very specific (-) but not very sensitive (+) for bacteriauria (tells you if you do not have a UTI). Nitrate dipstick test positive with protein, blood or nitrates, so not very sensitive.
Esterase detection by dipstick is very sensitive (+) but not specific (-) Itells you it’s a senstive and postiive test for bacteriuria). Esterase detects pyruia and WBC.
Management of lower UTI
Goal: low resistance and low collateral damage)
Nitrofurantoin (macrobid)
Trimethoprim-sulfamethoxazole (TMP-SMX bactrim)
Fosfomycin
Amoxicillin-Clavulanate when nothing else can be used.
Fluorquinolones are last line treatment with no alternative treatment options.
S/S of upper UTI
Pyelonephritis, renal abscess
Flank, low back, or abdominal pain
Fever, chills often present and usually indicate upper UTI
N/V
Mental status changes in the elderly
Lab/diagnositcs of upper UTI
WBC cast seen on urinalsis
ESR elevated in pyelonephritis
Leukocytosis with left shift
Management of upper UTI
Ciprofloxacin
Levofloxacin (but not moxifloxacin d/t inadequate tissue penetration)
Ceftriaxone
Bactrim (TMP-SMX) and nitrogurantoin not recommended due to not being able to reach therapeutic concentrations in the kidneys
For healthcare associated pyelonephritis use antipseudomonal agents other than fluoroquinolone such as ampicillin and an aminoglycoside.
Renal insufficiency
Decrease in renal function resulting in a decrease in the GFR (90-120) and a reduction in the clearance of solutes.
GFR naturally decreases with age.
Patients are often asytmptomatic until the later states o the disease and systemic changes are not evident until 25% of overall renal funciton is decreased.
This would then turn into AKI
Causes of renal insufficiency
Hypertensive nephrosclerosis
Glomerulonephritis
Diabetic nephropathy
Interstitial nephritis
Polycystic kidney disease
Acute Kidney Injury (AKI)
Sudden impairment of renal function.
Methods to Identify AKI:
Risk
Injury
Failure
Loss
ESRD
RIFLE
Relies on SCr, GFR and UO
- Risk: Increase SCr by 1.5 or decrease GFR by 25%
-UO <0.5ml/kg/hr over 6 hours - Injury: Increase SCr by 2 or decrease GFR by 50%
-UO <0.5ml/kg/hr over 12 hours - Failure: Increase SCr by 3 or decrease GFR by 75%
-UO <0.3ml/kg/hr over 24 hours or anuria for 12 hours. - Loss: Complete loss of kidney function greater than 4 weeks
- ESRD: Complete loss of kidney function greater than 3 months.
Prerenal
Caused by conditions that impair renal perfusion such as shock, dehydration, cardiac failure, burns, diarrhea, vasodilation/sepsis.
By definition, an episode of AKI is prerenal ONLY if it is reversed when the underlying cause of hypoperfusion is corrected.
There is no damage to the renal tubules.
Intrarenal
Also called renal or intrinsic.
Most common cause is from nephrotoxic agents such as aminoglycosides (end in mycin, also toxic to ears).
Other causes are disorders that directly affect the renal cortex or medulla such as hypersensitivity (allergic disorders), obstruction of renal vessels (embolism or thrombosis), mismatched blood transfusions.
Results in nephron damage: damage to the tubular portion of the nephron is the most common cause (ATN)
Postrenal
Results from urine flow obstruction
Caused by either mechanical or functional obstruction:
Mechanical: Calculi, tumors, urethral strictures, BPH
Functional: Neurogenic bladder, diabetic nephropathy.
Lab/diagnostics of Prerenal, intrarenal, and postrenal
- Prerenal disease:
-BUN:SCr ratio >20:1
-Urine Na+: <20
-Urine SG: >1.015
Urine sediment: Normal/few hyaline case
Fractional excretion of Sodium (FENa): <1 - Intrarenal disease:
-BUN:SCr ratio: 10:1
-Urine Na+: >40
-Urine SG: <1.015
-Urinary sediment: Granular/white casts
-FENa: >3 - Postrenal:
-BUN:SCr ratio: 10:1
-Urine Na+: >40
-Urine SG: <1.015
-Urinary sediment: Normal
-FENa: >3