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45 - Renal + Urologic Problems Flashcards

1
Q

UTI

A

infections that affect the urinary tract

  • 2nd most common bacterial disease
  • most common bacterial infection in women
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2
Q

most common pathogens causing UTI

A

E.coli

2nd candida albicans

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3
Q

which pathogen is commonly assoc w indwelling catheter

A

candida albicans

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4
Q

bacterial counts for diagnosis of UTI

A

> 10^5 microbe/mL
or
10^2-10^3 microbe/mL + s/s

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5
Q

can fungus + parasites cause UTI

A

yes but uncommon

-often occurs in patients who are immunosuppressed, have diabetes, kidney problems, or receive multibe abx therapy

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6
Q

inflammation of the bladder

A

cystitis

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7
Q

inflammation of renal parenchyma + collecting system

A

pyelonephritis

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8
Q

inflammation of urethra

A

urethritis

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9
Q

urosepsis

A

UTI has spread systemically

-life threatening

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10
Q

uncomplicated UTI

A

occurs in normal urinary tract

-usually only involves bladder

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11
Q

complicated UTI

A

occurs in a person w a structural or functional problem in urinary tract
ex) obstructions, stones, catheters, abnormal GU tract, AKI, CKD, renal transplant, diabetes, or neurogenic disease

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12
Q

how does the body maintain sterility to prevent UTI?

A
  • normal voiding w complete emptying
  • UVJ competence
  • ureteral peristaltic activity (propels urine toward bladder)
  • acidic pH of urine (<6pH)
  • high urea concentration
  • abundant glycoproteins
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13
Q

organisms that cause UTI originate in the ___

A

perineum

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14
Q

common cause of ascending infection is ____

A

urologic instrumentation such as catheters, cystoscopic exams

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15
Q

hematogenous transmission

A

blood borne bacteria invade the kidneys, uretersm or bladder fr elsewhere in the body
***for hematogenous transmission to occur, there must be injury to urinary tract like obstruction of ureter, stone damage, or renal scars.

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16
Q

most common health care assoc infection?

A

CAUTI

-caused by e.coli or pseudomonas.

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17
Q

LOWER Urinary Tract Syndromes [LUTS] occur in patients who have _____ UTI

A

UPPER urinary tract UTI

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18
Q

symptoms of problems w bladder storage or emptying

A
  • dysuria
  • frequency (more than Q2hr
  • urgency
  • suprapubic pressure

-urine may be hematuria, cloudy, or sediment

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19
Q

symptoms of upper UTI (renal parenchyma, pelvis, or ureters)

A

fever, chills, flank pain

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20
Q

T/F UTI confined to the lower urinary tract does not usually have systemic manifestations

A

T

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21
Q

instead of dysuria, + suprapubic pain, older adults tend to have…

A

nonlocalized abdominal discomfort

-may have cognitive impairment or generalized clinical deterioration

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22
Q

if patients are suspected w UTI, what diagnostic procedures should we run?

A

1 dipstrick urinalysis for presence of nitrates, WBC, leukocyte esterase
2 urine culture

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23
Q

which is the best diagnostic study for recurrent UTI, complicated UTI, CAUTI

A

URINE CULTURE

-also when infection is unresponsive to empiric therapy or diagnosis is questionable

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24
Q

2 most accurate diagnostic studies

A

1 specimen obtained by catheter

2 specimens obtained by clean catch method

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25
urine culture with _________ can determine the bacteria's susceptibility to a variety of abx drugs
sensitivity testing
26
uncomplicated vs complicated UTI | abx treatment
UNC: short term course abx (3 days) COMP: longer, 7-14 days or more
27
first choice abx for uncomplicated UTI
- trimethoprim/sulfamethoxazole TMP/SMX - nitrofurantoin - cephalexin - fosfomycin
28
which abx should only be used to treat COMPLICATED UTI
fluoroquinolone | like levoFLOXACIN and ciproFLOXACIN
29
which abx should be used for patients with fungal UTI
fluconazole aka Diflucan
30
phenazoprydine
a urinary analgesic to relieve severe dysuria
31
phenazopyridine
azo dye excreted in urine - topical analgesic on urinary tract mucosa * *causes urine to turn ORANGE or RED
32
how does pyelonephritis usually begin?
- infection of LOWER tract via ascending urethral route - ---usually bacteria found in intestinal tract - vesicoureteral reflux - dysfunction of LOWER tract - -----like BPH or stones
33
vesicoureteral reflux
mvmt of urine from lower tract to upper | -one of the causes of pyelonephritis
34
acute pyelonephritis often starts in the _____ and spreads to the ____
renal medulla adjacent cortex
35
one of the most important risk factors for acute pyelonephritis
pregnancy-induces physiologic changes
36
acute pyelonephritis | classic s/s
- fever +chills - N/V - malaise - flank pain - may include LUTS (dysuria, urge, freq) - CVA tenderness to percussion
37
acute pyelonephritis | diagnostic
urinalysis (WBC, bacteria, pyuria, cast) | ultrasound/CT scan (anatomic abnorm, hydronephrosis, abscess, obstructing stone)
38
chronic pyelonephritis
kidneys become inflamed -develop fibrosis (scarring)> >>loss of renal function> >>atrophy (shrinking)
39
chronic pyelonephritis is usually the result of...
- anatomic abnormalities - recurrent infection - may occur absent of hx of UTI
40
chronic pyelonephritis | diagnostics
- radiologic imaging | - renal biopsy can show loss of functioning nephrons, infiltration of parenchyma w inflammatory cells, fibrosis
41
chronic pyelonephritis can progress to ____
ESRD
42
glomerulonephritis
affects both kidneys equally | -3rd leading cause of ESRD
43
although the glomerulus is the primary site of inflammation in glomerulonephritis, ______, ________ ,________ w/in the kidney can occur
1 tubular + interstitial changes 2 vascular scarring 3 glomerulosclerosis
44
acute post-streptococcal glomerulonephritis [APSGN] is most common in ___
children, young adults, and adults over 60yr
45
acute post-streptococcal glomerulonephritis [APSGN] develops about 1-2 wks after an ______
infection of the tonsil pharynx, or skin by nephrotoxic strains of A-Bhemolytic streptococci
46
APSGN s/s
- generalized body edema - hypertension - oliguria - hematuria - varying proteinuria
47
edema occurs in APSGN bc of
decreased GFR | -first appears in low pressure tissue like orbitals then moves to body
48
titers for APSGN
ANTISTREPTOLYSIN-O | [ASO]
49
______ is highly suggestive of APSGN
ERYTHROCYTE CAST
50
chronic glomerulonephritis
syndrome of permanent + progressive renal fibrosis - can lead to ESRD - cause may not be found
51
chronic glomerulonephritis | onset
- slowly over time | - most are discovered accidentally during diagnostic studies for something else
52
chronic glomerulonephritis | s/s
- proteinuria - hematuria - slow dvlpt of uremia - INCR bun + serum creatinine
53
goodpasture syndrome
autoimmune disease - antibodies attack glomerular +alveolar basement membranes - super rare
54
goodpasture syndrome | s/s
- flu-like - pulmo (cough, SOB) - hemopytisis - crackles - pulmo insufficiency - hematuria - weakness - pallor - anemia
55
rapidly progressive glomerulonephritis [RPGN]
glomerular disease w glomerular crescent formation | --loss of renal function over days to weeks
56
possibly causes of RPGN
- complication of inflammatory/infectious disease (APSGN or goodpasture) - complication of systemic disease - idiopathic disease
57
RPGN | s/s
- hypertension - edema - proteinuria - hematuria - RBC cast
58
Interstitial Cystitis [IC]
chronic painful inflammation of BLADDER -urinary pain that CANNOT be attributed to other causes -cause is unknown AKA bladder pain syndrome or painful bladder syndrome PBS
59
IC/PBS | s/s
PRIMARY S/S: pain + bothersome LUTS (urge+freq) - severe cases may void 60x+ a day - suprapubic, vagina, rectum pain
60
IC/PBS is a diagnosis of ____
exclusion - necessary to rule out other possible causes that produce similar symptoms like cancer, stones, sndometriosis - absence of bacteria in utine - HUNTER LESIONS (distinct inflammatory area on bladder wall)
61
IC/PBS | treatment
- abx does NOT help - nutri + drug therapy - -eliminate caffeine, alcohol, citrus, carbonation, anything that can cause lower pH - pentosan (Elmiron) is the only drug approved

Med Surg (18 decks)

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