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Flashcards in Hematuria Cases Deck (6)
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1

Cystitis

Generalized infection of the kidneys (usually bacterial)

Presents with:
- painless hematuria
- mild abdominal discomfort with and without palpation
- increased urinalysis frequency/dysuria
- no CVA pain
- minimal to no infectious signs
- NO FEVER

Labs show
- RBCs and WBCs in urine

Treatment = empiric oral antibiotics and get urine culture samples. Adjust antibiotics accordingly once know causative agent is determined.
- follow up with resolution of symptoms, if not resolving recheck UA

2

Pyelonephritis

Looks pretty similar to Cystits except usually presents also with
- flu-like symptoms
- noteworthy CVA tenderness and suprapubic tenderness
- possible GI symptoms (N/V, anorexia, ab pain)
- tachycardia will almost always be present

Lab values
- proteinuria
- WBCs and RBCs
- **bacteria will also be readily present
- **normal platelets and no anemia (rules out HUS)

Treatment:
- admit to the hospital and start empiric IV antibiotics (usually super broad spectrum piperzillin/tazobactum/ceftriaxone/ceftamine)
- adjust antibiotics once culture gets back and also give IV fluids

3

Most common causative agents for acute pyelonephritis

1) E. Coli (80%)

2) klebsiella (5%)

3) staphylococcus saprophyticus (<3%)

4) anything else (1%)

4

What are the signs of acute pyelonephritis that requires hospitalization?

Patient has comorbidities present

They are hemodynamically unstable

Patient is presenting with renal dysfunction or metabolic/respiratory acidosis

Is male

Is pregnant

Looks toxic appearing and/or complains of severe flank/ab pain

Very high fever >103

Cant take liquids by mouth

5

Prostatitis

Generalized bacterial infection of the prostate that causes Hypertrophy of the prostate and sometimes infection of the urinary bladder

Symptoms:
- dysuria and hematuria
- mild lower ab pain/discomfort And may be noted at the base of the penis
- rectal exam will show enlarged prostate
- usually no fever or illness signs (but can still be present)

lab values
- proteinuria and nitrates will be seen in urine
- WBCs/RBCs are seen in urine

Treatment
- start oral antibiotics and get culture (usually start with levofloxacin) usually for 30 days
- adjust antibiotics when lab results come back

6

Risk factors for urinary tract malignancy in patients with microscopic hematuria

*microscopic hematuria = no gross hematuria, but dipstick testing shows RBCs in urine*

Risk factors:
- analgesic abuse
- exposure to chemicals or dyes occupationally
- history of chronic foreign bodies present
- history of chronic UTIs
- exposure to carcinogenic agents and chemotherapy
- history of gross hematuria
- history of irritative voiding symptoms
- history of pelvic irradiation
- male
- history of past urologic disorder
- older than 35 yrs
- smoking current or past