1. E. coli 2. Staph saprophyticus 3. Klebsiella, Proteus

Norris (UTI, stones, GN, AKI) Flashcards by Alexander Christy

complicated UTI factors (4)

upper UT (pyelonephritis)
structural/functional abnormality
significant infx
young and/or pregnancy
male

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Recurrent UTI status

> 2 UTIs in 6M

>3 UTIs in 1 Y

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Chief UTI bugs

E. coli
Staph saprophyticus
Klebsiella, Proteus

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Female: male ratio for UTI

30:1

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most common nosocomial dz due to

foli catheters

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Women UTI risk factors (3)

short urethra
sexual activity
diabetes (2-3X more likely)

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Men UTI risk factors (2)

uncircumcised

2. enlarged prostate (prostate secretes protective zinc–unless enlarged)

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Nitrite on dip stick

ENTEROBACTERIACAE convert nitrate –> nitrite –

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Dx of cystitis UTI (5)

Dipstick:
1. Nitrite
2. Leukocyte esterase
UA microscope
3. RBCs, WBCs, 
4. some casts
Urine culture
5. Gold standard

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Dx of pyelonephritis

Blood culture
1. oder if pt febrile or possibly septic
CBC
2. Leukocytosis w/ left shift
3. Neutrophilia and bands suggest pyelo
UA
4. * ^ protein & WBC casts
Imaging
5. look for structural abs
6. KUB, US, CT (CT is ^ choice)

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1st line Tx of UNCOMPLICATED and RECURRENT cystitis

Bactrim–TMP–SMX–Sulfa

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1st line Tx of COMPLICATED cystits

Cipro/ Levaquin–Fluoroquinolone

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1st line Tx of OUTPATIENT/ INPATIENT

Cipro/Levaquin

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Pyelonephritis associated w/ production of gas in renal and perinephric tissues–usually only in DM

Emphysematous pyelonephritis

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UTI when chronic urinary obstruction, together w/ chronic infx, leads to suppurative destruction of renal tissue

xanthogranulomatous pyelonephritis

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Indications for hospitalization for UTI ABSOLUTE

persistent vomiting
progression of uncomplicated UTI
possible sepsis
uncertain dx
UT obstruction

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R/O (2) for cystitis

vaginitis

2. STI’s

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Pyridium for analgesia will…

turn urine orange

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pain w/ bladder distention w/ out infection–dx of exclusion

interstitial cystits

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tx interstitial cystits w/

hydrodistension
amitriptyline
CCB

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nephro/ ureterlithiasis types (4)

calcium oxalate (80%)
other calcium salts (15%)
uric acid (5%)
struvite (5%)

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nephrolithiasis Sx

usually asymptomatic–possible hematuria

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ureterlithiasis Sx

severe paroxysmal pain, F/C, Hematuria, frequency

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Tx for nephro/ureterlithiasis (6)

Flomax (alpha-adrenergic) – relaxes smooth muscle
Analgesia
antiemetics
ABX for infection
hydration
strain urine

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Cut-off for spontaneous passage of stone

5-7 mm 60%

many stones get "stuck" at

UVJ ureterovesical junction

surgery for nephro/ureterlithiasis

1. lithotripsy (US) 2. ureteroscopy laser basket retrieval

Relative admission for stones (5)

1. persistent V 2. associated UTI 3. unremitting pain 4. stone >6mm 5. impaired renal function

Ca+ stone etiologies (4)

1. hypercalciuria 2. hyperoxaluria--* check oxalate in KIDS w/ stones 3. hypocitruria 4. hyperuricosuria--forms core

*uric acid stone risk factors (2)

1. low urine pH (<5.5) | 2. Gout

Struvite (staghorn) stone risk factors (2) Tx

1. Recurrent UTIs 2. urine pH >7.5 Tx: lithotripsy or surg and ABX

antibody-antigen associated glomerular injury steps (3)

1. antigen-antigen deposition 2. compliment activation 3. recruitment of leukocytes

nephrItic

Inflammation/ Blood

nephrOtic think

pOdocyte , prOtein

mild edema

nephritic

generalized/peripheral (anacarca)

nephrotic syndrome

oval fat bodies in urine

nephrotic

GFR normal at first

nephrotic

oliguria, azotemia immediately

nephritic

hypertension

nephritic

hematuria, dysmorphic RBC, Casts

nephritic

Hypoalbuminemia <3g/dL

nephrotic

60% of ________ cases are in children

nephritic

primary kidney diseases associated w/ nephritic syndrome (4)

1. postinfection GN (strep) 2. IgA nephropathy (Berger, HSP) 3. Membranoproliferative GN 4. Rapidly progressive GN (CRESCENTIC)

anti-GBM GN ex.

Goodpasture (systemic kidney disease --> nephritic syndrome)

hereditary nephropathy --> nephritic

Alport's

systemic diseases which can cause nephritic syndrome

1. Pauci-Immune (Churg, Microscopic Polyangiitis, Wegener's) 2. Anti-GBM GN (GP) 3. Hereditary nephropathy

Nephritic syndrome Urinalysis findings (4)

1. RBCs (dysmorphic) 2. RBC casts 3. WBCs 4. Possible mild proteinuria

renal bx findings for nephrotic syndrome

crescents

antinuclear antibodies associated w/

Lupus GN

Asthma and eosinophilia findings

chung-strauss syndrome

Tx post strep nephritic syndrome

1. Treat underlying infx or inflammatory agent: ABX 2. treat HTN: ACEI 3. don't use corticosteroids or immunosuppresants unless severe

nephrotic syndrome may present w/ hypercoagubility because

loss of serum proteins responsible for anti-thrombin

*Nephrotic syndrome in children is usually _______ while _____ in adults

primary, | secondary

serum findings in nephrotic syndrome (4)

1. HYPOalbuminemia 2. Total serum protein <6 g/dL 3. HYPERlipidemia 4. Complement levels

UA findings in nephrotic syndrome (3)

1. Proteinuria 2. Lipiduria (OVAL FAT BODIES) 3. BLAND URINE

Tx nephrotic syndrome

1. dietary (low fat, salt | 2. Loop diuretics (Lasix)

Angiotensin II ______ ________ glomerular capillary

dilates afferent

postinfectious GN appears how long after infection

1-3 weeks after infx resolves (usually Strep pyogenes--sometimes S. aureus)

test for postinfectious GN

Anti-streptolysin O (ASO)

Pt w/ POSTINFECTIOUS GN may complain of (2)

1. back or flank pain | 2. hematuria

Tx for postinfectious GN (2)

1. Tx infx--possibly w/ antiinflammatory ABX | 2. antihypertensives, salt restriction, diuretics

IgA nephropathy aka

Berger disease (IgA deposits in MATRIX)

most common cause of recurrent hematuria/ most common type of GN in adults

Berger disease

IgA nephropathy (Berger) dx (3)

1. serum IgA level 2. hematuria (cola-urine) 3. immunofluorescence IgA

Berger may be a localized variant of

Henoch-Schonlein Purpura (

Berger pathophys

deposition of IgA in mesangium

slowly progressive unremitting GN that can initially present as nephrotic syndrome

membranoproliferative GN (secondary to chronic infx HCV/lupus or immune cmpx's)

ANCA aka

Pauci (small)-immune GN

eosinophilia associated w/ asthma, allergic rhinitis, purpura

Churg-Strauss (Pauci-immune GN)

C-ANCA | P-ANCA

- Wegerner's (cytoplasmic pattern) | - Microscopic polyangitis (perinuclear pattern)

ANCA light microscopy findings (2)

1. necrotizing lesions | 2. crescents

Anti-GBM GN and Goodpastures differentiation

2/3 of GP pt present w/ alveolar hemorrhage (coughing up blood)

Anti-GBM GN dx

1. normal compliment levels | 2. Anti-GBM antibodies

hereditary nephritis

Alport syndrome--^males

Alport syndrome presentation

1. nerve deafness 2. various eye disorders (lens dislocation, cataracts, corneal atrophy) 3. hearing loss

plasmophoresis treatment used to

get rid of antibodies

most common cause of proteinuria in children (80%)

minimal change disease (nephrotic syndrome)

May follow URI, renal function preserved, insidious development of edema and nephrotic syndrome in otherwise healthy child

minimal change disease

minimal change disease UA findings + Tx

1. proteinuria 2. Oval fat bodies - -Corticosteroids

idiopathic sclerosis of certain segments in some but not all glomeruli

focal and segmental Glomerulosclerosis

nephrotic syndrome more likely to have nephritic sx (hematuria, HTN)

focal & segmental Glomerulosclerosis

Tx for focal and segmental glomerulosclerosis (3)

1. low salt/diuretics (tx the edema) 2. ACEI 3. statins

___% of focal and segmental glomerulosclerosis & membranous glomerulonephritis sufferers develop ESRD

50%

most common cause of nephrotic syndrome in adults

membranous glmerulonephritis (30-50yo)

most common cause of ESRD in USA

diabetic nephropathy

deposition of abnormal proteins that have become insoluble and clumped together in tissue (amyloid)

amyloidosis

dz largely due to immune complex deposition resulting in mesangial proliferation and GBM abnormalitis

systemic Lubus Erythematosus--can present as nephrotic or nephritic syndromes

Risk factors for AKI (4)

1. DM 2. HTN 3. Dehydration 4. Age

Acute renal failure S and Sx (3)

1. sudden ^BUN 2. ^creatinine 3. Oliguria

*urine sediment w/ pigmented granular casts and renal tubular epithelial cells

acute tubular necrosis (pathogneumonic)

85% of intrinsic AKI

acute tubular necrosis

2 main causes of acute tubular necrosis

1. ischemic--prolonged prerenal state | 2. nephrotoxins--(exogenous>endogenous)

Acute tubular necrosis UA findings (5)

1. muddy brown sediment (pig. gran. casts) 2. renal tubular epithelial cells 3. oliguric 4. FeNa >1 5. urine Na>20

caused by interstitial inflammatory response (often allergic)

acute interstitial nephritis

key features of acute interstitial nephritis (4)

1. fever 2. maculopapular rash 3. AKI 4. pyuria, WBC casts, hematuria

serum eosinophila findings ^

acute interstitial nephritis

Norris (UTI, stones, GN, AKI) Flashcards

(97 cards)