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AGACNP > Renal/Genitourinary disorders > Flashcards

Renal/Genitourinary disorders Flashcards

1
Q

Urinary Tract Infections (UTI)

A

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

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2
Q

S/S of lower UTI

A

Involving bladder and urethra.
Dysuria is the key symptom (remember, “it hurts to pee” is either a UTI or STD)
Frequency
Nocturia
Urgency
Hematuria

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3
Q

Lab/Diagnosits of lower UTI

A

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.

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4
Q

Management of lower UTI

A

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.

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5
Q

S/S of upper UTI

A

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

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6
Q

Lab/diagnositcs of upper UTI

A

WBC cast seen on urinalsis
ESR elevated in pyelonephritis
Leukocytosis with left shift

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7
Q

Management of upper UTI

A

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.

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8
Q

Renal insufficiency

A

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

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9
Q

Causes of renal insufficiency

A

Hypertensive nephrosclerosis
Glomerulonephritis
Diabetic nephropathy
Interstitial nephritis
Polycystic kidney disease

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10
Q

Acute Kidney Injury (AKI)

A

Sudden impairment of renal function.
Methods to Identify AKI:
Risk
Injury
Failure
Loss
ESRD

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11
Q

RIFLE

A

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.
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12
Q

Prerenal

A

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.

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13
Q

Intrarenal

A

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)

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14
Q

Postrenal

A

Results from urine flow obstruction
Caused by either mechanical or functional obstruction:
Mechanical: Calculi, tumors, urethral strictures, BPH
Functional: Neurogenic bladder, diabetic nephropathy.

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15
Q

Lab/diagnostics of Prerenal, intrarenal, and postrenal

A
  • 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
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16
Q

Management of AKI: prerenal, intrarenal and postrenal

A
  • Prerenal:
    -Expand intravascular volume
  • Intrarenal:
    -Maintain renal perfusion, stop nephrotoxic drugs, RRT as indicated
  • Postrenal:
    -Remove source of obstruction–check foley, renal US, CT scan.
17
Q

Criteria for dialysis

A

Any of these would be an indication for nephrology consult and dialysis.
* A: Acidosis, epscificall metabolic
* E: Electrolyte imbalances, dangerous ones such as hyperK+ and hyperCa+
* I: Intoxication-pt has a personality change and can’t reverse without dialysis.
* O: Oliguria (UO <400ml/24 hours) Anuria (UO <100ml/24hours)
* U: Uremia (urine in blood)

18
Q

Nephrolithiasis

A

A condition when one more more stones are located in the pelvis, kidneys or ureters.
Calculi may be composed of calcium, (most common) or uric acid, struvite, or cystine.

19
Q

S/S of nephrolithiasis

A

A stone may traverse the ureter without symptoms, however the passage usually produces pain and bleeding.
Acute (colic-like) flank pain is usually seen with increased intensity.
Radiation of pain downward to the groin indicates that the stone has passed to the lower third of the ureter, testicular pain may also occur.
N/V
Pain not relieved by position
Costovertebral angle tenderness.

20
Q

Lab/diagnostics of nephrolithiasis

A

CT scan (gold standard) along with baseline urinalysis, CBC, BMP.

21
Q

Management of nephrolithiasis

A

Relieve pain, nausea and vomitting.
Depends on the stone type, location, extent of obstruction, function of kidneys, and the progress of stone passage.
Analgesia (3 drug regimen) and hydration:
Morphine/dilaudid, toradol (watch for kidney dysfunction) and metoclopramide (helps move gut and pain relief)

Hydration will help hasten stone passage.

Lithotripsy for larger stones.

22
Q

Benign prostatic hypertrophy (BPH)

A

A progressive condition characterized by enlargement of the prostate gland, commonly seen in males greater than 50 years.
Can cause obstruction of the urethra with interference with urinary flow.
Hyperplastic process that results from an increase in cell numbers.

Cause is unknown, may have a response to androgen hormones overtime.

23
Q

S/S of BPH

A

Frequency
Dysuria
Urgency
Nocturia
Incontinence
Hesitancy
Starting and stopping flow
Dribbling
Retention

On digital exam, prostate may be enlarged but this does not correlate with severity of symptoms or degree of obstruction.
Should feel smooth and rubbery
Focal enlargement, nodularity or extreme hardness may represent malignancy– do transrectal US.

24
Q

Lab/diagnostics of BPH

A

Urinalysis to detect infection
BUN/Cr to detect renal insufficiency
PSA >4= abnormal;age specific ranges are based on having had a PSA <4
PSA normally increases with age.

Transrectal US for palpable node or elevated PSA

25
Q

Management of BPH

A

Observe condition and consult/refer to urologist as needed.

  • Alpha blockers: Terazosin, prazosin, tamsulosin
    -These relax smooth muscles of bladder and prostate.
    -Hypotension and dizziness are most commonly reported side effects.
  • 5-alpha-reductase inhibitors: Finasteride and dutasteride
    -These shrink large prostates, usually prescribed by urologist after US.
    -Blocks hormonal conversion restosterone to dihydrotestosterone
  • Surgery if signficant urinary symptoms persist with a transurethral resection of hte prostate (TURP).
  • Saw Palmetto:
    -May improve symptoms in some men, no evidence that it decreases prostate cancer risk. It’s a herb and not FDA approved.
  • Avoid meds that worsen S/S of BPH:
    -Benadryl
    -Sudafed
    -Afrin
    -SSRIs
26
Q

Gerontology considerations for renal

A
  • Diminished renal blood flow, kidney size, and GFR (up to 10% per decade after age 30)
  • Assessment of GFR or creatinine clearance is often needed for dose adjustment.
  • Reduced hormonal response to vasopressin and an impaired ability to conserve sodium (leads to an increased risk of dehydration)
  • Bladder tone, elasticity and capacity are reduced.
  • Increased residual urine and frequency and more nocturnal urine production which also increases risk for falls.
  • Prostate enlargement in men.
27
Q

Gerontological findings for renal considerations

A
  • Decrease drug clearance
  • Adverse drug reactions
  • Nephrotoxicity
  • Fluid overload
  • HypoNa+ and dehydration
  • HyperNa+
  • HyperK+
  • Metabolic acidosis
  • Urinary urgency
  • Incontinence
  • UTIs
  • Polyuria at night
  • Falls
28
Q

Normal creatinine clearance

A
  • Men: 97-137
  • Women: 88-128
    *~2ml/s

These values usually decrease with age

29
Q

Normal GFR

A

90-120
>60= normal
<60=kidney disease

AGACNP (25 decks)

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