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Renal/GU Flashcards

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1
Q

lower UTI: causes

A

cystitis (bladder)
urethritis

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2
Q

upper UTI: causes

A

pyelonephritis
renal abscess

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3
Q

lower UTI: labs/Dx

A

UA: pyuria (>10 WBC/ml)
+ nitrites (very specific but not sensitive for bacteriuria)
+ esterase (sensitive but not specific) –> order ABx

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4
Q

cystitis: management

A

For uncomplicated cystitis, choose one:
- Macrobid PO BID x5 days
- bactrim PO x3 days (avoid if resistance is >20%)
- fosfomycin PO x1

fluoroquinolone if no alternative options

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5
Q

Pyelonephritis: S/Sx

A

flank, low back, abdominal pain
fever, chills
N/V
AMS in elderly

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6
Q

upper UTI: labs/Dx

A

UA: +WBC
ESR elevated w/pyelonoephritis

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7
Q

pyelonephritis: management

A

empiric
- ciprofloxacin PO BID x7 days if uncomplicated
- levofloxacin
- ceftriaxone IV Q24h x14 days

Avoid
- moxifloxacin
- bactrim: high resistance
- Macrobid: does not reach therapeutic concentrations in kidneys

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8
Q

healthcare associated pyelonephritis: management

A

Choose one:
- amoxicillin + aminoglycoside (-mycin)
- cefepime
- imipenem
- meropenem
- pip-tazo

(antipseudomonal agent other than a fluoroquinolone)

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9
Q

renal insufficiency

A

decrease in renal function resulting in a decrease in the GFR and a reduction in the clearance of solutes
GFR decreases naturally with aging

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10
Q

renal insufficiency: causes

A

hypertensive nephrosclerosis
glomerulonephritis
diabetic nephropathy
interstitial nephritis
polycystic kidney disease

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11
Q

RIFLE class: increased serum Cr x1.5

A

risk for AKI

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12
Q

RIFLE class: decreased GFR by >25%

A

risk for AKI

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13
Q

RIFLE class: UOP less than 0.5 ml/kg/hr for 6 hours

A

risk for AKI

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14
Q

RIFLE class: increased serum Cr x 2

A

renal injury

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15
Q

RIFLE class: decreased GFR by >50%

A

renal injury

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16
Q

RIFLE class: UOP less than 0.5 ml/kg/hr for 12 hours

A

renal injury

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17
Q

RIFLE class: increased serum creatinine by x 3

A

renal failure

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18
Q

RIFLE class: decreased GFR by >75%

A

renal failure

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19
Q

RIFLE class: increased serum CR by >0.5 if baseline >4

A

renal failure

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20
Q

RIFLE class: UOP less than 0.3 ml/kg/hr for 24 hrs

A

renal failure

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21
Q

RIFLE class: anuria for 12 hours

A

renal failure

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22
Q

RIFLE class: complete loss of kidney function >4 weeks

A

loss of renal function

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23
Q

RIFLE class: complete loss of kidney function >3 months

A

ESRD

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24
Q

pre renal AKI

A

caused by conditions that impair renal perfusion (e.g. shock, dehydration, cardiac failure, burns, diarrhea, vasodilation/sepsis)

AKI is pre renal only if it is reversed when the underlying cause of hypo perfusion is corrected

No damage to renal tubules

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25
intrarenal AKI: causes, complications
caused by disorders that directly affect the renal cortex or medulla: **- nephrotoxic agents (e.g. aminoglycosides, contrast) -- most common** - hypersensitivity (e.g. allergic disorders) - obstruction of renal vessels (e.g. embolism or thombosis) - mismatched blood transfusion (RBCs hemolyze and block nephrons Results in nephron damage - acute tubular necrosis (damage to the tubular portion of the nephron) is the most common cause
26
post renal AKI
results from urine flow obstruction mechanical: calculi, tumors, urethral strictures, BPH functional: neurogenic bladder, diabetic neuropathy
27
Prerenal, intrarenal, or postrenal AKI: BUN/Cr ratio >20:1
prerenal
28
Prerenal, intrarenal, or postrenal AKI: urine sodium <20 mmol/dl
prerenal
29
Prerenal, intrarenal, or postrenal AKI: spec grav >1.015
prerenal
30
Prerenal, intrarenal, or postrenal AKI: urinary sediment normal/bland/few hyaline casts
prerenal
31
Prerenal, intrarenal, or postrenal AKI: FENa <1%
prerenal
32
Prerenal, intrarenal, or postrenal AKI: BUN/Cr ratio 10:1
intrarenal, postrenal
33
Prerenal, intrarenal, or postrenal AKI: urine sodium >40 mmol/dl
intrarenal, postrenal
34
Prerenal, intrarenal, or postrenal AKI: spec grav <1.015
intrarenal, postrenal
35
Prerenal, intrarenal, or postrenal AKI: urinary sediment w/granular/white casts
intrarenal
36
Prerenal, intrarenal, or postrenal AKI: FENa >3
intrarenal, postrenal
37
Prerenal, intrarenal, or postrenal AKI: urinary sediment normal
postrenal
38
prerenal AKI: management
expand intravascular volume
39
Fractional Excretion of Sodium (FENa)
amount of sodium that leaves the body through the urine (instead of being filtered and reabsorbed by the kidney)
40
intrarenal AKI: management
maintain renal perfusion stop nephrotoxic drugs renal replacement therapies as indicated
41
postrenal AKI: management
remove source of obstruction -- check foley, renal ultrasound, CT, egc
42
criteria for dialysis
A: Acidosis (metabolic) E: electrolyte imbalances I: intoxication (AMS) O: Oliguria (UOP <400ml/24 hrs) / anuria U: Uremia (urine in the blood) Any criteria: consult nephrology
43
Types of renal calculi
Calcium stones: most common, frequently familial -more common in men Uric acid stones: half of those developing uric acid stones also have gout -more common in men Struvite stones: "magnesium-phosphate stones"; d/t UTIs with urease-producing bacteria - more common in women Cystine stones: amino acid that becomes insoluble in urine
44
nephrolithiasis: S/Sx
passage of the stone usually produces pain and bleeding Acute colic-like flank pain radiation of pain downward toward the groin indicating that the stone has passed to the lower third of the ureter testicular pain may occur (r/o torsion and epidydmitis)
45
nephrolithiasis: labs/Dx
helical CT to identify quickly ultrasound UA: hematuria CBC BMP
46
nephrolithiasis: management
depends on the stone type, location, extent of obstruction, function of the kidneys, progress of stone passage Analgesia: - morphine or dilaudid - toradol - reglan (to keep gut moving) IV/PO hydration Lithotripsy for large stones
47
BPH: S/Sx
frequency dysuria urgency nocturia incontinence hesitancy "starting and stopping" urine flow dribbling retention
48
BPH: labs/Dx
PSA >4: abnormal **Approximately 40% of patients with prostate cancer present with normal PSA values. Trend over time and look for a sudden spike** UA to r/o infx transrectal ultrasound if there is a palpable nodule or elevated PSA
49
normal PSA: age 40-49
<2.5
50
normal PSA: age 50-59
<3.5
51
normal PSA: age 60-69
<4.5
52
normal PSA: age 70-79
<6.5
53
BPH: management
Alpha-blockers to relax muscles of the bladder and prostate -terazosin, prazosin, tamsulosin 5-alpha-reductase inhibitors to shrink large prostates -finasteride, dutasteride Saw palmetto: may improve symptoms in some men, but no evidence that it decreases prostate cancer risk TURP if significant urinary symptoms persist Avoid meds that worsen signs/symptoms of BPH -Benadryl, pseudoephedrine, oxymetazoline spray (Afrin), antidepressants such as SSRIs
54
Normal physiologic renal changes in the elderly
Diminished renal blood flow up to 10% per decade after age 30-40 Kidneys decrease in size, number and size of nephrons diminish, and number of glomeruli diminish GFR decreases ~10% per decade after age 30 Reduced hormonal response to vasopressin and impaired ability to conserve sodium (increases risk for dehydration) Reduced bladder tone, elasticity, and capacity Increased residual urine and frequency More nocturnal urine production Enlarged prostate
55
Normal creatinine clearance in males
97-137 ml/min
56
Normal creatinine clearance in females
88-128 ml/min
57
Common organisms that cause UTIs in elderly
Gram negative bacilli - e. coli - p. aeruginosa Gram positive - enterococci - s. aureus Fungi, esp in those w/Foleys
58
S/Sx UTI in elderly
weakness frequency urgency dysuria Atypical findings: -incontinence -lethargy -decreased appetite -dehydration -confusion
59
UTI: labs/Dx in elderly
UA: - WBCs may not be present in large numbers - leukocyte esterase and nitrites may be negative C&S: - high incidence of asymptomatic bacteriuria; only treated in pregnancy, patients undergoing urologic intervention, and perhaps renal transplant patients - multiple organisms often present
60
allergic interstitial nephritis: S/Sx
fever rash eosinophilia leukocyte casts in the urine
61
Prerenal, intrarenal, or postrenal AKI: urinary sediment w/muddy brown casts
intrarenal (acute tubular necrosis)
62
Indications for emergent dialysis
Symptomatic uremia (including pericarditis, neuropathy, unexplained AMS) Significant fluid overload Refractory hyperkalemia Refractory metabolic acidosis
63
Stage 1 renal disease: eGFR
eGFR >90 with evidence of renal damage (e.g. proteinuria)
64
Stage 2 renal disease: eGFR
60-89
65
Stage 3A renal disease: eGFR
45-59
66
Stage 3B renal disease: eGFR
30-44
67
Stage 4 renal disease: eGFR
15-29
68
Stage 5 renal disease: eGFR
<15 or hemodialysis
69
How do NSAIDs affect the kidneys?
NSAIDs inhibit COX enzymes, resulting in the reduction of GFR by inhibiting renal vasodilation
70
Most common cause of acute prostatits (pathogen)
E. coli Typically caused by organisms that cause other genitourinary infections -sexually active males are more likely to have prostatitis caused by sexually transmitted pathogens (e.g. chlamydia trachoma's, neisseria gonorrhea)
71
acute prostatitis: S/Sx
fever, chills dysuria cloudy urine Exam: edematous, firm, tender prostate
72
first line treatment for chronic prostatitis
fluoroquinolones alternative: bactrim
73
diabetic nephropathy: presentation
HTN proteinuria eventually microalbuminuria that becomes macroalbuminuria with elevated serum creatinine often also have diabetic retinopathy
74
hydrocele
collection of peritoneal fluid that lies between the parietal and visceral layers of the tunica vaginalis (the layer surrounding the testis and spermatic cord that extends to form the peritoneal lining of the abdomen)
75
hydrocele: S/Sx
swelling Transilluminates on exam
76
hydrocele: management
indicated if symptomatic surgical excision of the hydrocele sac
77
normal urine spec grav
1.005-1.030
78
azotemia
buildup of nitrogenous products and creatinine in the blood (elevated BUN and Cr)
79
75% nephron loss and mild azotemia
renal insufficiency
80
50% nephron loss and doubled creatinine
diminished renal reserve
81
90% nephron loss, azotemia, metabolic alterations
ESRD

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