Renal Infectious Disease

Question 1

Symptoms of renal abscess

Answer 1

fever, abdominal pain, weight loss, dysuria, hematuria

Question 2

Diagnostic procedure of choice for renal abscess

Answer 2

CT scan

Question 3

Treatment for renal abcess

Answer 3

IV abx and percutaneous drainage

Question 4

What does acute pyelonephritis affect?

Answer 4

cortex with sparing of glomeruli and vessels

Question 5

What are white cell casts in urine pathognomonic for?

Answer 5

acute pyelonephritis

Question 6

What bacteria are most commonly implicated in acute pyelonephritis?

Answer 6

e. coli, proteus, klebsiella, enterobacter

Question 7

What is emphysematous pyelonephritis?

Answer 7

life-threatening necrotizing infection of the kidneys characterized by gas formation within or surrounding the kidneys

Question 8

Risk factors for emphysematous pyelonephritis

Answer 8

DM, immunocompromised, or urinary tract obstruction due to lithiasis

Question 9

Symptoms of acute pyelonephritis

Answer 9

high fever, arthralgias, myalgias, flank pain w/CVA tenderness

Question 10

What might a CT scan show for acute pyelonephritis?

Answer 10

hydronephrosis and attenuation caused by inflammation/infection

Question 11

Common abx for acute pyelonephritis

Answer 11

IV ampicillin. PO-cipro, oxfloacin, Bactrim DS for 21 days.

Question 12

How long should IV abx be cont’d?

Answer 12

for 24hrs after fever has resolved and then you can switch to PO

Question 13

T/F chronic pyelonephritis occurs almost exclusively in patients with normal kidneys

Answer 13

false, occurs with major anatomical anomalies

Question 14

What is one of the most common problems encountered by pediatric urologists?

Answer 14

Vesicoureteral reflux (VUR)

Question 15

What percent of infants presenting with UTI have VUR?

Answer 15

70%

Question 16

Etiology of primary VUR

Answer 16

deficiency in the longitudinal muscle fibers in ureterovesical junction

Question 17

Etiology of secondary VUR

Answer 17

Bladder outlet obstruction at the posterior uretheral valve or stenosis. Functional obstruction (Neurogenic and non neurogenic bladder dysfunction)

Question 18

How do newborns present with VUR?

Answer 18

failure to thrive, difficult feeding, or lethargy

Question 19

What is required for a child < 5yrs w/UTI, male childe w/UTI, or febrile UTI?

Answer 19

Standard VCUG and US

Question 20

What percent of gr. 1 reflux spontaneously resolve before adolescence?

Answer 20

90%

Question 21

Characteristics of chronic pyelonephritis

Answer 21

asymmetric corticomedullary scarring, thyroidization of the kidney, eosinophilic casts in tubules

Question 22

symptoms of chronic pyelonephritis

Answer 22

fever, lethargy, N/V, flank pain, dysuria

Question 23

How does IVP establish diagnosis of chronic pyelonephritis?

Answer 23

reveal caliceal dilatation and blunting with cortical scars.

Question 24

Tx of chronic pyelonephritis due to stage 1 and 2 VUR

Answer 24

ABX (Amoxicillan, Bactrim, Septra, Nitrofurantoin) until puberty or until reflux resolves

Question 25

Tx of chronic pyelonephritis due to stage 3 and 4 VUR

Answer 25

Surgery involving the reimplantation of the ureters

Question 26

What is xanthogranulamtous pyelonephritis?

Answer 26

variant of chronic pyelonephritis that, in two-thirds of cases, is a complication of obstruction induced by infected renal stones.

Question 27

What is the outcome for most patients with XPN?

Answer 27

massive destruction of the kidney requiring nephrectomy

Question 28

T/F XPN is sometimes referred to as pseudotumor

Answer 28

true

Question 29

Signs/Symptoms of XPN

Answer 29

flank pain, fever, weight lose, palpable flank mass with or without CVA tenderness

Question 30

Treatment for XPN

Answer 30

nephrectomy

Question 31

What is cystitis most commonly due to?

Answer 31

coliform bacteria (usually E. coli) and occasionally from gram-positive bacteria (enterococci)

Question 32

symptoms of cystitis

Answer 32

irritative voiding, suprpubic discomfort, hematuria

Question 33

Tx of choice for uncomplicated cystitis

Answer 33

Fluroquinolones and nitrofurantoin for 1-3 days

Question 34

What percent of urethritis is caused by n. gonorrhea?

Answer 34

80%

Question 35

symptoms of urethritis

Answer 35

discharge, dysuria, itching, heaviness in genitals (males)

Question 36

What work-up should be performed for all patients presenting with urethritis?

Answer 36

full STD work-up

Question 37

Tx for urethritis

Answer 37

Zithromax, fluroquinolones, doxycycline orally or if compliance is questionable, IM Rocephin

Question 38

what usually causes acute/chronic bacterial prostatitis?

Answer 38

gram-negative rods, esp E. coli, pseudomonas

Question 39

symptoms of acute prostatitis?

Answer 39

Perineal, sacral, or suprapubic pain | Fever, irritative voiding, urinary retention

Question 40

What do you need to be careful of with an acute prostate exam?

Answer 40

careful exam must be performed as vigorous manipulation can cause septicemia

Question 41

Tx for acute prostatitis

Answer 41

I.V. antibiotics (ampicillan and aminoglycosides). PO antibiotics (quinolones) are used for 4-6 weeks

Question 42

Difference between acute and chronic prostatitis

Answer 42

Physical exam of the prostate is often unremarkable and UA is normal in chronic prostatitis

Question 43

What is necessary to make diagnosis of chronic prostatitis?

Answer 43

Culture of post-prostatic massage urine specimen

Question 44

Tx fo chronic prostatitis

Answer 44

Septra has the best cure rate, quinolones, erythromycin, cephalexin also used 6-12 wks

Question 45

What is the most common of the prostatitis syndromes?

Answer 45

nonbacterial prostatitis

Question 46

Symptoms of nonbacterial prostatitis

Answer 46

identical to chronic but no history of UTI

Question 47

Bugs that contribute to the STD forms of epidiymitis

Answer 47

chlamydia or N. gonorrhoea

Question 48

What is non STD form of epididymitis associated with?

Answer 48

UTI’s and prostatitis and result from gram-neg rods

Question 49

What medication is associated with self-limited epidiymitis?

Answer 49

amiodarone

Question 50

symptoms of epididymitis

Answer 50

scrotal pain/swelling, fever, enlarged/tender mass, tender prostate

Question 51

Tx for epididymtitis

Answer 51

Bed rest with scrotal elevation in the acute phase | ABO therapy is directed at causative organism for 10-21 days