Renal/genitourinary Disorders And Stds

Front 1

what are the causes of lower UTI's?

Back 1

cystitis, urethritis/dysuria frequency syndrome

Front 2

what are the causes of upper UTI's?

Back 2

pyelonephritis, renal abscess, etc

Front 3

what is the most common causative organism for uti's in women? Men?

Back 3

e. coli
proteus species in men

Front 4

what are the s/s of a lower uti?

Back 4

***dysuria is the key symptom***
frequency
nocturia
urgency
hematuria - occurs in 40-60% of patients

Front 5

what is diagnostic in the lab for a UTI?

Back 5

urinalysis-will show pyuria (>10 WBC/ml)
presence of nitrate by dipstick is very specific but not a sensative test for bacteriuria (shows if you dont have it better than if you do)
esterase detection by dipstick is very sensitive but not specific

Front 6

what is the management for lower uti's? i.e. what antibiotics and for how long?

Back 6

3 day therapy maximizes benefits and minimizes drawbacks of treatment (i.e., fewer side effects, more effective than a single dose and less costly than 7 day course)
if older person, put them on 5 days
Antibiotics:
Bactrim
Cipro (fluroquinolone 2) and amoxicillin/clavulanate (augmentin)
other considerations: amoxicillin (amoxil), levofloxacin (levaquin) (fluroquinolone), nitrofurantoin (macrobid; macrodantin), trimethoprim (primsol), fosfomycin (monurol)
during pregnancy: amoxicillin (amoxil), nitrofurantoin (macrobid), cephalexin (keflex) (cephalosporin) for 7-10 days of therapy

Front 7

what are s/s of upper uti's?

Back 7

flank, low back, or abdomninal pain may be present
***fever and chills***
N/V
mental status changes in elderly

Front 8

what labs do you draw if you think your pt may have an upper uti?

Back 8

WBC casts are seen on urinalysis
ESR is elevated with pyelonephritis

Front 9

what is the management (which antibiotics and for how long) for an upper UTI?

Back 9

14 days to 6 weeks!!!
bactrim, ciprofloxacin (cipro) (fluroquinolone), one of the other quinolones, amoxicillin/clavulanate (augmentin), aminoglycosides (gent, tobra)

Front 10

when should you admit a patient with suspected pyelonephritis?

Back 10

when they have n/v, and those with more severe illness

Front 11

what is renal insufficiency? how is it defined?

Back 11

it is a decrease in renal function resulting in a decrease in the gomerular filtration rate and a reduction in the clearance of solutes; gfr decreases w/ aging. normal gfr is > 30.
aka mild azotemia here, only 25% nephrons functioning

Front 12

what are some causes of renal insufficiency? (azotemia)

Back 12

hypertensive nephrosclerosis
glomerulonephritis
diabetic nephropathy
interstitial nephritis
polycystic kidney disease

Front 13

what are the s/s of renal insufficiency?

Back 13

often asymptomatic until late stages
direct relationship between nephron loss and renal function
systemic changes not evident until overall renal function is < 20-25% of normal

Front 14

2 types of renal insufficiency, what are they and explain s/s in terms of their labs.

Back 14

acute and chronic
acute is sudden, BUN increased out of proportion to creat
usually due to obstruction, ATN, or contrast media (give mucomyst)
reversible w/ proper therapy

Chronic: progressive impairment over months to years (chronic renal failure) there is a steady increase in BUN and serum creatinine: (10:1) ratio
chronic can be slowed but is irreversible

Front 15

what are the stages of renal failure?

Back 15

1. diminished renal reserve: 50% nephron loss, creatinine doubles
2. renal insufficiency: 75% nephron loss, mild azotemia present
3. end stage renal disease: 90% nephron damage, azotemia, metabolic alterations

Front 16

what are the indications for dialysis?

Back 16

AEIOU
acidosis or azotemia
electrolyte imbalance
intoxication
oliguria
uremia

Front 17

how do you treat acute renal failure?

Back 17

determine the cause and intervene to prevent permanent kidney damage

Front 18

how do you treat chronic renal failure?

Back 18

SLOW THE PROGRESSION!!!
control htn and DM
reduce dietary protein to 40g/day
modify the dosage of medications

Front 19

how do you treat the following complications of renal failure:

Back 19

diuretics to reduce volume overload
monitor and treat metabolic acidosis as required
monitor electrolytes (hypercalcemia occurs in CRF)
treat anemia of CRF as needed
treat azotemia (BUN > 100 mg/dl w/ renal replacement therapies/dialysis.

Front 20

Name the categories and causes of Acute Renal Failure.

Back 20

Prerenal (outside kidney)
shock dehydration, cardiac failure, burns, diarrhea, vasodilation/sepsis, etc. conditions that cause impaired renal function. its only Prerenal if its reversible when hypoperfusion is corrected. no damage to tubules.

Intrarenal (think intrinsic, or renal) caused by disorders that DO affect the renal cortex or medulla like hypersensitivity (allergic disorders), obstruction of renal vessels (embolism or thrombosis), ***nephrotoxic agents (most common cause), mismatched blood transfusions (RBCs hemolyze and block nephrons). There is nephron damage!! damage to tubular portion of the nephron isthe most common cause (think ATN)

Postrenal-from obstruction--i.e. tumors, calculi, BPH, urethral strictures or functional, neurogenic bladder, diabetic neuropathy.

Front 21

How do you treat pre, intra and post renal acute renal failure?

Back 21

pre-give volume & pressors
intrarenal-maintain perfusion, stop drugs and do renal replacement as necessary
post-remove obstruction

Front 22

what is the BUN:creat ratio, urine Na, Specif Gravity, Urinary Sediment and functional excretion of sodium in pre, itra, and postrenal acute renal failure

Back 22

BUN:creat-pre >10:1
intra 10:1
post 10>1
Urine Sodium: Pre <20 mmol/dL**
Intra >40
post usually >40
Specific Gravity: pre >1.015**
intrta < 1.015
post < 1.015
Urinary sediment: pre-normal/few hyaline casts
intra: granular/white casts
Post: normal

Fractional Excretion of Sodium (FEna) pre <1**
intra >3
post usually > 3

Front 23

what is the percentage of the population that will develop urinary calculi during their lifetime?

Back 23

10%

Front 24

Tell me about calcium stones:

Back 24

account for 80% of stones
are freq familial
more common in men
avg age of onset is >30
**independent of Ca intake--hurts when it moves)

Front 25

Tell me about uric acid kidney stones:

Back 25

more common in men
1/2 of those developing uric acid stones also have gout

Front 26

tell me about struvite kidney stones.

Back 26

mainly in women
result from UTIs with urease-producing bacteria
known as "magnesium-ammonium-phosphate stones"
may grow to a large size and fill the renal pelvis and calyces

Front 27

tell me about Cystine kidney stones.

Back 27

cystine is the only amino acid that becomes insoluable in urine
difficult to manage

Front 28

what are the s/s of a kidney stone?

Back 28

pain/bleeding
acute colic-like flank pain, increases in intensity when it moves
radiation of pain toward groin indicates that the stone has passed to the lower 1/3 of the ureter; testicular pain may also occur
a stone in the portion of the ureter within the bladder wall causes frequency, urgency and dysuria

Front 29

what lab/diag tests are used to diagnose kidney stones?

Back 29

elevated levels of the minerals responsible for the stone
crystals seen in urinary sediment
abd xray
CT

Front 30

how are kidney stones managed?

Back 30

depends on the type of stone, location, extent of obstruction, the function of the kidneys and the progress of passage.
important initial treatment: ***morphine or dilaudid, toradol, and metoclopramide (reglan or zofran)
diuretics (e.g. thiazides) may be used in some cases: controversial
if stone is obstructing outflow or accompanied by infection, removal is indicated
extracorporeal, percutaneous ultrasonic lithotripsy can be used
larger fragments may be removed by cystoscopy

Front 31

what is BPH?

Back 31

benign prostatic hypertrophy is a progressive condition chac. by enlargement of the prostate gland commonly seen in males greater than 50 yo

Front 32

what is the incidence of BPH?

Back 32

50% of men by age 50
80% of men by age 80

Front 33

what are the s/s BPH?

Back 33

frequency/dysuria/urgency, nocturia, incontinence, hesitancy, starting and stopping flow, dribbling, rentention

Front 34

at what age to digital rectals start?

Back 34

age 40

Front 35

what lab would you do if someone comes to you w/ frequ, dysuria, urgency?

Back 35

UA first
PSA 2nd

Front 36

what is a normal PSA value?

Back 36

age specific, but based on an avg of < mng/ml:
40-49 <2.5
50-59 <3.5
60-69 <4.5
70-79 <6.5

***approx 40% of pts with postate CANCER present wi/ normal PSA value

Front 37

what is the lab test/diag used for BPH?

Back 37

Transrectal ultrasound if there is a palpable node or elevated PSA

Front 38

what drugs are used in the mgmt of BPH?

Back 38

alpha blockers-terazocin (hytrin), prazocin (minipress), tamsulosin (flomax), etc. to relax the muscles of the bladder and prostate

Front 39

what treatments other than drugs are used to diagnose BPH?

Back 39

TURP if have signf. urinary s/s
saw palmetto--improved s/s in men, no evidence if it decreases CA risk.
avoid meds that worsen s/s of BPH (OTC meds, benadryl, pseudoephedrine (sudafed) oxymetazoline spray (afrin), antidepressants like SSRIs,

***Zyrtec DOES NOT cause s/s
saw palmetto promotes clotting, not bleeding, also interacts w/ anesthesia