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24 Cards in this Set
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Definitions:
cystitis: pyelonephritis: bacteriuria: pyuria: UTI: |
cystitis - bladder
pyelonephritis - anything above bladder bacteriuria - duh pyuria - >5 WBC per high power literally means pus in urine UTI - duh |
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Clinical manifestations:
urethritis: cystitis: pyelonephritis: May be only sign in kids < 2 y/o of UTI: Some long-term complications of UTI's: UA/Cx: + in UTI's: |
dysuria, frequency
dysuria, frequency, suprapubic tenderness above + flank pain, N/V/systemic S/S fever HTN, renal scarring, impaired renal growth/fxn leukocytes, nitrites proteins, blood |
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Major pathogen of UTI's:
Are bagged urines OK for UA/Cx to R/O UTI? Most accurate method to get urine especially in infants? Gold standard for UTI's? Most accurate rapid indicator of UTI's in children? why might this show false negatives on someone who pees frequently? |
E. Coli
No - contamination suprapubic tap Urine Culture Nitrites- urine must spend 4 hrs sitting to have detectable amount of bacteria |
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Pyuria = ___ WBC's per high-powered field (centrifuged?/uncentrifuged?)
Bacteriuria = _____ bacteria per high-powered field: Gold standard for UTI varification... Urine Cx - # cfu's for clean catch + test? for cath? for suprapubic? |
>5 centrifuged if uncentrifuged >10
Any clean catch - >100,000 cath - >50,000 suprapubic - any G-, >a few thousand G+ |
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SHould you start a kid on antbiotics before the culture comes back if you suspect UTI? Why?
Which ones? |
Yes to prevent kidney scaring
3rd generation Cef |
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Common Abx for UTI's?
Risk factors for pediatric UTI's? UTI evaluation guidelines for kids? |
Amox, Bactrim, Nitrofurantoin, Cefixime, Cephalexin
female, uncircumcised, white race, genetic, urinary obstructions, chronic caths fever of unknown origin, <1 y/o, white, fever for days, temp >39C |
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Chart time remember this... if suspect UTI in peds and...
a. great than 5 y/o what is next question? |
Male or female then with or without systemic signs same if less than 5 y/0
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If male with no system signs and older than 5 suspected UTI treatment?
If Femail older than 5 without systemic signs of UTI treatment? |
1. oral antibiotics, ultra sound, VCUG
2. oral antibiotics, treatment group B |
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What is VCUG?
What are classification? What it treatment? |
voiding cystourethrogram assess for reflux which may predispose person to pyelonephritis
Grades- 1-5 treatment depends on bilateral or unilateral usually watched to see if there is improvement over the years Grade 1,2 usually just watch |
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Current AAP guidlines for followup in children 2 months to 2 yrs with UTI
What other peds go by these same standards? |
routine RUS and VCUG
- girls <3 yrs with first UTI - any age with febrile UTI - recurrent UTIs - first UTI + poor growth + family hx of renal, HTN, UTI |
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This infection is of the renal parenchyma and is usually caused by ascending infection of the lower urinary tract
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pyelonephritis
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Do you normally see clots in glomerular disease?
How do the RBC's look in glomerular disease? Color of urine? Is protein elevated? |
No
Dysmorphic- not normal RBC casts brown Yes - >100 mg |
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Gross hematuria:
Microscopic hematuria: benign or not? Some medications that cause heme-negative red urine? foods that cause red urine? common causes of gross hematuria? (3) |
increased RBC's in urine, visible to naked eye
common finding, 3-4% schoolchildren have it, mostly benign causes. Make sure you moniter about 6 months... blood and protein = cause of concern doxorubicin, chloroquine, ibuprofen, iron sorbitol, *rifampin* beets, blackberries, food coloring UTI, local irritation, trauma |
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Common causes of gross hematuria in peds urology?
Common causes in peds nephrology? What should you evaluate on PE in kids? |
urethral trauma/irritation, UTI, congenital
29% glomerular causes- IGA nephropathy, Alport syndrome, 37% non glomerular causes- hypercalciuria BP, edema/weight gain, skin, direct visualization of genitals, close eval of abdomen (Wilm's tumor) |
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with hematuria urinalysis what are key findings that distinguish glomerular vs non-glomerular?
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Glomerular- red cell casts, dysmorphic appearance, brown color, protein elevated >100mm/m2- early am)
- Nonglomerular- urine pink or red, shows uniform size and shape of RBC clots almost never seen |
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Test to order for:
trauma: flank pain: dysuria/fever: what mimics bacterial UTI? What are S/S of glomerular disease? Test ordered for strep Ab's? |
trauma - CT
flank pain - U/S UAC, G stain- adenovirus mimics Proteins, RBC casts, HTN, edema ASO titer |
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A Ca+/creatinine ratio >0.2 suggests:
3 etiologies for persistent microscopic hematuria (asymptomatic pt)? |
hypercalciuria
1. glomerulopathies:IGA nephropathy, Alport's syndrome, thin basement membrane 2.hypercalciuria 3. Nutcracker syndrome |
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Describe IGA nephropathy:
Thin basement membrane disease: (benign familial hematuria) diagnosis and inheritence? |
Hx of gross hematuria,URI/AGE 1-5 d. prior, Most common form of glomerulonephritis, recurrent hematuria common
autosomal dominant, thinned glomerular membranes on EM from biopsy |
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Classic Alport syndrome:
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Recessive X-linked
hearing loss ocular abnormalities progressive renal failure affects A-5 Type 4 collagen chains thickened membranes in kidney |
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Post infectious glomerulonephritis:
What drugs can decrease hematuria in hypercalciuria diagnostic for hypercalciuria?? Nutcracker syndrome? |
post-streptococcal
10 (pharyngitis) -21 (impetigo) days post infection rarely recurrent hematuria most resolve <6 mo. Thiazide diuretics hypercalciuria usually > 6y/o calcium/creatine ration >.2mg/mg L renal vein compression between aorta, sup mesenteric a.; common in Asians (damn!) |
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Most common presentation of hematuria in kids? Tx?
When should you refer an asymptomatic micropic with proteinuria kid? |
asymptomatic isolated- repeat urine eval 2-3 weeks
1st void urine protein > 0.2 mg creatinine >4 mg protein/hr. elevated serum creatinine |
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Symptomatic microscopic hematuria:
1. new onset dysuria/frequency/urgency: 2. recent URI/skin infection (1-2 d., 2-3 wks) 3. flank pain radiating to groin: 4. flank pain, no radiation, fever, dysuria, urinary S/S: 5. deafness: |
1. UTI
2. 1-2 d: IGA nephropathy, 2-3 wks: post strep glomerulonephritis 3. kidney stone 4. acute pyelonephritis 5. Alport's syndrome |
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Symptomatic microscopic hematuria:
6. family hx of hematuria, renal disease: 7. weight loss, mass/tumor in abdomen: 8. extrarenal manifestations: |
6. Alport's, thin basement membrane, kidney stones
7. Wilm's tumor 8. Lupus, Henoch-Schonlein purpura |
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What is brick dust urine
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pink dust on diaper concentrated urine crystals common for breast feeding
-uric acid crystals |
