52 terms

Dysuria

Test 2
STUDY
PLAY

Terms in this set (...)

Dysuria
Painful urination resulting from
UTI
Prostatitis
Tumors of the urinary tract
non-inflammatory causes
gynecologic disorders
Uncomplicated UTI
Symptomatic bacteriuria without anatomical, functional or drug related factors, cystitis, lower urinary tract infection
Complicated UTI
Associated with anatomical, functional, or pharmacologic factors predisposing the patient to persistent infection, recurrent infections or treatment failures
Recurrent Infection
new infection with different organisms
Relapse
infection with same organism
Pyuria
Presence of WBCs in the urine
Pyelonephritis
Infection of the kidneys
Urosepsis
Hypotension, confusion, bacteremia, multi-organ involvement, and systemic toxicity secondary to UTI
What are some predisposing factors of UTI in adults.
Obstruction
Stasis of urine
foreign bodies
Incomplete emptying of bladder
What are the s&s of an UTI.
Dysuria
Frequency
Lower Abdominal Pain
Suprapubic tenderness
Back Pain
Flank Pain
Fever, chills, malaise
CVAT
How do the elderly present with UTIs
Mental status changes
Decreased appetite
Somnolence
Weakness
Dyspnea/cough
Mild Fever or hypothermia
Abdominal pain
Nausea/vomiting
Uncomplicated UTI in women
Non-pregnant woman with no evidence of urologic abnormality, symptoms <7 days
What are complicated UTIs likely to have?
Resistant uropathogen
Poor response, even if "bug" sensitive
Complications
Characteristics of complicated UTI
Primarily men and women >50
Can range from mild cystitis to urosepsis
Broad range bacterial pathogens
Resistance common
Therapeutic choices must be individualized
What conditions increase the risk of serious complications with UTIs?
Obstruction or other structural or functional abnormality
Foreign bodies
Other conditions
What are some major decisions that have to be made when deciding treatment for UTI?
Does the patient have pyelonephritis and whether to admit or treat on outpatient basis
Does the patient have an STI or cystitis?
Does the female patient have external or internal dysuria?
What does a dipstick UA test for?
Specific gravity
pH
Leukocyte esterase
Nitrate
Blood
Protein
What does microscopy test for?
RBCs
WBCs
Bacteria
Casts
Sediment
What are the s/s of pyelonephritis?
Dysuria and frequency
Ill appearing
Temp >38.5C
Leukocytosis with left shift
Nausea/vomiting may exist
Risk factors for pyelonephritis in healthy women?
Recent UTI
Frequency of sexual intercourse
Spermicide use
history of maternal recurrent UTIs
Diabetes
Urinary incontinence
How do you manage a UTI?
Fluoroquinolones
TMP/SMX (Bactrim)
In pregnancy, use ampicillin, amoxicillin, cephalosporins, or nitrofuratoin
Which group of drugs is E. coli most resistant to?
Ampicillin
What drug is E. Coli least resistant to?
Ciprofloxacin
When should you admit a patient to the hospital with a UTI?
Complicated UTI
Inability to take oral medications
Immunocompromised
Pregnant
Urological abnormalities
What drugs should be used to treat pyelonephritis?
IV
Fluroquinolones
Ampicillin and gentamycin
Cefotamine/ceftriaxone
Piperacillin
Extended-spectrum penicillin
When can you switch to oral medications in pyelonephritis?
Usually after 24-48 hours of IV administration and follow up with 14 day course
What are some considerations in catheterized patients?
Prophylactic therapy generally not indicated
May consider prophylaxis if:
Isolation of strains associated with high risk bacteremia
Renal Transplant patients
Granulocytopenic patients
Patients undergoing surgery (GU, prosthesis)
Explain hematuria.
Normal daily excretion of RBCs up to 3 cells per hpf
Hematuria defined as >3-8 RBCs per hpf
May be transient or persistent
Explain Hematuria in glomerular conditions.
Glomerulonephritis
IgA Nephropathy (Berger's disease)
Lupus Nephritis
Interstitial Nephritis
Pyelonehritis
Vasculitis
Explain hematuria in non-glomerular conditions.
Infection
neoplasm
calculi
polycystic kidney disease
sickle cell disease
hemorrhagic cystitis
increased bleeding time
schistosoma
What are some miscellaneous causes of hematuria?
Trauma
Indwelling Catheters
Drug induced
Exercise induced
Endometriosis
What are some causes of pseudohematuria?
Menses
Hemoglobinuria
Myoglobinuria
Red food dye
quinine
phenothiazines
rifampin
What are the causes of hemoglobinuria?
Transfusion reaction
hemolytic anemia
burns
infections
exercise
What are the causes of myoglobinuria?
muscle trauma
prolonged coma
muscle wasting disease
extensive exertion
malignant hyperthermia
seizures
What does a positive dipstick with presence of RBCs indicate?
Hemoglobinuria or Myoglobinuria
What does presence of proteinuira and hematuria indicate?
These are clues to a renal source of problem
What does presence of casts indicate?
Origin from renal parenchyma
What do dysmorphic RBCs indicate?
Feature transglomerular bleeding
What diagnostic consideration should be make when nitrates are found on dipstick?
Want to culture urine and treat
Repeat UA after treatment
What type of radiologic diagnostics should be performed when pyelonephritis is suspected?
IVP
Renal ultrasound
Referral if tests positive or if hematuria persists despite negative tests, will need uretorenoscopy
How do you manage hematuria?
Treat any UTI
Order renal labs
Schedule IVP/renal US
Referral to urology
Explain proteinuria.
Up to 150mg normally excreted per day
Defined as >150 mg/24 hours
Microalbuminuria = 30-300 mg/day
Macroalbuminuria >300mg/day
What are normal urine protein levels?
Tamm-Horsfall = 40-50%
Albumin = 30-40%
Various plasma proteins = 20-30%
What factors contribute to protienuria?
Prevention of excretion by the glomerular capillary wall
Resorption and catabolism by the proximal tubule cells
Production of low-molecular weight protein (overflow origin)
Cockcroft-Gault Equation.
GFR = (140-age) (Wt in kg) (0.85 if female) / (72 * Cr)
Modification of Diet in Renal Disease MDRD Equation.
Calculates the GFR based upon diet changes and factors in gender and ethnicity (african american)
What are normal GFR values?
Females = 100ml/min per 1.73m2
Males = 120ml/min per 1.73m2
What are some causes of proteinuria?
Drug induced - lithium, cyclosporin, ciplatin, NSAIDs
Hereditary - polycystic kidney disease, medullary kidney disease
Increased production - multiple myeloma
Metabolic - amyloid
Immune - drug allergies, collagen/vascular disorders, IgA nephropathy, sarcoid
Infection - bacterial, fungal, parasitic, Tb
Vascular - DM, HTN, sickle cell
What test result would indicate the patient is not at increased risk?
Standard dipstick negative/trace protein
Total protein-creatinine ratio is less than 200mg/dl (recheck at next md visit); >200mg/dl diagnostic eval needed
What should be done with patients at an increased risk when proteinuria is found?
Albumin specific dipstick should be performed; if negative then recheck at periodic visit; if positive then perform albumin-creatinine ratio
if less than 30 recheck periodically
if greater than 30 diagnostic evaluation is needed
What are some diagnostic pitfalls associated with proteinuria?
Amount & concentration can alter tests; test strips most sensitive to albumin
Results can be affected by multiple foods, medications, urine pH, and test strip freshness
How do you manage protienuria?
Treat any UTI and repeat UA
check for orthostatic causes
ACEI/ARB agents
Control of hypertension and/or hyperlipidemia
Referral to renal specialist