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URINARY TRACT INFECTION, NEPHROLITHIASIS, CHRONIC RENAL FAILURE - Coggle…
URINARY TRACT INFECTION
Infection of urethra, bladder, or kidney
-
CHRONIC
PYELONEPHRITIS
-
Etiology:
- Vesicoureteral reflux children
- Obstruction in adults (Kidney stones,
BPH, cervical carcinoma)
- Recurrent or inadequately treated
episodes of acute pyelonephritis
CYSTITIS
Infection of
the bladder
Clinical: Dysuria, urinary frequency,
urgency, and suprapubic pain.
Pathogens:
1) E coli (80%)
2) Staphylococcus saprophyticus - young, sexually active women (but E coli is still more common in this population)
3) Klebsiella pneumoniae
4) Proteus mirabilis - alkaline urine with ammonia scent
5) Enterococcus faecalis
*IF Sterile pyuria (pyuria SO > 10 WBCs + leukocyte esterase) with a negative urine culture →Chlamydia trachomatis or Neisseria gonorrhoeae (dominant presenting sign of urethritis is dysuria)
Laboratory findings:
- Urinalysis cloudy urine with > 10 WBCs
- Dipstick: + leukocyte esterase (pyuria), + nitrites
- Culture <100,000 CFU (gold standard)
Tx: antibiotics
(TMP-SMX, nitrofurantoin)
*Systemic
signs absent
(fever-chills,
malaise)
-
NEPHROLITHIASIS
-
CLINICAL
- Colicky pain (back pain radiating to the groin) USUALLY SUDDEN ONSET
- Hematuria
- Unilateral flank tenderness
- Rare in children/teens except: nephrocalcinosis if tubular renal acidosis and recurrent in Cystinuria.
- Stones should passed within hours- 12 days if not >> Qx
FINDINGS
- Calcium stones 75-80% cases: oxalate octahedron shape, square with X in center & phosphate elongated, wedge shaped forms rosettes
- Magnesium ammonium phospate (Struvita) 15% rectangular prism
- Uric acid 5% Yellow-red-brown diamond/rhombus, no radiographic opacity, needs contrast
- Cystine 1% flat yellow hexagonal
Tx
Base in the etiology:
- Cystinuria: Urinary alkalinization (acetazolamide)
- Tx of the underlying cause
- Thiazide (chlorthalidone, hydrochlorothiazide) in Hypercalciuria
CHRONIC RENAL FAILURE
End-stage kidney failure
Result from glomerular, tubular, inflammatory, or vascular insults
Most common causes are diabetes mellitus, hypertension, and glomerular
disease.
Clinical features
- Uremia → ↑↑ BUN (azotemia) → nausea, anorexia, pericarditis, platelet dysfunction, encephalopathy + asterixis, and deposition of urea crystals in skin→ dark skin and uremic frost
- Salt and water retention with resultant hypertension
- Hyperkalemia with metabolic acidosis
- Anemia due to decreased erythropoietin production by renal peritubular interstitial cells
- Hyperuricemia (can't pee uric acid)
- Hypocalcemia due to decreased 1-alpha-hydroxylation of vitamin D by proximal renal tubule cells and hyperphosphatemia
- Low vitamin D
- Renal osteodystrophy due to secondary hyperparathyroidism, osteomalacia, and
osteoporosis
Tx
- Dialysis or renal transplant.
- Cysts often develop within shrunken e
nd-stage kidneys during dialysis→ ↑↑ risk
for renal cell carcinoma