NRNP 6550 Final
Urine way of life with UTI
a hundred.000 colonies in asymptomatic: bacteruria
10 - 10.000 colonies in symptomatic patients however additionally pyuria
pyuria: more than 10 leukocytes
increased erythrocytes with pyelonephritis
WBC in urine
fake wonderful with tumor, urethritis and poor series method
Repeat in pregnant women
Lower urinary tract UTI and upper urinary tract UTI
bladder and urethra: cystitis/ urethritis/ prostatitis
kidney and ureters: pyelonephritis/ renal abcess
Uncomplicated and complex uti
Uncomplicated: in ordinary operating urinary tract
Complicated: defects in urinary tract or with other fitness issues
Common pathogens for UTI
E.Coli (elderly women)
Staphylococcus
proteus mirabilis (aged guys)
Klebsiella
enterecoccus
pseudomonas
Providencia (institutionalized)
Fungus: candida
Risk elements for UTI
Female
critically ill
elderly
catheter (because of biofilm)
DM
,calculi, tumor, stricture
neurogenic bladder
Women:
sexual intercourse or new intercourse accomplice
being pregnant
preceding UTI
Men:
prostate enlargement
prostatitis
lack of circumcision
gay
HIV
Findings UTI
Lower:
Dysuria/ urgency/ frequency/ incontinence
suprapubic ache
hematuria
fever/ chills uncommon
No flank ache
Upper:
flank ache
fever and chills
hematuria
n/v
ams (in elderly)
malaise
tachycardia/ tachypnea
Testing and outcomes for UTI
Gold general: urine lifestyle and sensitivity: detection of micro organism. Start with POC: urine
evaluation.
UA: pos for nitrite or leukocyte or blood
CBC: leukocyte with left shift in pyelonephritis
For recurrent UTI in girls or UTI in men rule out obstruction, calculi, or necrosis with:
xr voiding
CT abdomen
US pelvis
MRI pelvis
,Management acute cystitis
First line:
- Single dose Fosfomycin (monurol)
- 3 day: sulfa: trimethoprim/ sulfa (bactrim) (do no longer provide close to shipping of toddler,
give cephalexin instead) or sulfa
- 5 days: nitrofurantoin, warning in elderly
Second line:
- qiunolones: ciprofloxain or levofloxacin for three days (no longer for pregnant ladies!)
- B-lactams: amoxi-clav, cefdinir for 3 - 7 days
Management uncomplicated upper UTI
Outpt:
quinolone: ciprofloxacin for 7 days or levofloxacin for 5 days
Sulfa: trimethoprim/ sulfa (bactrim) for 14 days
Inpt:
Ceftriaxone or cefotaxime
Ampicillin
CAUTI:
bacterial: deal with with AB for 7 days
Candiduria: fluconazole for 14 days
Discomfort: Pyridium
Management acute complicated bacterial pyelonephritis
- Admit
- Aminoglycosides: gentamicin/ tobramycin (now not for monotherapy), based on renal
characteristic (trough much less than 2 and top degree five-10mg/L) and do no longer deliver for
CKD
- Ampicillin
- Cefazolin
- Cefotaxime and Ceftriaxon primarily based on weight problems and pulm disease
Urine analysis: glucose and ketones
Serum glucose at least 180mg/dl for glucose to seem in urine
Glucose in ua as a result of:
- Fancone Syndrome (bad wall: resulting from ahminoglycosides for instance)
- DM
, - Cushing's
- Vit C can provide fake bad
Ketones in urine:
- Alcohol
- Diabetic
- Starvation
Acute Kidney Injury
-Acute renal function loss with lack of ability to excrete metabolic waste merchandise (urea
nitrogen and creatinine) to incapacity to maintain fluid and electrolyte stability.
- Resolves within 3mo
- labeled with RIFLE or etiology
RIFLE
Risk: creatinine up x 1.Five from baseline, GFR lower more than 25% and UO less than
0.5ml/kg/hr for 6hr
Injury: creatinine up x 2 from baseline, GFR decrease greater than 50% and UO much less than
0.5ml/kg/hr for 12hr
Failure: creatinine up x 1.5 from baseline, GFR decrease extra than 25% and UO less than
zero.3ml/kg/hr for 12hr or anuria for 12hr
Loss: Complete loss of renal feature for more than 4 weeks
End-degree Kidney Disease: RRT need for more than 3mo
Prerenal renal failure
Most often the motive of RF
- Decreased blood deliver; intravascular extent depletion, vasodilatory states
- Increased tubular sodium and water reabsorption, inflicting: oliguria, decreased urine sodium,
high urine osmolality, extended urine particular gravity
because of:
1. Low CO
2. Hypovolemia
3. RAS (renal artery stenosis)
4. Aminoglycosides, NSAIDS
Urine way of life with UTI
a hundred.000 colonies in asymptomatic: bacteruria
10 - 10.000 colonies in symptomatic patients however additionally pyuria
pyuria: more than 10 leukocytes
increased erythrocytes with pyelonephritis
WBC in urine
fake wonderful with tumor, urethritis and poor series method
Repeat in pregnant women
Lower urinary tract UTI and upper urinary tract UTI
bladder and urethra: cystitis/ urethritis/ prostatitis
kidney and ureters: pyelonephritis/ renal abcess
Uncomplicated and complex uti
Uncomplicated: in ordinary operating urinary tract
Complicated: defects in urinary tract or with other fitness issues
Common pathogens for UTI
E.Coli (elderly women)
Staphylococcus
proteus mirabilis (aged guys)
Klebsiella
enterecoccus
pseudomonas
Providencia (institutionalized)
Fungus: candida
Risk elements for UTI
Female
critically ill
elderly
catheter (because of biofilm)
DM
,calculi, tumor, stricture
neurogenic bladder
Women:
sexual intercourse or new intercourse accomplice
being pregnant
preceding UTI
Men:
prostate enlargement
prostatitis
lack of circumcision
gay
HIV
Findings UTI
Lower:
Dysuria/ urgency/ frequency/ incontinence
suprapubic ache
hematuria
fever/ chills uncommon
No flank ache
Upper:
flank ache
fever and chills
hematuria
n/v
ams (in elderly)
malaise
tachycardia/ tachypnea
Testing and outcomes for UTI
Gold general: urine lifestyle and sensitivity: detection of micro organism. Start with POC: urine
evaluation.
UA: pos for nitrite or leukocyte or blood
CBC: leukocyte with left shift in pyelonephritis
For recurrent UTI in girls or UTI in men rule out obstruction, calculi, or necrosis with:
xr voiding
CT abdomen
US pelvis
MRI pelvis
,Management acute cystitis
First line:
- Single dose Fosfomycin (monurol)
- 3 day: sulfa: trimethoprim/ sulfa (bactrim) (do no longer provide close to shipping of toddler,
give cephalexin instead) or sulfa
- 5 days: nitrofurantoin, warning in elderly
Second line:
- qiunolones: ciprofloxain or levofloxacin for three days (no longer for pregnant ladies!)
- B-lactams: amoxi-clav, cefdinir for 3 - 7 days
Management uncomplicated upper UTI
Outpt:
quinolone: ciprofloxacin for 7 days or levofloxacin for 5 days
Sulfa: trimethoprim/ sulfa (bactrim) for 14 days
Inpt:
Ceftriaxone or cefotaxime
Ampicillin
CAUTI:
bacterial: deal with with AB for 7 days
Candiduria: fluconazole for 14 days
Discomfort: Pyridium
Management acute complicated bacterial pyelonephritis
- Admit
- Aminoglycosides: gentamicin/ tobramycin (now not for monotherapy), based on renal
characteristic (trough much less than 2 and top degree five-10mg/L) and do no longer deliver for
CKD
- Ampicillin
- Cefazolin
- Cefotaxime and Ceftriaxon primarily based on weight problems and pulm disease
Urine analysis: glucose and ketones
Serum glucose at least 180mg/dl for glucose to seem in urine
Glucose in ua as a result of:
- Fancone Syndrome (bad wall: resulting from ahminoglycosides for instance)
- DM
, - Cushing's
- Vit C can provide fake bad
Ketones in urine:
- Alcohol
- Diabetic
- Starvation
Acute Kidney Injury
-Acute renal function loss with lack of ability to excrete metabolic waste merchandise (urea
nitrogen and creatinine) to incapacity to maintain fluid and electrolyte stability.
- Resolves within 3mo
- labeled with RIFLE or etiology
RIFLE
Risk: creatinine up x 1.Five from baseline, GFR lower more than 25% and UO less than
0.5ml/kg/hr for 6hr
Injury: creatinine up x 2 from baseline, GFR decrease greater than 50% and UO much less than
0.5ml/kg/hr for 12hr
Failure: creatinine up x 1.5 from baseline, GFR decrease extra than 25% and UO less than
zero.3ml/kg/hr for 12hr or anuria for 12hr
Loss: Complete loss of renal feature for more than 4 weeks
End-degree Kidney Disease: RRT need for more than 3mo
Prerenal renal failure
Most often the motive of RF
- Decreased blood deliver; intravascular extent depletion, vasodilatory states
- Increased tubular sodium and water reabsorption, inflicting: oliguria, decreased urine sodium,
high urine osmolality, extended urine particular gravity
because of:
1. Low CO
2. Hypovolemia
3. RAS (renal artery stenosis)
4. Aminoglycosides, NSAIDS
