Nephro- UTIs & cancer

What is an infection in any part of the urinary system (urethra, bladder, ureter & kidney), most commonly in the lower urinary tract?

UTI

What causes UTIs in children under 5?

Congenital abnorms of urinary tract such as vesicoureteral reflux or obstruction

What causes UTIs in children 6-15 y/o?

Functional abnorms of urinary tract such as dysfunctional voiding, hygiene

What causes UTIs in females ages 6-35 years/o?

Sexual intercourse & diaphragm use

What are RF for UTIs in females 36-65 y/o?

Gynecologic surgery & prolapse

What causes UTIs in females > 65 y/o?

Loss of estrogen in menopause thins vagina & urethra, soiling of perineum from fecal incontinence, chronic use of catheters

Who is UTI MC in, uncircumcised teen males or circumcised teen males?

Uncircumcised

What causes UTIs in males 16-35 y/o?

Sexual intercourse & STIs

What causes UTIs in males > 65 y/o?

Almost always prostate issues (MC BPH)

What are proactive properties of urine against UTIs?

Osmolality, urea concentration, organic acid concentration, & pH inhibit bacterial growth

Tamm-horsfall glycoprotein inhibits bacterial adherence

What are the 4 possible modes of bacterial entry into the GU tract?

Ascending route (MC), hematogenous spread, lymphogenous spread, & direct extension

Why are women more likely to get UTIs than men?

Short nature of urethra & it’s close proximity to the vaginal vestibule and rectum

What is the most common pathogen of uncomplicated cystitis & pyelonephritis?

E. coli

Which bacteria are more likely to cause recurrent UTIs?

Klebsiella, proteus, enterobacter

Which bacteria are more likely to be associated with hospital acquired UTIs?

Pseudomonas & staphylococcus

What is the most common pathogen that causes UTIs in sexual active female adolescents?

Staph saprophyticus

What is the MC type of UTI that is also most commonly seen in women?

Acute cystitis

What is acute cystitis?

Bladder infx caused by enteric organisms such as E. coli, typically through ascending route

What ssx are associated with acute cystitis?

Irritative voiding sx → frequency, urgency, dysuria, suprapubic pain, post-coital trigger

What is the diagnostic workup for acute cystitis?

H&P, urine dipstick, microscopic analysis, gram stain, C&S, pregnancy test in females

What is a relapsing infection of acute cystitis?

Recurrent infx w/ same organism → suggests urolithiasis

Check renal US & non-contrast CT & differentiate from reinfection (different organism)

What is the treatment for asymptomatic non pregnant females with uncomplicated acute cystitis?

None

What is the treatment for symptomatic non pregnant women with uncomplicated acute cystitis?

Nitrofurantoin, Cipro, Fosfomycin,

Trimethoprim-sulfamethoxazole (Septra DS) → can be ineffective in significant # of pts d/t emergence of resistant organisms

What is the treatment for symptomatic & asymptomatic pregnant females with uncomplicated acute cystitis?

Augmentin, Reflex, Cefpodoxime

What is a urinary analgesic agent that can discolor urine, fabric, & contact lenses?

Phenazopyridine (Pyridium)

What are adjunctive tx options for acute cystitis?

Phenazopyridine, post coital urination, hot sitz bath, cranberry juice

How is acute cystitis in men treated differently than in women?

MUST work it up to look for a cause bc rare → anatomic defect, infected stones, prostatitis, chronic urinary retention, STIs

Same tx as females, refer to uro if recurrent

What is another name for interstitial cystitis?

Painful bladder syndrome

What condition is primarily a disease of middle aged women characterized by fibrosis of bladder wall with consequent loss of bladder capacity?

Interstitial cystitis

How is interstitial cystitis diagnosed?

Dx of exclusion- need neg UA, Cx, & cytology bx of bladder wall

What are the 4 cardinal sx of interstitial cystitis?

Bladder or pelvic pain, urgency, frequency, nocturia

What is the treatment for interstitial cystitis?

No cure, half spontaneously resolve ~ 8 mos

Supportive → hydrodistention (dx & tx), vesical lavage w/ silver nitrate, amitriptyline, DMSO, steroids, voiding training, pelvic floor exercises

What condition is an infectious inflammatory disease involving kidney parenchyma and renal pelvis, that usually ascends from lower urinary tract?

Acute pyelonephritis

What organisms most commonly cause acute pyelonephritis?

Gram negative, E coli

What symptoms are associated with acute pyelonephritis?

F/c, flank pain, irritative voiding, N/V, possible diarrhea, fever, tachycardia, CVAT

What is the dx for acute pyelonephritis?

CBC → leukocytosis

UA → pyuria, bacteriuria, hematuria, white cell casts (hallmark)

Urine Cx+ for offending pathogen

What might imaging show in a complicated case of acute pyelonephritis?

Hydronephrosis from stone/other obstruction

What complications can occur with acute pyelonephritis?

Sepsis w/ shock, abscess formation if not treated, diabetics can have life threatening emphysematous pyelonephritis from gas producing organisms

What is the outpatient treatment for acute pyelonephritis?

*reserved for non pregnant, compliant pts w/ mild uncomplicated dz

FQs → cipro or levo; F/U in 2 days

What patients would be admitted for acute pyelonephritis?

Severe/complicated infx → pregnancy, obstructive uropathy, diabetics, multi resistant pathogens, uncontrolled sx

What is the inpatient treatment for acute pyelonephritis?

IV ceftriaxone or ampicillin & aminoglycoside while awaiting C&S results

Continue IV until fever free x 24 hrs, then switch PO

F/U urine Cx for TOC

What is the next step if a fever persists ≥ 72 hours in acute pyelonephritis treatment?

US or non contrast CT to exclude complicating factors

What is the etiology of bacterial prostatitis?

Ascent up urethra & reflux of infected urine into prostatic ducts

What bacteria usually cause bacterial prostatitis?

Gram neg rods, esp e. coli & pseudomonas

How do patients with bacterial prostatitis present?

Abrupt onset of perineal, sacral, or suprapubic pain, fever, chills, malaise, & irritative voiding

How do labs appear in bacterial prostatitis?

Leukocytosis, pyuria, bacteriuria, varying degrees of hematuria, positive urine cx

What is the treatment for bacterial prostatitis?

FQs (best), TMP-SMX, macrolides

IV ampi & aminoglycosides if severe

F/U with urine cx

*30 days- 4-6 wks for acute; 3-4 mos for chronic

If urinary retention develops in bacterial prostatitis, what is contraindicated?

Urethral catheter, need suprapubic aspiration instead

What can develop if bacterial prostatitis is inadequately treated?

Prostate abscess or chronic bacterial prostatitis

What is the MC type of kidney cancer that arises from PCT/small tubules of the nephron?

Renal cell carcinoma (RCC)

What are RF for RCC?

Smoking, obesity, analgesics, FMH, MC in 50-70 y/o

How would RCC present?

Palpable mass, CVAT, back pain, mets to bone, hematuria, hypercalcemia

Dx w/ US, CT, or MRI

What is the treatment for RCC?

Nephrectomy, interferon, biologics

What is the MC childhood abdominal malignancy?

Wilm’s tumor (nephroblastoma)

What age is wilms tumor MC in?

3.5 - 5 y/o

What are causes of wilm’s tumor?

WT1 gene anomalies at chromosome 11p15, cryptorchidism, horseshoe kidney, hypospadias

How does wilm’s present?

Abd mass and/or pain, UTI, HTN

Dx w/ UA, CT, MRI

What is the treatment for wilm’s tumor?

Nephrectomy, chemo, RT; good prognosis