R&U Systems 2

Urinary tract infection

Infection secondary to pathogenic microorganisms

Risk Factors:

• Female anatomy (shorter urethra)

• Sexual activity

• Birth control- specifically diaphragms and spermicidal agents

• Menopause

• Anatomical urinary tract problems

• Blockages – kidney stones or enlarged prostate

• Suppressed immune system

• Catheter use

• Recent urinary procedure

TYPES OF UTI

Lower UTI

• Cystitis: bladder

• Prostatitis: prostate

• Urethritis: urethra

Upper UTI

• Pyelonephritis: kidneys

• Interstitial Nephritis: kidney tubules

• Renal Abscesses

LOWER URINARY TRACT INFECTION

Bacteria gain access to lower urinary tract → Evade host defensive mechanisms

Due to:

• Immunosuppression

• Decreased acidity of urine

• Reflux of urine

• decreased mucosal/IgA/prostatic secretions

• damage to lining of system, etc.

all of which are a risk of infection!!!

#1 cause: e.coli

UTI signs and symptoms

Kidneys

• Back or side pain

• High fever (infection)

• Shaking and chills

• Nausea

• Vomiting

Bladder

• Pelvic pressure

• Lower belly discomfort

• Frequent, painful urination

• Blood in urine

Urethra

• Burning with urination

• Discharge

Elderly = confusion

Urinalysis and urine culture

If bacteria found in UA → Pt will need a urine culture and sensitivity (C & S)

Why?

• which type of antibiotic is given (ONLY TREAT AFTER URINALYSIS

• before do a general antibiotic

UTI treatments and prevention

Antibiotics - to treat the cause

Commonly used for simple UTIs:

• Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS)

• Fosfomycin (Monurol)

• Nitrofurantoin (Macrodantin, Macrobid, Furadantin): proactively

• Cephalexin

• Ceftriaxone

+ Phenazopyridine (Pyridium)- for symptoms: To relieve pain, burning, urgency and frequency; turns urine a crazy color and will stain.

PATIENT EDUCATION: PREVENTION OF UTI

• Drink plenty of liquids, especially water.

• Try cranberry juice.

• D mannose

• Wipe from front to back.

• Empty your bladder soon after having sex. Also drink a full glass of water to help flush bacteria.

• Avoid potentially irritating feminine products: deodorant sprays, douches and powders

• Change birth control method

GLOMERULONEPHRITIS

Definition: inflammation of glomerular structures

What happens in the glomerulus? Filtration through the membrane

Etiology: exact cause unknown but immune reaction causes antibody-antigen complexes (hypersensitivity type III) to get trapped in the basement membrane.

Now things that shouldn’t get into Bowman’s Capsule do

Types

 Acute, chronic

 Primary – usually due to Group A Beta-hemolytic strep (GABHS)

 Secondary – some other disease triggers – like SLE

Signs & Symptoms

• Hematuria- blood in urine

• Proteinuria- protein in urine

• Azotemia – waste products stay in blood because nephron isn’t filtering them out

• Fatigue

• Oliguria – dramatic decrease in urine output

• Edema – protein spilled into urine

• Hypertension – kidney isn’t regulating NA-K like normal

• Decreased GFR (Quickly pushing fluids through)

• Increased glomerular membrane permeability; change how fluids flow out and

Glomerulonephritis treatment

Acute

• Symptomatic support

• Resolution

Chronic

• Permanent scarring

• Can lead to renal failure

• ACE inhibitors → protect blood flow into the kidneys

• Corticosteroids → decrease inflammation → less scar tissue

• Diuretics → remove excess fluid

• Diet changes → eating less protein, Na, & K

• If renal failure: Dialysis

Pyelonephritis

Inflammation of the kidneys (tubules, interstitium, pelvis)

Etiology

Acute: ascending infection (from GU)

• Gram-negative bacteria (E.Coli) most common

Chronic

• Reflux (fluid going back up into kidneys) and infection

Signs & symptoms

• Fever, chills, malaise

• Back pain (CVA tenderness = costovertebral angle bottom of rib cage)

• Cloudy urine, foul odor

• Dysuria, → frequency & urgency

• WBCs & protein in urine

• Elevated WBC in CBC and maybe serum

• Chronic = change in ability to concentrate urine

• What will specific gravity and urine osmolality look like?

• specific gravity will go down, and will be diluted

• Waste cannot leave body if unable to dilute

PYELONEPHRITIS TREATMENT

Antibiotics:

• Trimethoprim-sulfamethoxazole (TMP-SMX)

• Amoxicillin or Augmentin

• Ceftriaxone or cephalexin

• Ciprofloxacin or levofloxacin: achilles tendon rupture

Hydration:

• IVF

Symptom management:

• Pain

• Nausea

Kidney Labs

Creatinine

• Normal range: 0.6-1.2 mg/dL

• Waste product from digestion of protein and normal breakdown of muscle tissue: workout normal muscle tears.

• Healthy kidneys filter creatinine from blood

Blood urea nitrogen (BUN)

• Normal range: 8-20 mg/dL

• Liver produces ammonia (contains nitrogen)

• Nitrogen combines with carbon, hydrogen and oxygen = urea

• Healthy kidneys filter urea from blood

• If elevated but creatinine isn’t- usually dehydration

Creatinine and BUN ↑ when kidneys are stressed

Glomerular filtration rate

• Measures kidney function

• Decreases with kidney disease and age

A 35-year-old woman presents with high fever, chills, dysuria, flank pain, and nausea. Physical examination reveals costovertebral angle (CVA) tenderness on the right. Urinalysis shows pyuria, bacteriuria, and white blood cell casts. A diagnosis of acute pyelonephritis is made.

Which of the following best explains the underlying pathophysiology of this condition?

A. Direct invasion of renal glomeruli by viral pathogens

B. Immune-mediated destruction of renal tubules

C. Ascending infection of the urinary tract leading to inflammation of the renal parenchyma and pelvis

D. Crystal deposition within the renal tubules causing tubular obstruction and necrosis

C. Ascending infection of the urinary tract leading to inflammation of the renal parenchyma and pelvis

a is glomerulonephritis

Chronic renal failure

• Chronic renal failure is the deterioration & destruction of nephrons with progressive loss of renal function

• Renal function lost cannot be regained

• Function well below our anatomic reserve

• Most common causes of CRF = long term uncontrolled DM & HTN

What are the stages in the progression of the disease?

• Renal insufficiency (stages 3-4)

• Renal failure (stage 5)

• End stage renal disease (ESRD

Diminished renal reserve

Renal Insufficiency

• headaches

• nocturia/polyuria

• GFR-25% of normal

• Increase BUN and serum creatinine

• weakness and fatigue

End Stage

• shallow yellow discoloration pruritus & uremic frost

• CNS depression, peripheral neuropathy

• anorexia, N/V, GI bleeding peptic ulcer disease

• hyperglycemia, hyperlipidemia, gout

• psychological changes, withdrawal, depression, psychosis

• anemia-bleeding

• hyperparathyroid, amenorrhea, infertility, impotence, renal osteodystrophy, GFR less than 10%

• Hemodialysis

Uremic Frost

Chronic Renal Failure complications

CHRONIC RENAL FAILURE: ALTERED HOMEOSTASIS

Problems associated with CRF reflect inability of the kidneys to perform necessary functions

• Waste excretion

• Fluid & electrolyte balance

• Acid-base regulation

• Vit D synthesis

• Erythropoietin synthesis

• Regulation of BP

CHRONIC RENAL FAILURE COMPLICATIONS

1) Accumulation of nitrogenous wastes (urea, creatinine, uric acid)

• Azotemia

2) Declining ability to produce urine

• Oliguria, anuria, uremia

3) Electrolyte imbalances

• Hyperkalemia

4) Fluid imbalance

• HTN, Increase risk of HF

6) Decreased erythropoietin production

• Anemia

7) Acid-base imbalance

• Acidosis

8) Decreased activation of vitamin D

• Hypocalcemia

• Increased phosphorous