,
,Ampicillin
CAUTI:
bacterial: treat with AB for 7 days
Candiduria: fluconazole for 14 days
Discomfort: Pyridium
Management acute complicated bacterial pyelonephritis Correct answer- - Admit
- Aminoglycosides: gentamicin/ tobramycin (not for monotherapy), based on renal
function (trough less than 2 and peak level 5-10mg/L) and do not give for CKD
- Ampicillin
- Cefazolin
- Cefotaxime and Ceftriaxon based on obesity and pulm disease
Urine analysis: glucose and ketones Correct answer- Serum glucose at least 180mg/dl
for glucose to appear in urine
Glucose in ua caused by:
- Fancone Syndrome (bad wall: caused by ahminoglycosides for example)
- DM
- Cushing's
- Vit C can give false negative
Ketones in urine:
- Alcohol
- Diabetic
- Starvation
Acute Kidney Injury Correct answer- -Acute renal function loss with inability to excrete
metabolic waste products (urea nitrogen and creatinine) to inability to maintain fluid and
electrolyte balance.
- Resolves within 3mo
- classified with RIFLE or etiology
RIFLE Correct answer- Risk: creatinine up x 1.5 from baseline, GFR decrease more
than 25% and UO less than 0.5ml/kg/hr for 6hr
Injury: creatinine up x 2 from baseline, GFR decrease more than 50% and UO less than
0.5ml/kg/hr for 12hr
Failure: creatinine up x 1.5 from baseline, GFR decrease more than 25% and UO less
than 0.3ml/kg/hr for 12hr or anuria for 12hr
Loss: Complete loss of renal function for more than 4 weeks
, End-stage Kidney Disease: RRT need for more than 3mo
Prerenal renal failure Correct answer- Most often the cause of RF
- Decreased blood supply; intravascular volume depletion, vasodilatory states
- Increased tubular sodium and water reabsorption, causing: oliguria, decreased urine
sodium, high urine osmolality, increased urine specific gravity
caused by:
1. Low CO
2. Hypovolemia
3. RAS (renal artery stenosis)
4. aminoglycosides, NSAIDS
Result:
- low urine volume
- increased urine creatinine with normal serum creatinine
- minimal proteinuria
- serum K moderately increased
- serum phos moderately increased
- serum calcium normal
- normal renal size on US
4. Low Na+
5. Low H2O
6. High osmolality (500 and up)
7. High uric acid
8. Specific gravity: greater than 1,010
9. Urinary sodium: less than 20
10. Sediment*: 0 (hyaline casts)
11. BUN/ creat ratio: greater than 10/1
Intrarenal Correct answer- Cause:
- Ischemia or nephrotixic injury (rhabdo, multiple myeloma, aminoglycosides, chemo,
contrast)
- Necrosis (acute tubular necrosis ATN) (prolonged hypotension, low CO, liver disease)
- Acute tubulointerstitial nephritis from bacterial pyelonephritis, drug-induced,
immunologic disorders
- oliguric/ anuric
- decreased urine creatinine
- no proteinuria
- serum creatinine increased
- serum K increased
- serum phos increased
- serum Calcium decreased
Low Na+
,Ampicillin
CAUTI:
bacterial: treat with AB for 7 days
Candiduria: fluconazole for 14 days
Discomfort: Pyridium
Management acute complicated bacterial pyelonephritis Correct answer- - Admit
- Aminoglycosides: gentamicin/ tobramycin (not for monotherapy), based on renal
function (trough less than 2 and peak level 5-10mg/L) and do not give for CKD
- Ampicillin
- Cefazolin
- Cefotaxime and Ceftriaxon based on obesity and pulm disease
Urine analysis: glucose and ketones Correct answer- Serum glucose at least 180mg/dl
for glucose to appear in urine
Glucose in ua caused by:
- Fancone Syndrome (bad wall: caused by ahminoglycosides for example)
- DM
- Cushing's
- Vit C can give false negative
Ketones in urine:
- Alcohol
- Diabetic
- Starvation
Acute Kidney Injury Correct answer- -Acute renal function loss with inability to excrete
metabolic waste products (urea nitrogen and creatinine) to inability to maintain fluid and
electrolyte balance.
- Resolves within 3mo
- classified with RIFLE or etiology
RIFLE Correct answer- Risk: creatinine up x 1.5 from baseline, GFR decrease more
than 25% and UO less than 0.5ml/kg/hr for 6hr
Injury: creatinine up x 2 from baseline, GFR decrease more than 50% and UO less than
0.5ml/kg/hr for 12hr
Failure: creatinine up x 1.5 from baseline, GFR decrease more than 25% and UO less
than 0.3ml/kg/hr for 12hr or anuria for 12hr
Loss: Complete loss of renal function for more than 4 weeks
, End-stage Kidney Disease: RRT need for more than 3mo
Prerenal renal failure Correct answer- Most often the cause of RF
- Decreased blood supply; intravascular volume depletion, vasodilatory states
- Increased tubular sodium and water reabsorption, causing: oliguria, decreased urine
sodium, high urine osmolality, increased urine specific gravity
caused by:
1. Low CO
2. Hypovolemia
3. RAS (renal artery stenosis)
4. aminoglycosides, NSAIDS
Result:
- low urine volume
- increased urine creatinine with normal serum creatinine
- minimal proteinuria
- serum K moderately increased
- serum phos moderately increased
- serum calcium normal
- normal renal size on US
4. Low Na+
5. Low H2O
6. High osmolality (500 and up)
7. High uric acid
8. Specific gravity: greater than 1,010
9. Urinary sodium: less than 20
10. Sediment*: 0 (hyaline casts)
11. BUN/ creat ratio: greater than 10/1
Intrarenal Correct answer- Cause:
- Ischemia or nephrotixic injury (rhabdo, multiple myeloma, aminoglycosides, chemo,
contrast)
- Necrosis (acute tubular necrosis ATN) (prolonged hypotension, low CO, liver disease)
- Acute tubulointerstitial nephritis from bacterial pyelonephritis, drug-induced,
immunologic disorders
- oliguric/ anuric
- decreased urine creatinine
- no proteinuria
- serum creatinine increased
- serum K increased
- serum phos increased
- serum Calcium decreased
Low Na+
