Renal, Urinary Systems & Electrolytes

Question 1

Clinical Manifestation:

Stress incontinence

Answer 1

1. pelvic floor weakness on PE

2. Hx of small amounts of spontaneous urine release with activities that increase intraabdominal pressure.

Question 2

Describe the results of the following tests in a patient with stress incontinence:

1. Urine analysis
2. Cystometery
3. Postvoid residual volume

Answer 2

All are normal in a patient with stress incontinence

Question 3

When might you consider doing a low dose CT to evaluate renal colic in a pregnant patient?

Answer 3

In the second and third trimesters

Question 4

What is the recommended method to diagnose renal colic in pregnant patients?

Answer 4

Kidney and pelvic ultrasound

Question 5

Describe the effect of pregnancy on serum BUN and creatinine.

Answer 5

During pregnancy there is (1) increased renal plasma flow and (2) increased glomerular filtration rate. Resultingly, there is a decrease in serum BUN and creatinine.

Question 6

Treatment:

Stress incontinence

Answer 6

1. Pelvic muscle exercises (Kegel exercises)
2. urethropexy

*Be sure to attempt Kegel exercises first because surgery is invasive and carries risks.

Question 7

How might epidural anesthesia during labor affect bladder function?

Answer 7

Epidural can impair bladder function such that it becomes overdistended and loses its ability to contract. This can lead to (1) urinary retention and (2) overflow incontinence

Question 8

Treatment:

Urinary retention in postepidural patient

Answer 8

short-term indwelling catheterization

Question 9

Diagnosis:

Asymptomatic bacteriuria

Answer 9

1. asymptomatic patient

2. urine culture grows >100,000 CFU/ml of any single organism

Question 10

Treatment:

Asymptomatic bacteriuria in a pregnant patient?

Answer 10

• Nitrofurantoin 5-7 days
• Amoxicillin 3-7 days
• Amoxicillin-clavulanate 3-7 days
• Fosfomycin (single dose)

Prompt treatment is necessary to prevent progression to pyelonephritis!

Question 11

Why are women more likely to develop UTIs than men?

Answer 11

1. women have a shorter urethra than men

Question 12

What are the predisposing factors for UTIs?

Answer 12

1. Female gender
2. Sexual intercourse
3. Recent antibiotic use
4. Spermicidal contraceptives
5. Close proximity of the urethra to the anus

Question 13

Indicated vs. Contraindicated

Fluoroquinolones for asymptomatic bacteriuria during pregnancy

Answer 13

Contraindicated

Question 14

Indicated vs. Contraindicated

Trimethoprim/sufamethoxazole for asyptomatic bacteriuria during pregnancy

Answer 14

Contrainidicated during the 1st and 3rd trimesters

Question 15

Indicated vs. Contraindicated

Nitrfurantoin for asymptomatic bacteriuria during pregnancy

Answer 15

Indicated!

Give for 5-7 days.

Question 16

What pathogen is responsible for more than 70% of all cases of asymptomatic bacteriuria?

Answer 16

Escherichia coli

Question 17

What risks are associated with asymptomatic bacteriuria during pregnancy?

Answer 17

1. cystitis
2. pyelonephritis
3. preterm birth
4. low birth weight
5. perinatal mortality