JVMM NOTES | OB II|RENAL DISORDERS & UTI

RENAL DISORDERS & UTI IN Cephalosporin 2g

PREGNANCY Nitrofurantoin 200mg
Fosfomycin 3g
RENAL PHSYIOLOGY IN NORMAL PREGNANCY 3-Day Course Amoxicillin 500g
*due to poor Ampicillin 250g
PREGNANCY-INDUCED URINARY TRACT CHANGES . . . compliance, locally it
1051 is 7-day tx
Cephalosporin 500mg BID
Nitrofurantoin 100mg BID
INCREASED DECREASED for Treatment Nitrofurantoin 100mg QID for
blood volume systemic vascular Failure 21d
RBC mass (50%) resistance for suppression Nitrofurantoin 100mg for
BP in 1st-2nd trimester for bacterial remainder of pregnancy at
CO (30%)
persistence or bedtime
renal size (1 cm) serum creatinine * Nitrofurantoin if prolonged in use
recurrence
urine protein (150 (20%) has some pulmonary effect, HA or
260) o due to inc RBF congenital in 3rd tri.
o <300 is dec GFR (30%)
abnormal check for GFR, 24hr crea PCP Guidelines on Diagnosis and Mgt of UTI in
clearance, prot/crea, Adults 2013
albm/crea, Cephalexin/Cefuroxime 500mg BID x 7d
pelvocalyceal dilatation Amoxicillin-clavulanate 625mg BID x 7d
more on the right Nitrofurantoin 100mg QID x 7d (given 2nd
due to trimester)
o ureter compression by gravid uterus + Fosfomycin 3g single dose (safe for whole
smooth muscle relaxation pregnancy)
urinary retention * Bactrin (sulfamethoxazole and trimethoprim) not the choice
due to resistance and unsafe during 1st and 3rd trimester
due to:
o enlargement of retroverted uterus
FOLLOW-UP
o fibroid/myoma
urine culture 1 wk after course completion
o pelvic mass
complications:
resolves by
- preterm infants
o 16 wks (uterus grows out of pelvis)
- low-birthweight neonates
- acute cystitis
URINARY TRACT INFECTIONS
URINARY TRACT INFECTIONS . . . . . . . . . . . . . . . . . . . - pyelonephritis
1052
most common bacterial infection during II. Acute Uncomplicated Cystitis
pregnancy
CLINICAL MANIFESTATIONS
most common pathogen: E. coli
dysuria, frequency, urgency, pyuria,
bacteriuria, hematuria
I. Asymptomatic Bacteriuria (ASB)
persistent actively multiplying bacteria w/in
DIAGNOSIS
UT producing NO symptoms pretreatment urine C&S test of midstream
clean catch urin
SCREENING
if absent, lab critera accdg. to PCPG
urine culture NOT cost-effective when
- 8 pus cells/mm3 in uncentrifuged
prevalence is low
urine OR 5 pus cells/HPF in
At lower concentrations, it is prudent to treat
centrifuged urine
due to high risk of pyelonephritis
- PLUS (+) dipstick for leukocyte
PCP Guidelines on Diagnosis & Mgt of UTI in
esterase and nitrite test
Adults 2013
- Screen ALL pregnant women for ASB
MANAGEMENT
once, between 9-17 wks AOG, preferred 3-day regiment is 90% effective (Williams)
on 16th wk AOG
if insufficient, may lead to pyelonephritis by
strong recommendation due to high
ascending infection
quality of evidence
- Std Urine C&S: screening test of choice
PCP Guidelines on Diagnosis and Mgt of UTI in
- in absence of urine C&S, Adults 2013
Gram of uncentrifuged urine Cephalexin 500mg QID x 7d
>1 organism/OIF Cefuroxime 500mg BID x 7d
- Urinalysis or Dipstick for WBS esterase Amoxicillin-clavulanate 625mg BID x 7d
and/or nitrite tests Nitrofurantoin 100mg QID x 7d
NOT recommended as initial screen
NB:
DIAGNOSIS
if no C&S done, empiric tx is based on local
100,00 CFU/mL in 2 consecutive midstream
susceptibility of uropathogens
clean-voided specimen OR
concurrent GDM and/or urolithiasis should be
100,00 CFU/mL in a single catheterized
monitored at monthly intervals until delivery
specimen
to ensure urine remains sterile during
pregnancy
MANAGEMENT
Single-Dose Amoxicillin 3g
Urethritis
Ampicillin 2g

UST FMS 2016 | 2ND SEM, AY 2014-15 |joelvergilmmendiola@yahoo.com 1

 JVMM NOTES | OB II|RENAL DISORDERS & UTI

pyuria, lower urinary tract sx, sterile urine

culture, mucopurulent cervicitis NEPHROLITHIASIS
etiology: Chlamydia trachomatis NEPHROLITHIASIS . . . . . . . . . . . . . . . . . . . . . . . . . . . .
mgt: azithromycin 1056

III. Acute Pyelonephritis Calcium Salts

most common serious medical complication - 80% of stones
of pregnancy since it is the leading cause of - new stone formation every 2-3 years
septic shock - c. oxalate if acidic urine, c. phosphate if
alkaline
CLINICAL MANIFESTATIONS
fever (>38c) w/ lumbar or flank pains, CVA GENERAL MGT
tenderness, nausea and vomiting increase fluids (IV or oral)
decrease sodium and potassium intake
analgesics
LABORATORY FINDINGS
pyuria >5 WBC/HPF centrifuged urine WORK-UP
bacteriuria >10,000 CFU/ml on urine culture if w/ abn dilatation w/o stone visualization,
- transabdominal color Doppler sonography
Philippine Clinical Practice Guidelines on the ureteral jets of urine
Diagnosis & Mgt of UTI in Adults 2013 - one-shot pyelogram
urine C&S not routinely done - MRI 2nd line test
blood culture not routinely recommended r/o hyperPTH
EXCEPT in septic patients
renal UTZ reserved for women who failed to
respond to initial tx

MANAGEMENT
admission
intravenous hydration cornerstone of tx MANAGEMENT
antipyretics Obstructive Relief
work-ups: CBC, urine C&S, serum creatinine, cystoscopic placement of double-J ureteral stent
electrolytes percutaneous nephrostomy placement
insert indwelling Foley catheter (IFC) surgical removal of stones
if w/ dyspnea/tachypnea, CXR w/ abdominal - intractable pain, obstruction, infection, heavy
shield hematuria
Antibiotics - via cystoscopy using flexible basket
o Ampicillin+Gentamycin OR - extracorporeal shock-wave lithotripsy C/I in
Ampicillin+Sulbactam (if G+ organisms) pregnancy
o Cefazolin or Ceftriaxone
o shift to oral for 7-10d when afebrile for 48 Other topics not in the lecture:
hrs PREGNANCY AFTER RENAL TRANSPLANTATION . . . . .
o recommended duration: 14 days 1057
POLYCYSTIC KIDNEY DISEASE . . . . . . . . . . . . . . . . . . .
FOLLOW-UP & COMPLICATIONS 1058
complications due to endotoxins GLOMERULAR DISEASES . . . . . . . . . . . . . . . . . . . . . . .
o pulmo injury (ARDS) 1058
o anemia CHRONIC RENAL DISEASE . . . . . . . . . . . . . . . . . . . . . .
1060
o uterine contractility
ACUTE KIDNEY INJURY . . . . . . . . . . . . . . . . . . . . . . . .
repeat urine C&S 1wk after completion (test
1063
of cure)
LOWER URINARY TRACT LESIONS . . . . . . . . . . . . . . . .
monthly urine cultures until delivery
1064
for px w/ recurrence and whose cultures show
the same organisms as initial, recommend 4-
6 wk regimen
cranberry juice is NOT recommended in
prevention
if no clinical improvement:
o r/o obstruction or others (e.g.
intrarenal/perinephric abscess)
o request for
renal sonography for
ureteral/pyocalcyeal dilatation *Items in smaller fonts are from Dra. Sisons side
plain abd x-ray detects 90% of comments.
stones

UST FMS 2016 | 2ND SEM, AY 2014-15 |joelvergilmmendiola@yahoo.com 2