Podcasts about Pyelonephritis

UTIs - who hasn't had one! Or... thinks they've had? We're talking all things UTIs, pyelonephritis, and all things that ...aren't quite UTIs. Chug some ural, fill your drink bottles, and get some good quality loo roll! Ps Scomo was not on our 2024 bingo card but here we are! Tune in and drink up!

Episode 168: UTI in MalesFuture Dr. Tran gives a summary of UTIs in Males, including epididymitis, orchitis, urethritis, prostatitis, and pyelonephritis. Diagnosis and treatment were briefly described and some differences with female patients were mentioned by Dr. Arreaza.  Written by Di Tran, MS-3, Ross University School of Medicine. Editing and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.WHAT ARE URINARY TRACT INFECTIONS?Urinary Tract Infection (UTI) is an infection of any part of the urinary tract system. It may involve any part of the renal system, the kidneys, the ureters, the bladder, the prostate, and the urethra.  Different from men, a woman may get a UTI more easily due to their anatomical difference. A woman's urethra is shorter and lies close in proximity to both the vagina and the anus, which allows easy access for bacteria to travel up to the bladder.UTI is further subdivided into two different categories, depending on where the infection takes place within the urinary tract:Lower Tract Infection – cystitis and urethritis when the infection occurs on the bladder and the urethra, respectively.  Common infections are a result of bacteria migrating from the skin (and also from sexual organs) to the urethra and ending up in the bladder.In males, other forms of lower tract infection can result in prostatitis, epididymitis, and orchitis.Upper Tract Infection - aka pyelonephritis, is a more concerning infection that involves the upper parts of the urinary system, in other words, the ureters, and kidneys.AGE DIFFERENCES IN UTI FOR MEN:For men, the incidence of UTI increases with age. Dr. John Brusch reports UTI rarely develops in young males and the prevalence of bacteriuria is 0.1% or less.  Men who are 15-50 years of age often have urethritis due to sexually transmitted infection (STI), mainly by Neisseria gonorrhoeae and Chlamydia trachomatis.  Symptoms include frequency, urgency, and dysuria (most common).Men who are 50 years or older, especially those with prostatic hyperplasia, will have signs and symptoms of incomplete bladder emptying, hesitancy, slow stream, difficulty initiating urination, and dribbling after urinating. Due to the enlargement of the prostate gland, there will be partial blockage of urine flow from the bladder, which in turn, creates a reservoir where bacteria can grow and cause an infection. The most common offending microorganism for this age group is Escherichia coli.Interestingly, while UTIs are rare among men under 60, by the age of 80, both women and men have similar incidence rates. The bladder tends to have a higher residual volume in older males because the prostate grows no matter what, it´s just a part of aging for males. Some may end up with more or less lower urinary tract symptoms, but the prostate is enlarged in general.Other risk factors for UTI in males are men who are not circumcised, urethral strictures, fistulas, hydronephrosis (or dilated ureters overfilled with urine due to failure of drainage to the bladder), and the use of urinary catheters. DIFFERENT TYPES OF UTIs IN MALES:EPIDIDYMITIS:The infection starts from the retrograde ascending route from the prostatic urethra, backing up to the vas deferens, and eventually ending in the epididymis.In men who are younger than 35 years of age, the usual pathogens are C. trachomatis and N. gonorrhoeae (sexually transmitted).In men who are older than 35 years of age, the usual offending agents are Enterobacteriaceae and gram-positive cocci (E. coli as mentioned previously).ORCHITIS:This unique UTI is caused by viral pathogens, such as mumps, coxsackie B, Epstein-Barr (EBV), and varicella (VZV) viruses.  Several studies have shown that patients having orchitis have a history of epididymitis. Fortunately, this infection is uncommon, and it was the main reason to develop the MMR vaccine. It is caused by viruses other than mumps, so you can still have orchitis even if you are vaccinated. Antibiotics are not prescribed for viral orchitis.BACTERIAL CYSTITIS:Having a similar pathophysiology of ascending infection mechanism, male patients in this category often present frequency, urgency, dysuria, nocturia, and suprapubic pain. On a side note, having hematuria is concerning, especially without symptoms, because it's automatically a red flag that should prompt an immediate evaluation in search of other causes besides infection, such as underlying malignancy. Possible etiologies are calculi, glomerulonephritis, and even schistosomiasis infection that can ultimately result in squamous cell carcinoma of the bladder. Arreaza: Let me share a little anecdote about hematuria. One Sunday when I was a resident I woke up with hematuria. Of course, I immediately went to urgent care, knowing hematuria means trouble in men. I had a urine dipstick test, which was normal. The first thing the nurse practitioner asked me was, “Did you eat any beets?”, and I never eat beets, but that day I had a full bag of beet chips. So, yes, that was the cause of my pseudo-hematuria. Lesson learned: Always ask about beets when you have a patient with painless hematuria with a normal dipstick. PROSTATITIS:This is an infection of the prostate gland. The most common offending agent is E. coli. Acute prostatitis will present with signs of “acute” infection, such as fever, chills, and suprapubic pain. On rectal exam, we will find a prostate that is warm, swollen, boggy, and very tender. Make sure you perform a gentle prostate exam as you may spread bacteria to the blood and cause bacteremia and potentially sepsis. Patients are normally very sick and it is not your typical cystitis, but it is more severe. Chronic Prostatitis can arise from different causes, ranging from retrograde ascending infection, “chronic” exposure to urinary pathogens, and even autoimmune etiologies. The majority of patients often are asymptomatic.   URETHRITIS:This infection is further classified into two groups, gonococcal and non-gonococcal. For gonococcal urethritis, N. gonorrhoeae is the most common pathogen. Agents of non-gonococcal urethritis include C. trachomatis, Ureaplasma, trichomonas, and Herpes Simplex Virus (HSV).  Patients often present symptoms of dysuria, pruritus, and purulent penile discharge.PYELONEPHRITIS:Following a retrograde ascending mechanism, an infection may travel from the bladder and make its way to the kidney, causing damage and inflammation to the renal parenchyma. According to Dr. John Brusch, E. coli is responsible for approximately 25% of cases in males. Pyelonephritis presents with chills, fever, nausea/vomiting, flank pain/costovertebral angle tenderness, and dysuria.  Other findings include pyuria and bacteriuria.  Pyelonephritis is a common cause of sepsis. Diagnosis of UTIs.URINE STUDIES: Urine culture remains the gold standard for diagnosis of UTI. Other studies include suprapubic aspiration, catheterization, midstream clean catch, and Gram stain. Imaging studies are not always needed, but you may order plain films, ultrasonography, CT scans, and MRIs.  It will depend on the severity of your case and your clinical judgment.UTIs in women: In males, we should perform urine culture and susceptibility studies. However, in women, urine studies are not needed all the time, they should be reserved for women with recurrent infection, treatment failure, history of resistant isolates, or atypical presentation. This is done to confirm the diagnosis and guide antibiotic selection.Interestingly, in a recent evidence review, published in the American Family Physician journal, women can self-diagnose their uncomplicated cystitis. All that is needed is having typical symptoms (frequency, urgency, dysuria/burning sensation, nocturia, suprapubic pain), without vaginal discharge. If you have those elements, you have enough information to diagnose, or even the patient can self-diagnose, an uncomplicated UTI without further testing, but in males, you should ALWAYS perform urine studies.TREATMENTS:Men with UTI should ALWAYS receive antibiotics, with urine culture and susceptibility results guiding the antibiotic choice. Laboratory results will help us determine the best treatment plan. UTIs are often treated with a variety of antibiotics.  Dr. Robert Shmerling, of Harvard Medical School, states that most uncomplicated lower tract infections can be eradicated with a week of treatment with antibiotics. Common antibiotics for UTI are fluoroquinolones, trimethoprim-sulfamethoxazole (TMP-SMZ), minocycline, or nitrofurantoin.On another hand, if it's an upper tract infection or prostatitis, the course of treatment can be extended for longer periods. For those patients who are hemodynamically unstable or have severe upper UTI, hospital admission is required to monitor for complications and IV antibiotics.UTIs in males are less frequent than UTIs in females, except when patients are 80 years and older when the incidence is similar in both sexes. UTIs in males must prompt further evaluation because if left untreated, they can have detrimental effects on your patients' health. As a take-home point, UTI in males is less common than in females, and it requires urine studies or other studies to identify the etiology and guide treatment. Antibiotics are always used, and you may guide your treatment depending on the results. Imaging is not always needed, but use your clinical judgment to make a more specific diagnosis and detect complications promptly. __________Conclusion: Now we conclude episode number 168, “UTI is Males.” Future Dr. Tran described the different anatomical areas that can be infected in males with UTI. She reminded us that UTIs in males always need to be treated with antibiotics and urine cultures are done to guide treatment. Dr. Arreaza mentioned a few differences in the diagnosis and treatment of UTIs in females. For example, women can self-diagnose an uncomplicated cystitis, and urine studies or antibiotics are not always needed in women. This week we thank Hector Arreaza and Di Tran. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Shmerling, R. H. (2022, December 5). Urinary tract infection in men. Harvard Health Publishing. https://www.health.harvard.edu/a_to_z/urinary-tract-infection-in-men-a-to-z.Brusch, J. L. (2023a, March 27). Urinary tract infection (UTI) in males. emedicine.medscpae.com. https://emedicine.medscape.com/article/231574-overview.Kurotschka PK, Gágyor I, Ebell MH. Acute Uncomplicated UTIs in Adults: Rapid Evidence Review. Am Fam Physician. 2024;109(2):167-174. https://www.aafp.org/pubs/afp/issues/2024/0200/acute-uncomplicated-utis-adults.htmlRoyalty-free music used for this episode: Tropicality by Gushito, downloaded on July 20, 2023, from https://www.videvo.net/royalty-free-music/

FDA withdraw multiple myeloma treatment after a confirmatory trial showed an increased risk of death; latest efficacy results for lower respiratory tract disease vaccine; CDC Chikungunya virus vaccine recommendations; Complete Response Letter issued to investigative schizophrenia treatment; new treatment for complicated UTIs including pyelonephritis; over-the-counter eye ointments recalled.  

In this crossover episode of BackTable OBGYN with Urology, Dr. Suzette Sutherland, Director of Female Urology at the University of Washington, and Dr. Anne Cameron, Professor of Urology at the University of Michigan, share their insights on the prevention and management of urinary tract infections (UTIs). First, they emphasize the importance of dispelling misconceptions about recurrent UTIs being a result of poor hygiene or incorrect behaviors, explaining that they can stem from genetic or hormonal risk factors. Dr. Cameron describes her algorithm for managing UTIs in specific patient populations. She further discusses the impact of factors such as fluid intake, bowel habits, and vaginal health on the incidence of UTIs. Dr. Cameron also highlights the potential for UTIs in diabetic patients on certain medications and the importance of a collaborative approach with diabetic healthcare teams. Additionally, the doctors explore various treatment strategies, such as cranberry supplements and gentamicin bladder installations, cautioning against antibiotic overuse due to the risk of resistance. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/2P5fzK --- SHOW NOTES 00:00 - Introduction 02:13 - Understanding UTIs: Definitions, Symptoms, and Prevalence 04:39 - Recurrent UTIs: Definitions, Causes, and Treatment Challenges 12:00 - Understanding Asymptomatic Bacteriuria 15:00 - Cystitis vs. Pyelonephritis vs. Urosepsis 20:57 - Antimicrobial Resistance and Antibiotic Stewardship 24:36 - Treatment Guidelines for UTIs 31:13 - Self-start Antibiotic Therapy for UTIs 34:37 - Preventing UTIs: Hydration, Lifestyle Factors, and Bowel Health 38:33 - The Connection Between Vaginal Health and UTIs 42:40 - The Role of Supplements in UTI Prevention: D-Mannose and Cranberry, and Methenamine Hippurate 57:18 - Identification and Treatment of UTIs in Patients with Indwelling Catheters 01:00:04 - The Role of Gentamicin Bladder Installations in UTI Prevention 01:04:27 - The Impact of Diabetes Medications on UTIs --- RESOURCES AUA Guidelines for UTI Treatment: https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti

In this crossover episode of BackTable OBGYN with Urology, Dr. Suzette Sutherland, Director of Female Urology at the University of Washington, and Dr. Anne Cameron, Professor of Urology at the University of Michigan, share their insights on the prevention and management of urinary tract infections (UTIs). First, they emphasize the importance of dispelling misconceptions about recurrent UTIs being a result of poor hygiene or incorrect behaviors, explaining that they can stem from genetic or hormonal risk factors. Dr. Cameron describes her algorithm for managing UTIs in specific patient populations. She further discusses the impact of factors such as fluid intake, bowel habits, and vaginal health on the incidence of UTIs. Dr. Cameron also highlights the potential for UTIs in diabetic patients on certain medications and the importance of a collaborative approach with diabetic healthcare teams. Additionally, the doctors explore various treatment strategies, such as cranberry supplements and gentamicin bladder installations, cautioning against antibiotic overuse due to the risk of resistance. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/2P5fzK --- SHOW NOTES 00:00 - Introduction 02:13 - Understanding UTIs: Definitions, Symptoms, and Prevalence 04:39 - Recurrent UTIs: Definitions, Causes, and Treatment Challenges 12:00 - Understanding Asymptomatic Bacteriuria 15:00 - Cystitis vs. Pyelonephritis vs. Urosepsis 20:57 - Antimicrobial Resistance and Antibiotic Stewardship 24:36 - Treatment Guidelines for UTIs 31:13 - Self-start Antibiotic Therapy for UTIs 34:37 - Preventing UTIs: Hydration, Lifestyle Factors, and Bowel Health 38:33 - The Connection Between Vaginal Health and UTIs 42:40 - The Role of Supplements in UTI Prevention: D-Mannose and Cranberry, and Methenamine Hippurate 57:18 - Identification and Treatment of UTIs in Patients with Indwelling Catheters 01:00:04 - The Role of Gentamicin Bladder Installations in UTI Prevention 01:04:27 - The Impact of Diabetes Medications on UTIs --- RESOURCES AUA Guidelines for UTI Treatment: https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti

Understanding Urinary Tract Infections (UTI), including complicated vs uncomplicated UTI, symptoms, diagnosis and UTI treatment. Also covers Urinary Tract Infection pathophysiology. Consider subscribing on YouTube (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is a UTI?1:00 Urinary Tract Infection Pathophysiology2:57 UTI Causes & Risk Factors5:07 UTI Symptoms6:19 UTI Diagnosis7:11 UTI TreatmentReferences:MSD Manuals Pro (2023) Bacterial Urinary Tract Infections & Urinary Tract Infections Overview. Available at Urinary Tract Infections (UTIs) - MSD Manual Professional Edition (msdmanuals.com)Czajkowski, K (2021) Urinary tract infection in women. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077804/Clinical Knowledge Summaries (2023) Urinary tract infection (lower) - women, Pyelonephritis - acute, Urinary tract infection (lower) - men. Available at Urinary tract infection (lower) - men | Health topics A to Z | CKS | NICE Pyelonephritis - acute | Health topics A to Z | CKS | NICE Urinary tract infection (lower) - women | Health topics A to Z | CKS | NICEBritish National Formulary (2023) Urinary Tract Infections. Available at https://bnf.nice.org.uk/treatment-summaries/urinary-tract-infections/Please remember this podcast and all content from Rhesus Medicine is meant for educational purposes only and should not be used as a guide to diagnose or to treat. Please consult a healthcare professional for medical advice. 

Ms Katie McComb from BURST urology describes the BJUI article: Xanthogranulomatous pyelonephritis: a systematic review of treatment and mortality in more than 1000 cases. https://bjui-journals.onlinelibrary.wiley.com/doi/10.1111/bju.15878 Katie McComb is in her first year of Urology themed Core Surgical training in the North West Deanery of England

In this episode, Lilian Abbo, MD, FIDSA; Julie Ann Justo, PharmD, MS; and David van Duin, MD, PhD, FIDSA, FAST, discuss key concepts about extraintestinal pathogenic Escherichia coli, including:Diverse strains and virulence factors associated with invasive diseaseAntimicrobial resistance profiles seen in clinical practiceVarious disease manifestationsPrevalence and burden of invasive infectionsPopulations at riskRisk factors for multidrug-resistant strainsEmerging vaccine technologiesActive clinical trials Benefits of vaccines and the challenges associated with developmentImportance of antimicrobial stewardship and potential role of vaccines to reduce antimicrobial resistanceProgram Director: Lilian Abbo, MD, FIDSAAssociate Chief Medical Officer in Infectious DiseasesJackson Health SystemProfessor of Infectious DiseasesDepartment of Medicine & Miami Transplant InstituteUniversity of Miami Miller School of MedicineMiami, FloridaFaculty:Julie Ann Justo, PharmD, MSClinical Associate ProfessorDepartment of Clinical Pharmacy and Outcomes SciencesUniversity of South Carolina College of PharmacyInfectious Diseases Clinical Pharmacy SpecialistDepartment of PharmacyPrisma Health Richland HospitalColumbia, South CarolinaDavid Van Duin, MD, PhD, FIDSA, FASTProfessor of Medicine Director, Immunocompromised Host Infectious Diseases ProgramDivision of Infectious DiseasesUniversity of North CarolinaChapel Hill, North CarolinaContent based on a CME program supported by an educational grant from Janssen Therapeutics.Follow along with a downloadable slideset at:https://bit.ly/3eG29BnLink to full program:https://bit.ly/3eFHfCl

Short, quick review of PANCE topics with associated printable cards to include for your board review prep

About this episode Today we continue the our new question dissection series with DaVinci Academy. Patrick and Dr. Maxwell Cooper review the case of a 43 year old woman who presents with painful urination for the past 5 days, along with a past history of type 2 diabetes, severe left sided back pain, nausea/vomiting, and chills. Links for this episode DaVinci Academy on YouTube DaVinci Academy website - Discount code ITB20 for 20% off at checkout! #DaVinciCases on Spotify #DaVinciCases on Apple Podcasts The DaVinci Hour on Spotify The DaVinci Hour on Apple Podcasts Study on the go for free! Download the Audio QBank by InsideTheBoards for free on iOS or Android. If you want to upgrade, you can save money on a premium subscription by customizing your plan until your test date on our website! All of our podcasts: The InsideTheBoards Podcast The InsideTheBoards Study Smarter Podcast Crush Step 1 Step 2 Secrets Physiology by Physeo Step 1 Success Stories Beyond the Pearls The Dr. Raj Podcast The Health Beat Produced by Ars Longa Media To learn more about us and this podcast, visit arslonga.media. You can leave feedback or suggestions at arslonga.media/contact or by emailing info@arslonga.media. Produced by: Christopher Breitigan and Madison Linden. Executive Producer: Patrick C. Beeman, MD Legal Stuff InsideTheBoards is not affiliated with the NBME, USMLE, COMLEX, or any professional licensing body. InsideTheBoards and its partners fully adhere to the policies on irregular conduct outlined by the aforementioned credentialing bodies. The information presented in this podcast is intended for educational purposes only and should not be construed as professional or medical advice. Learn more about your ad choices. Visit megaphone.fm/adchoices

Looking for more information on this topic? Check out the Cystitis and Pyelonephritis brick. If you enjoyed this episode, we'd love for you to leave a review on Apple Podcasts.  It helps with our visibility, and the more med students (or future med students) listen to the podcast, the more we can provide to the future physicians of the world. Follow USMLE-Rx at: Facebook: www.facebook.com/usmlerx Blog: www.firstaidteam.com Twitter: https://twitter.com/firstaidteam Instagram: https://www.instagram.com/firstaidteam/ YouTube: www.youtube.com/USMLERX Learn how you can access over 150 of our bricks for FREE: https://usmlerx.wpengine.com/free-bricks/ from our Musculoskeletal, Skin, and Connective Tissue collection, which is available for free. Learn more about Rx Bricks by signing up for a free USMLE-Rx account: www.usmle-rx.com You will get 5 days of full access to our Rx360+ program, including nearly 800 Rx Bricks.  After the 5-day period, you will still be able to access over 150 free bricks, including the entire collections for General Microbiology and Cellular and Molecular Biology.

Diese Fakten solltest du über eine Blasenentzündung und Nierenbeckenentzündung definitiv wissen!

This episode features Dr. Travis Jones from DASON. The article reviewed in this episode is available here: https://doi.org/10.1016/j.ijantimicag.2022.106560. For more information about DASON, please visit: https://dason.medicine.duke.edu.

This episode covers pyelonephritis.Written notes can be found at https://zerotofinals.com/surgery/urology/pyelonephritis/ or in the urology section of the Zero to Finals surgery book.The audio in the episode was expertly edited by Harry Watchman.

In this episode of The Injured Senior Podcast, Dr. Johnny Cascone, an Infectious Disease physician, joins host Steve Heisler to discuss Urinary Tract Infections and their prevalence in the nursing home community. You'll also learn risk factors, signs, symptoms, and even the best practices on preventing and treating UTIs so they don't become septic and lead to shock - or even death. Tune in to hear more from Dr. Cascone and his tips and information on Urinary Tract Infections, especially if you're a caregiver to an elderly loved one. In This Episode: [03:00] Dr. Johnny Cascone speaks about the prevalence of UTIs in the elderly population, how often and why they can occur[05:00] Dr. Cascone explains common symptoms and types of UTI's and how an untreated UTI can turn into sepsis[09:00] Risk factors, Common causes, and predispositions of urinary tract infections[11:00] How untreated infections affects the body and can lead to sepsis and septic shock and best practices for prevention of UTIs and sepsis[15:00] Why UTIs are common in nursing homes and how the use of catheters can affect the probability of an infection[19:30] The best way to deal with UTIs and recognizing symptoms as a caregiver of an elderly personKey Takeaways: Urinary Tract Infections are more common in women and occur in 25-50% of women over the age of 80 and live in nursing homes. Most of this is due to their anatomy.If patients get treated, it's relatively easy to recover from, however, left untreated for a long time can lead to sepsis, septic shock, and even death. UTI's fall into two categories: cystitis, a lower urinary tract infection mainly the urethra and bladder and is most common. Pyelonephritis is the other category and is more commonly known as a kidney infection.The best practices for preventing UTIs are practicing good hygiene and being aware of your body and any symptoms you might be having. Early treatment for symptoms is key.Meet Dr. Johnny CasconeJohnny Cascone is a board-certified internal medicine and infectious disease physician. His internal medicine residency was done at the University of Kansas and infectious disease fellowship at the University of Missouri-Columbia. Dr. Cascone is the medical director of nursing homes in southwest Missouri. His medical practice includes the care of residents in long-term care facilities, infectious disease consultations, and telemedicine infectious disease services to rural facilities. Dr. Cascone has a special interest in the diagnosis and treatment of sepsis, Clostridium difficile colitis, Staphylococcus aureus bacteremia, antimicrobial stewardship, and pressure ulcers. He lives in Joplin, Missouri with his family.

Pregnant and breastfeeding patients aren't always hospitalized for obstetric reasons and can be placed throughout the hospital. Dr. Michelle Solone, OBGYN talks to us about how we can assess these patients, what to look out for, and how nurses can promote pumping and breastfeeding during a hospitalization.Common reasons for non-OBGYN related hospitalization for pregnant patients:Medical: Kidney Stones, Chemo, Pyelonephritis, Cardiac ConditionsSurgical: Cholecystitis, AppendicitisTraumaWhich floor does the Pregnant Patient receive care on?Less than 20 weeks → regular medical floor20 weeks & up → Labor & Delivery FloorSituational Examples:  L&D Nurses don't interpret EKG's, which will influence which floor a patient can be assigned → CCU/ICUED for asthma exacerbation, traumasRespiratory Distress/IV Drip Monitoring →need ICU nurse with L&D Nurse present to monitor babyPhysiologic Differences of Pregnant PatientsIncreased Blood Volume which can lead to dilutional anemia (ex: Hct 34), due to plasma>RBCsIncreased Cardiac Output and decreased vascular resistance (↓BP) CPR: Left lateral decubitus positioning or Left Uterine displacement for CPR over 20 weeks →Have mom supine, and have a coworker push the uterus about 2 inches over to the Left side for circulation returnIncreased WBCsDecreased lung capacity, but increased tidal volume (RR should be same)Increased risk for VTE Nursing Interventions: SCD's, mobilization, sleep on left sideMedical Intervention: Lovenox, HeparinIncreased GFR →some medications may need adjustments/labsAssessment ABC's of PregnancyA. Amniotic FluidB. Bleeding (never normal, need OBGYN at bedside)C. Contractions/Abdominal PainD. DysuriaE. Edema (DVT or Pre-Eclampsia)F. Fetal MovementMedications and Imaging in PregnancyThere is a fear of giving moms pain medications, but most narcotics are safe in short term, such as with kidney stones. Chronic use would be of concern. Antibiotics such as Vancomycin and Ampicillin are very common for the treatment of infection in pregnant patientsImaging is safe Preference →ultrasound to avoid radiation, followed by MRI (no gadolinium) if neededCT (with or without contrast) is also safeCare of the Postpartum and Lactating PatientImportant: Advocate for breastfeeding and Pumping! Get a Pump in the room early on!Save ALL milk → DON'T DUMP Unnecessarily Label milk to later review with MD if safe for babyWhat meds are compatible with breastfeeding? Almost all medications are compatible with breastfeedingNotable exception: Codeine/Tramadol (such as Tylenol with Codeine)Regular Tylenol and Motrin safe for Postpartum PatientsPhysiological Changes in Postpartum Fluid Shifts: all blood from uterus rush and return back to heart → flash pulmonary edema, fluid overload within 24 hrs after deliveryPreeclampsia may present after deliveryAnemia →PP mom may need blood transfusions/iron

Renal Disorders: Acute Kidney injury, Chronic Kidney injury, Polycystic Kidney Disease, Pyelonephritis, Glomerulonephritis and many more.

This episode covers pyelonephritis!

This episode covers pyelonephritis!

In the September 2020 episode, Kris Maday, PA-C, and Adrian Banning, PA-C, discuss CME articles on infectious disease considerations in immunocompromised patients and bronchiolitis as well as necrotizing fasciitis and a QRS on pyelonephritis.

Today we discuss acute cystitis, diagnostic approach and treatment options Please follow us at Follow us at urgentcarebasics.com facebook.com/Urgentcarebasics/ instagram.com/urgentcarebasics/ Or email us at urgentcarebasics@gmail.com   Also check out the recommend page at urgentcarebasics.com/recommended

Show notes at pharmacyjoe.com/episode472. In this episode, I ll discuss an article about using piperacillin-tazobactam for the treatment of ESBL pyelonephritis. The post 472: Is Piperacillin-Tazobactam Effective for the Treatment of Pyelonephritis Caused by ESBL Producing Organisms? appeared first on Pharmacy Joe.

What are you supposed to do with all those pesky urine samples that you collect on your pregnant patients in prenatal clinic? Should you treat that bacteriuria? And what do you do if they have pyelonephritis?  Fei and Nick answer these questions on this episode of CREOGs Over Coffee.  Twitter: @creogsovercoff1  Instagram: @creogsovercoffee Facebook: www.facebook.com/creogsovercoffee Website: www.creogsovercoffee.com Patreon: www.patreon.com/creogsovercoffee You can find the OBG Project at: www.obgproject.com

Xanthogranulomatous pyelonephritis

Its good to be back thanks for staying tuned and staying stoked. For your patients I have a super extra long episode for you. I share with you what happend to me and my kidney while in Japan during the month of October. Mahalo to the staff f at Mishima Hospital for helping stay alive. We visit with Michael Miller from Tiki's Grill & Bar about his new position on the board of the Hawaii Food Bank. You can Help out and make a donation to the food bank here http://hawaiifoodbank.org We feature music from Kalani Pe'a, Eric Hutchinson, Kahulanui, Willie K, Steff Mariani and comedy as well as a lesson in pigeon from Andy Bumatai. (Hey Andy i think i mispronounced your name several times I'm sorry but i stay dyslexic but still love you) Here are the show notes Aloha and welcome back to Hawaii Posts Hawaii’s only weekly update for weather surf and island events I’m your host Tom e Gaupp a.k.a. Tom e Stokes It’s good to be back and i thank you for staying tuned and staying stoked. In this our 11th episode we have our 777 followed by in interview with Michael Miller a new board member with the Hawaii Food Bank and we will close out the show with a few songs from our events featured artist The month of october was a wild month and I actually made a podcast for the first 2 months but fell short of posting it on my way to the airport. I was in Japan for a few weeks with my family while at Tokyo Disneyland nearly collapsed from abdominal pain, I thought it was just kidney stones but upon the insistence of my wife and father inlay i was taken to the emergency room and diagnosed with acute kidney infection, Pyelonephritis, caused by passing massive kidney stones that caused tearing in the ureter which is the tube between the kidney and the bladder. I was admitted to Mishima hospital for 7 days. It was pretty serious, my blood test revealed deadly levels of bacteria and high white blood cell count. The doctor braced me to prepare for the worse but hope for the best. I was on the verge of sepsis or septicemia which is a blood infection which could lead to septic shock which has a 50% mortality rate. Dr. Suzuki and Dr. Okubo and the whole staff at Mishima Hospital worked hard to heal me and by the grace of God i was cured in 5 days. But its a long road to recovery. It was pretty scary at first, being in a foreign land far from home. My Japanese is pretty limited but i am always trying to learn more and improve my japanese vocabulary. I speak survival japanese I can from greeting to and direction i talk about the weather, food and nod politely but i needed to communicate with the medical staff at the hospital if i wanted tell them how i felt and what i needed or just wanted to know what was going on inside my body. While in the hospital i used google translator app to converse with the doctors, nurses, pharmacist food service and staff. I am blessed to have a loving wife with caring in-laws. Both my mother and father inlaws came to my room several times to check in on me and bring me some much need snack and my favorite VitaC1000 dinks. My wife had to travel on with my boys, because the trip was for my kids and a chance for my wife to visit the grave sites of her recently deceased. Hospitals are no place for kids to hang out so off to Legoland and Kyoto they went. It’s safe to say that most of you may never spend a single day in a Hospital but let me tell you. The staff is so kind and caring the facilities are clean and well managed and the food, i ate everything they served me and enjoyed every bit of it. I tried new foods that prior to my stay in the hospital, might have otherwise passed up for the more popular japanese food such as my go-to sushi plates and udon noodles. But in the Mishima Hospital the dishes were more like japanese country cuisine bamboo shoots, nabe, wide varieties of fish, salads and side dishes. Needless to say after my first two days as i started to regain my health i ate very well. Fortunately i still have my mother and father in my life. My Dad sends my a prayer book from “Today” every two moths, i found it interesting that the first night in the hospital the lesson and prayer was titled “The Stone”. My mom is a retired nurse form the Ohio State University hospital and she is my personal medical assistant always there to help me understand what is wrong with me my wife or kids. She offered insight and loving comfort which was greatly needed at that time Laying in my hospital bed It game me plenty of time to think about my life, loved ones and the direction i would wish to proceed. I busted out some sophmorish artwork to keep up with my 4Buckeyes comic strip (learning that i can’t draw very well and i miss my computer to generate clean graphics and much better text … because my handwriting is worse than my 4 y.o. son) As Sinatra would sing in the standard “My Way”, “Regrets i have a few but then again too few to mention”. I decided that i would confess to this audience and anyone there after that i am not perfect, that i have said and done things that i wish i could take back or do again with a little more love in my heart. I resolved to be a better person every day and practice the golden rule of doing unto others as i would have them do unto me. I asked god for forgiveness, a chance to heal and the strength improve upon my life every day after. I was scared so reached out to my friend and family asking for their thoughts and prayers, something i never have done before but in the darkness of my hospital room thousands of miles from home, i cried in pain and was overwhelmed with sorrow and guilt wanting to be a better husband, father, son and friend to all. With great delight i received the thoughts and prayers from those i asked. It built up my spirit and health. Let me tell you Humility and Prayer works. Remarkably i was healed faster than 7 days the doctor predicted, I was discharged after 5 days and got to re-join my family and travel on to Osaka. Still weak and sore and irritable i realized that changing my was would take time tobe the better person i desire to be. I thank God, my family, friends and the entire staff at Mishima Hospital. Dr. Suzuki, Dr. Okubo, Then nurses Hitomi, Nagisa, Yuka, Yutom, Kaho, Yuka, Azumi, Tomoko. The food service staff Kotomi and Mieko. The pharmacist Yuichi Naito I have a few check ups with my doctor and urologist coming up in the near future but i am on the road to recovery, feeling better. I have started new exercise routines to strengthen my body mind and spirit. While there are many causes for Kidney Stones, Hydration may be the best prevention flushing your system of Oxalate excessive vitamin D or protein. In the last 10 years i have been drinking lots of water but the fact is my stones have been forming all my life and working in the hot sun as a life guard and surf cameraman over the years may have caused dehydration. I think back to my youth and realize that i didn’t drink enough water, even though i was a swimmer surrounded by water i just didn’t drink enough water. My kids take water to school and refill their bottles while at school. I remember this days in school waiting my turn at the drinking fountain and those friendly taunts and teases while i took my turn drinking “Hey save some for the fish!”. My best advise is stay hydrated. I just wanted to share that with you Now on with the show…… Here is your 7 7 7 forecast for Weather Surf and Events for all of the hawaiian islands 7 Day Weather Currently its 84 and sunny Winds have shifted from the typical NE tradewinds to south east winds with bings with it a little more humidity, vog and a good chance of epic sunsets. Light Trades will return on friday november 8th The next 7 days will be mostly sunny with occasional passing showers in the morning and evenings temperatures will range from 69-72 lows and highs from 79-84. Next thursday the 15th we have a good chance of more frequent precipitation https://www.timeanddate.com/weather/usa/honolulu Sun this week sunrise today was 6:38 and the sun set today is at 5:51 providing you with 11hr 13min of daylight losing an average 56 sec of sunlight every day next thursday the 15th sunrise will be 6:42am and sunset at 5:51 giving you 11hr 7min of daylight https://www.timeanddate.com/astronomy/usa/honolulu Our moon phase this week today its at a waxing minimum of 1.7% …. just a teeny tiny sliver that will be nearly invisible since the moon rise is at 7:37 am and moon set at 7:07pm The moon is waxing so that sliver will become a half moon by next thursday the 15th with the moon rise at 1:16pm and will be setting at 12:02am with a rumination of 55.7% In the night Sky Jupiter will set shortly after the sun around 6:45 and visible only aft the sun sets Mercury will set after the sunset @ 7:10 and visible in western sky Saturn is visible directly above after sunset and the will set around 9:10pm Mars will be the prominent planet in the evening setting around 12:50am If you have binoculars you can see Neptune which sets at 2:13a Uranus which will set at 5:32 Venus is a early bird shining bright rising at 5:12a in the east just before sunrise constellations Directly above is Pegasus North - Ursa Minor NW - Draco and Hercules W - High in the sky is Aquila SW - Capricornus above the horizon, Sagittarius along the horizon S - from the horizon looking up you will see Tucana, Pieces and Aquarius SE - Eridunus and cetus above that E - you’ll see Orions left side on the horizon and Pices higher in the East NE - from horizon and above you will see Auriga Perseus & Triangulum SURF High Tides at sunrise and sun set with the lows mid day North Shores: on the rise through the weekend saturday 4-6 with 6-10 faces sunday peaking at 5-8 thats 8-14 faces (2stories) then dropping but expect more bumps and swells throughout the week. West Shores: 2-5 (3-8 faces) Saturday and peaking at 3-6 (5-10) dropping on monday East Shores: holding at 1-2 (2-4faces) sunday may see a secondary swell around 2to 4 (3-7) South Shores holding at 1-2 Events Big Island Hawaii Kona Coffee Cultural Festival OCCURS BETWEEN: FRIDAY, NOVEMBER 9, 2018 - SUNDAY, NOVEMBER 18, 2018, 10:00AM - 5:00PM 48th Annual Kona Coffee Festival, Kona Coffee Cultural Festival on Alii Dr. in Kailua Kona 100% Pure Kona Coffee Half Marathon OCCURS ON: SATURDAY, NOVEMBER 10, 2018, 6:30AM - 11:30AM Come and join us for the 3rd annual 100% Pure Kona Coffee Half Marathon. Run the scenic coastline of Kailua-Kona from Coconut Grove Marketplace Hilo Hula Tuesday At The Bandstand OCCURS BETWEEN: TUESDAY, NOVEMBER 13, 2018 - TUESDAY, DECEMBER 18, 2018, 11:00AM - 12:00PM Every Tuesday from 11 a.m. to 12 noon our well-known local entertainers provide a program of Hawaiian music and hula at this FREE event in Historic Downtown Hilo at the bandstand across from the Hilo Farmers Market.   Maui Above the Fold: New Expressions in Origami OCCURS BETWEEN: THURSDAY, NOVEMBER 8, 2018 - SATURDAY, DECEMBER 1, 2018, 10:00AM - 5:00PM Gallery hours: Tue – Sun 10 am - 5 pm (Also open before Castle Theater shows and during intermission) Maui Chef's Table OCCURS BETWEEN: THURSDAY, NOVEMBER 8, 2018 - SATURDAY, DECEMBER 29, 2018, 6:00PM - 9:00PM AN INTERACTIVE, MULTI-COURSE DINING EXPERIENCE Dive into a menu of dishes inspired by The Mill House Chefs' personal stories and told through Maui's seasonal ingredients Hula O Nā Keiki OCCURS BETWEEN: FRIDAY, NOVEMBER 9, 2018 - SATURDAY, NOVEMBER 10, 2018, 8:00AM - 9:00PM Kā'anapali Beach Hotel is proud to host its 28th annual Hula O Nā Keiki – Maui's only children's solo hula competition. This year's event will be held November 9-10, 2018 in the Kanahele ballroom. Chinese Heritage Festival in Lahaina OCCURS ON: FRIDAY, NOVEMBER 9, 2018, 10:00AM - 8:00PM Lahaina celebrates the town's enduring Chinese heritage Oahu Bruno Mars will be in town doing 3 shows tonight Nov 8, sat nov 10, sunday nov 11 Peter Gene Hernandez, known by his stage name Bruno Mars, is an American singer-songwriter and record producer. Raised in Honolulu, Hawaii, by a family of musicians, Mars began making music at a young age and performed in various musical venues in his hometown throughout his childhood. He graduated from high school and then moved to Los Angeles, California Hawaii International Film Festival (38th Annual) OCCURS BETWEEN: THURSDAY, NOVEMBER 8, 2018 - SUNDAY, NOVEMBER 18, 2018 Established as the premier international film of the pacific at the Regal Cannery Theaters 735 Iwilei Rd Bishop Museum Presents the "Rapa Nui: The Untold Stories of Easter Island" Exhibition OCCURS BETWEEN: THURSDAY, NOVEMBER 8, 2018 - SUNDAY, MAY 5, 2019, 9:00AM - 5:00PM More than 150 cultural treasures and never-before-seen biological specimens from Bishop Museum’s collections will be on display together for the first time in the Celebrating the 150th Anniversary of the Meiji Restoration and Immigration to Japan Exhibition OCCURS BETWEEN: THURSDAY, NOVEMBER 8, 2018 - SUNDAY, JANUARY 6, 2019, 10:00AM - 4:30PM In 1868, Japan underwent a political revolution. With the coronation of Emperor Mutsuhito (known commonly as the Meiji Emperor), the Imperial Family regained political control, and the feudal stratocracy Honolulu Museum of Art @900 S Beretania HIC Pro OCCURS BETWEEN: THURSDAY, NOVEMBER 8, 2018 - FRIDAY, NOVEMBER 9, 2018, 8:00AM - 4:00PM The HIC Pro annually kick-starts the North Shore’s competitive surf season and is characteristically graced with monstrous surf and high drama. The event takes place at Sunset Beach, which is one of the world’s most preeminent deep-water big wave spots that spans across a stadium-sized venue Royal Hawaiian Band At Kapiolani Bandstand OCCURS BETWEEN: THURSDAY, NOVEMBER 8, 2018 - SUNDAY, NOVEMBER 25, 2018, 2:00PM - 3:00PM Founded in 1836 by King Kamehameha III, it is the only band in the United States with a royal legacy. With cultural roots dating back to the time of the Hawaiian monarchy, the mission of the Royal Hawaiian Band is to promote and foster hawaiian music The Music of Pink Floyd OCCURS ON: FRIDAY, NOVEMBER 9, 2018, 7:30PM - 10:00PM Any Colour You Like - https://youtu.be/bK7HJvmgFnM Windborne Music and Brody Dolyniuk are back! Last season we brought you The Music of Journey and The Music of Led Zeppelin – this season, we're bringing you Windborne's Rock Symphony The Music of Pink Floyd, featuring singer Brody Dolyniuk. World War One Centennial and Veteran's Day Commemoration OCCURS ON: SUNDAY, NOVEMBER 11, 2018, 6:00AM - 8:30PM In Commemoration of the 100th anniversary of the end of WWI there will be a full day of activities at or around the Waikiki Natatorium War Memorial. Hawaiian Pro OCCURS BETWEEN: MONDAY, NOVEMBER 12, 2018 - SATURDAY, NOVEMBER 24, 2018, 8:00AM - 4:00PM The opening event of the Vans Triple Crown of Surfing, the Hawaiian Pro has created a local legacy that sets the bar for competition and initiates the start of peak surf season on Oahu. The break at Haleiwa Ali‘i Beach, simply referred to as ‘Haleiwa’, offers a wide variety of rideable Vans Triple Crown of Surfing OCCURS ON: MONDAY, NOVEMBER 12, 2018, 8:00AM - 4:00PM The Vans Triple Crown of Surfing has been crowning the greatest competitive surfer of the North Shore's infamous big wave season alongside elite World Champions for 36 years. Oahu attracts the world's best athletes to a 7-mile stretch of coastline in Haleiwa from October through December, Diamond Head Arts & Crafts Fair 2018 OCCURS ON: SUNDAY, NOVEMBER 11, 2018, 9:00AM - 2:00PM Enjoy your day doing your Christmas shopping early at this community event for the whole family, featuring Made in Hawaii arts and crafts, plants, food, entertainment and cultural events and lots of free parking. With more than 200 crafters and handmade crafts, @ Kapiolani Community College BLUE NOTE HAWAII FEATURES Kalani Pe’a No ‘Ane’i - https://youtu.be/UqPBOkks5_Y OCCURS ON: FRIDAY, NOVEMBER 9, 2018, 6:30PM - 11:00PM Kalani Pe’a will be performing at Blue Note Hawaii with 2 shows nightly at 6:30pm & 9:00pm. Kalani's soulful voice showcases his many influences growing up, but his love for our culture keeps it right where it needs to be," said Jaz Kaiwikoʻo. Peʻa was determined in perpetuating Hawaiian Eric Hutchinson Eric Hutchinson - a million bucks on a queen motel bed (The FlowerSchool Sessions https://youtu.be/Bwjy7V8sfVw OCCURS BETWEEN: SATURDAY, NOVEMBER 10, 2018 - SUNDAY, NOVEMBER 11, 2018, 6:30PM - 11:00PM Eric Hutchinson will be performing at Blue Note Hawaii with 2 shows nightly at 6:30pm & 9:00pm. Singer, songwriter, performer, producer, DJ - Eric Hutchinson is a constantly evolving musician, driven by his passion and curiosity for all things musical and creative Kahulanui E Mau - https://youtu.be/hqR6zkTcbYI OCCURS ON: MONDAY, NOVEMBER 12, 2018, 6:30PM - 11:00PM Kahulanui will be performing at Blue Note Hawaii with 2 shows nightly at 6:30pm & 9:00pm. GRAMMY® nominated and Nā Hōkū Hanohano Award-winning group Kahulanui is a nine-piece Hawaiian Swing Band from the Big Island of Hawaii, comprised of four horns, guitar, bass, ukulele, drums and steel. Willie K You Ku’uipo - https://youtu.be/txQj9pOCPMY OCCURS ON: TUESDAY, NOVEMBER 13, 2018, 6:30PM - 11:00PM Willie K Will be performing at Blue Note Hawaii with 2 shows nightly at 6:30pm & 9:00pm. The Hawaiian phenomenon Willie K is undoubtedly the only artist in the world who can go into an Irish pub in the middle of Maui and play anything from indigenous acoustic Hawaiian music to jazz, reggae, rock Stef Mariani Stay Gold https://youtu.be/5JUxDux2rt0 OCCURS ON: WEDNESDAY, NOVEMBER 14, 2018, 6:30PM - 11:00PM Stef Mariani will be performing at Blue Note Hawaii with 2 shows nightly at 6:30pm & 9:00pm. Stef Mariani delivers sensitive folk melodies and driven lyrics that come together to form a passionate sound straight from the heart. Andy Bumatai Presents Hawaii Comedy Showcase Hawaiian Pidgin 101 - Ethnicities https://youtu.be/e_LVtykh09w OCCURS ON: THURSDAY, NOVEMBER 15, 2018, 6:30PM - 11:00PM Andy Bumatai Presents Hawaii Comedy Showcase will be performing at Blue Note Hawaii with 2 shows nightly at 6:30pm & 9:00pm. The Blue Note is very proud to present this showcase of the hottest comedians in Hawaii and hosted by our friend and Hawaiian Comedy Legend, Andy Bumatai! ♫ Mr. Sun Cho Lee ♪ (with lyrics) ♫ Keola & Kapono Beamer Mr. Sun Cho Lee - https://youtu.be/kS2YLvGGtwY Kauai In the Kitchen - Poipu Food & Wine Festival OCCURS ON: THURSDAY, NOVEMBER 8, 2018, 8:00AM - 6:00PM Cook with some of Poipu's finest Chefs at this year's Poipu Food Wine Festival. Participate in a hands-on cooking class with some of Poipu’s top chefs in their own restaurant. Classes at $50.00 per person per class will be limited in size and include a tasting and a commemorative gift. NTBG Free Weekly Hula Show OCCURS BETWEEN: THURSDAY, NOVEMBER 8, 2018 - THURSDAY, DECEMBER 26, 2019, 2:00PM - 2:45PM Come out the National Tropical Botancial Garden South Shore Visitors Center and experience a traditional hula performance. Wahine Comedy Festival (4th Annual) OCCURS BETWEEN: FRIDAY, NOVEMBER 9, 2018 - SATURDAY, NOVEMBER 10, 2018, 8:00PM - 10:00PM The Female Comics of Hawaii present the 2018 4th Annual Wahine Comedy Festival at Trees Lounge in Kapaa on Veteran's Day weekend: Friday 11/9 and Saturday 11/10 8-10pm both nites. Enjoy original standup comedy. Na Hoku comedy album winner Brandi Morgan from Oahu headlines

In this VETgirl online veterinary continuing education podcast, we review the prevalence of subclinical bacteriuria, bacterial cystitis and pyelonephritis in dogs with chronic kidney disease (CKD).

In this VETgirl online veterinary continuing education podcast, we review the prevalence of subclinical bacteriuria, bacterial cystitis and pyelonephritis in dogs with chronic kidney disease (CKD).

Pyelonephritis Affects up to 2% of women in pregnancy. Complications can include preterm labor, preterm rupture of membranes, Urosepsis, and ARDS. In this podcast, we will cover the clinical presentation, work up, and management of "Pyelo" in pregnancy. Data taken from the American College of OB/GYN.

Pyelonephritis doesn't always present text book and cystitis doesn't always require a dipstick. Uncomplicated pyelonephritis can be treated out patient - today we're going to show you how! We'll also teach you how to identify those high risk patients who should definitely be admitted. Here's what you need to know about the UTI. Enjoy! Subscribe to our YouTube here: http://www.youtube.com/subscription_center?add_user=paboards Follow us on Instagram here: https://www.instagram.com/paboards and https://www.instagram.com/pance_panre_usmle_review/ Ace your exams: https://learn.physicianassistantboards.com/collections Have questions about this podcast? Email gray@physicianassistantboards.com

When should you commit to getting urine? When can you wait? When should you forgo testing altogether? When do I get urine? Symptoms – either typical dysuria, urgency, frequency in a verbal child, or non-descript abdominal pain or vomiting in a well appearing child. Fever – but first look for an obvious alternative source, especially viral signs or symptoms. No obvious source? Risk stratify before “just getting a urine”. In a low risk child, with obviously very vigilant parents, who is well appearing, you may choose not to test now, and ensure close follow up. Bag or cath? The short answer is: always cath, never bag. (Pros and cons in audio) What is the definition of a UTI? According to the current clinical practice guideline by the AAP, the standard definition of a urinary tract infection is the presence of BOTH pyuria AND at least 50 000 colonies per mL of a single uropathogen. Making the diagnosis in the ED: The presence of WBCs with a threshold of 5 or greater WBCs per HPF is required. What else goes into the urinalysis that may be helpful? Pearl: nitrites are poorly sensitive in children.  It takes 4 hours for nitrites to form, and most children this age do no hold their urine. Pearl: the enhanced urinalysis is the addition of a gram stain.  A positive gram stain has a LR+ of 87 in infants less than 60 days, according to a study by Dayan et al. in Pediatric Emergency Care. When can I just call it pyelonephritis? In an adult, we look for UTI plus evidence of focal upper tract involvement, like CVA tenderness to percussion or systemic signs like nausea, vomiting, or fever.  It is usually straightforward. It’s for this reason that the literature uses the term “febrile UTI” for children.  Fever is very sensitive, but not specific in children. The ill-appearing child has pyelonephritis.   The well-appearing child likely has a “febrile UTI”, without upper involvement.  However, undetected upper tract involvement may be made in retrospect via imaging, if done. How should I treat UTIs? For simple lower tract disease, treat for at least 7 days.  There is no evidence to support 7 versus 10 versus 14 days.  My advice: use 7-10 days as your range for simple febrile UTI in children. Pyelonephritis should be treated for a longer duration.  Treat pyelonephritis for 10-14 days. What should we give them? Sulfamethoxazole and trimethoprim (Bactrim) is falling out of favor, mostly because isolates in many communities are resistant.  There is an association of Stevens-Johnson Syndrome (SJS) with Bactrim use.  This may be confounded by its prior popularity; any antibiotic can cause SJS, but there are more case reports with Bactrim. Cephalexin (Keflex): 25 mg/kg dose, either BID or TID.  It is easy on the stomach, rarely interacts with other meds, has high efficacy against E. coli, and most importantly, cephalexin has good parenchymal penetration. Nitrofurantoin is often used in pregnant women, because the drug tends to concentrate locally in the urine.  However, blood and tissue concentrations are weak.  It may be ineffective if there is some sub-clinical upper tract involvement. Cefdinir is a 3rd generation cephalosporin available by mouth, given at 14 mg/kg in either one dose daily or divided BID, up to max of 600 mg.  This may be an option for an older child who has pyelonephritis, but is well enough to go home. Whom should we admit? The first thing to consider is age.  Any infant younger than 2 months should be admitted for a febrile UTI.  Their immune systems and physiologic reserve are just not sufficient to localize and fight off infections reliably. The truth is, for serious bacterial illness like pneumonia, UTI, or severe soft tissue infections, be careful with any infant less than 4-6 months of age. Of course, the unwell child – whatever his age – he should be admitted.  Think about poor feeding, irritability, dehydration – in that case, just go with your gut and call it pyelonephritis, and admit. What is the age cut-off for a urine culture? In adults, we think of urine culture only for high-risk populations, such as pregnant women, the immunocompromised, those with renal abnormalities, the neurologically impaired, or the critically ill, to name a few. In children, it’s a little simpler.  Do it for everyone. Who is everyone? Think of the urine rule of 10s: 10% of young febrile children will have a UTI 10% of UAs will show no evidence of pyuria Routine urine culture in all children with suspected or confirmed UTI up to about age 10 What do I do then with urine culture results? From a quality improvement and safety perspective, consider making this a regular assignment to a qualified clinician. Check once in 24-48 hours to find possible growth of a single uropathogen with at least 50 000 CFU/mL.  Look at the record to see that the child is one some antibiotic, or the reason why he may not.  Call the family if needed. A second check at 48-72 hours may be needed to verify speciation and sensitivities. The culture check, although tedious, is important to catch those small children who did not present with pyuria and who may need antibiotics, or to verify that the right agent is given. Ok, so your UA is negative…now what? The culture is cooking, but you are not convinced.  Below is the differential diagnosis for common causes of pyuria in children:   What kind of follow-up should the child get? The younger the child, the more we worry about missing a decompensation.  Encourage the parents to call the child's primary care clinician for a re-check in a few days, and to discuss whether or not further work-up such as imaging is indicated.  As always, strict return to ED precautions are helpful. Who needs imaging? A more accurate question is: what is an important anomaly to detect? Vesiculo-ureteral reflux – a loose ureteropelvic junction causes upstream reflux when the bladder constricts. Uretero-pelvic junction obstruction – in older children or young adults with hematuria, UTI, abdominal mass, or pain.  Infants born with UPJ obstruction have congenital hydronephrosis. Ureterocoele – a cystic mass in the bladder.  It is not malignant, but can cause ureteral dilation, and hydronephrosis.  Treatment is surgical. Ectopic ureter – either a duplication of the draining system, or an abnormal connection, such as the epidydimis or cervix. Posterior urethral valves – occur only in boys, and they are a bit of a misnomer.  The most common type of congenital bladder outlet obstruction, posterior urethral valves are just extra folds of membrane in the lumen of the prostatic urethra.  Usually ablation by cystoscopy does the trick. Urachal remnant – a leftover from fetal development, and an abnormal connection between the bladder and the umbilicus.  Look for an “always wet” belly button in an infant, or an umbilical mass with pain and fever in an older child. Imaging of choice as an outpatient? Renal and bladder ultrasound (RBUS) after the first UTI is recommended (although incompletely followed in practice). If the RBUS is positive, or with the second UTI, DMSA scan to evaluate possible renal scarring. So, with all of this testing – are we over doing it? Like anything, it’s a balance.  A few tips to avoid iatrogenia by way of a summary. If a child over 3 months of age is well, has no comorbidities, has a low grade fever "in the 38s" (38-38.9 °C) without a source, especially if less than 24 hours, you are very safe to do watchful waiting at home. More to the point, an otherwise well child with an obvious upper respiratory tract infection has a source of his fever. If your little patient has risk factors for UTI, or you are otherwise concerned, send the UA and send the culture.  You can opt out of the culture by middle school in the otherwise healthy child. And finally, deputize parents to carry the ball from here – the child needs ongoing primary care and his pediatrician may elect to do some screening.  Don’t promise or prime them for it – rather, encourage the conversation. BONUS: Suprapubic aspiration (details in podcast audio; video below) BONUS BONUS: Infant Clean Catch Technique Step One: feed the baby, wait twenty minutes.     Step Two: clean the genitals with soap and warm water and dry with gauze.  Have your sterile urine container open and at the ready.     Step Three: one person holds the baby under his armpits with his legs dangling.  The other person gently taps the bladder (100 taps/min), then massages the lower back for 30 seconds.     Step Four: Clean Catch! (can also repeat process)   References Bonsu BK, Shuler L, Sawicki L, Dorst P, Cohen DM. Susceptibility of recent bacterial isolates to cefdinir and selected antibiotics among children with urinary tract infections. Acad Emerg Med. 2006 Jan;13(1):76-81. Coulthard MG, Lambert HJ, Vernon SJ, Hunter EW, Keir MJ, Matthews JN. Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits. Arch Dis Child. 2014 Apr;99(4):342-7. Dayan PS et al.  Test characteristics of the urine Gram stain in infants

AAP Guideline on Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months http://pediatrics.aappublications.org/content/128/3/595.long UK NICE guideline: Urinary tract infection in children http://guidance.nice.org.uk/cg54 Summary: For children with fever, UTI should be suspected. For children at a very low risk for UTI, […] The post Pediatric UTI appeared first on Family Pharm Podcast.

The pathology of chronic pyelonephritis

Video podcast of the pathogenesis and pathology of chronic pyelonephritis

The causes, morphology and complications of acute pyelonephritis

Vincent and Michael recorded this episode at the 53rd ICAAC in Denver, where they spoke with James Gern and James Johnson about rhinoviruses and extra-intestinal pathogenic E. coli. Links for this Episode: Virus/allergen interactions in asthma (Curr Allerg Asth Rep) Features of rhinovirus C (Microbes Infect) Multidrug resistant ExPec in animals and food (Vet Micro) STS131 an emerging pathogen among veterans (Clin Inf Dis) Send your microbiology questions and comments (email or mp3 file) to twim@twiv.tv, or call them in to 908-312-0760. You can also post articles that you would like us to discuss atmicrobeworld.org and tag them with twim.

Vincent and Michael recorded this episode at the 53rd ICAAC in Denver, where they spoke with James Gern and James Johnson about rhinoviruses and extra-intestinal pathogenic E. coli. Links for this Episode: Virus/allergen interactions in asthma (Curr Allerg Asth Rep) Features of rhinovirus C (Microbes Infect) Multidrug resistant ExPec in animals and food (Vet Micro) STS131 an emerging pathogen among veterans (Clin Inf Dis) Send your microbiology questions and comments (email or mp3 file) to twim@twiv.tv, or call them in to 908-312-0760. You can also post articles that you would like us to discuss atmicrobeworld.org and tag them with twim.

Vincent and Michael recorded this episode at the 53rd ICAAC in Denver, where they spoke with James Gern and James Johnson about rhinoviruses and extra-intestinal pathogenic E. coli. Links for this Episode: Virus/allergen interactions in asthma (Curr Allerg Asth Rep) Features of rhinovirus C (Microbes Infect) Multidrug resistant ExPec in animals and food (Vet Micro) STS131 an emerging pathogen among veterans (Clin Inf Dis) Send your microbiology questions and comments (email or mp3 file) to twim@twiv.tv, or call them in to 908-312-0760. You can also post articles that you would like us to discuss atmicrobeworld.org and tag them with twim.

Vincent and Michael recorded this episode at the 53rd ICAAC in Denver, where they spoke with James Gern and James Johnson about rhinoviruses and extra-intestinal pathogenic E. coli.

Video podcast of the pathogenesis and pathology of chronic pyelonephritis

The causes, morphology and complications of acute pyelonephritis