Peer # 1 (Rukia)
Definition of Bacteriuria: A urinalysis is usually used to detect the presence of bacteria in the urine. It might or might not be connected to UTI (urinary tract infection) symptoms (Klein, 2020).
Additional History Needed for Diagnosis:
History Needed for Diagnosis: In order to establish a diagnosis, further information must be obtained regarding recent sexual activity, UTI history, any recent urinary tract instrumentation, past antibiotic use, and the existence of any comorbid conditions, such as immunosuppression or diabetes mellitus (Schaeffer & Schaeffer, 2021).
Diagnostic Studies and Rationale:
Urine culture and sensitivity: to ascertain the most suitable antibiotic therapy and to identify the causal organism.
Renal ultrasonography: to check for urinary tract anatomical anomalies, such as renal calculi or blockage.
Cystoscopy: if there are any other troubling examination or imaging results, or if recurring UTIs are suspected (Hooton et al., 2020).
Possible Reasons for Pain and Differential Diagnosis:
The symptoms of acute pyelonephritis include costovertebral soreness, fever, and flank pain.
Urolithiasis: renal calculi that block the kidneys and cause pain in the flanks.
Recurrent cystitis: When there is increased frequency, urgency, and persistent dysuria.
Similar symptoms are caused by a chronic inflammation of the bladder called interstitial cystitis (Hanno et al., 2015).
Diagnostic Tests to Confirm Diagnosis:
Urinalysis and urine culture: to detect infection and identify the microorganism causing it.
Inflammatory markers and the complete blood count (CBC) are used to detect systemic inflammation.
Renal calculi and structural abnormalities can be assessed by renal ultrasonography or CT scan (Sultan & Davis, 2019).
The reasons behind recurrent lower urinary tract infections (UTTIs) include incomplete removal of the pathogen, anatomical abnormalities, urinary tract blockages, retention of urine, and underlying medical conditions like immunosuppression or diabetes mellitus (Raz et al., 2020).
Distinctions Between Acute Renal Failure: Prerenal, Intrarenal, and Postrenal Reduced renal perfusion, as in hypovolemia or reduced cardiac output, is the cause of prerenal acute renal failure. Hypovolemic shock is one example.
Damage to the renal parenchyma, such as acute tubular necrosis (ATN) brought on by ischemia or nephrotoxic drugs, can result in intrarenal acute renal failure. Example: Nephropathy brought on by contrast.
Urinary tract obstruction resulting in decreased urine flow and consequent kidney damage is the cause of postrenal acute renal failure. As an illustration, consider kidney stones blocking the ureters (Kellum & Prowle, 2018).
Peer # 2 (Courtney)
Case #1: A 55-year-old woman presents to the office with bloody urine and dysuria
of 12-hour duration. She was recently married and has never had similar
symptoms. She denies chills and fever. On physical examination she is afebrile, has normal vital signs, and has mild tenderness in the midline above the pubis. Her urinalysis shows too many to count (TNTC) red blood cells.se
What is the definition of bacteriuria? Bacteriuria is the presence of bacteria in the urine (McCance & Huether, 2019).
What additional history do you need to make a diagnosis? Assess for burning, frequency, dribbling, odor, and urgency. Assess for mental status changes. Assess for flank or abdominal pain. Assess kidney and urinary history and assess for trauma. Assess recent medications and menopausal status. Assess where exactly blood is coming from- vagina, anus, urethra.
What diagnostic studies would you order and why? I would recommend ordering a Urine Culture to assess for any bacterial presence or urinary tract infections. Additionally, a Kidney Ultrasound would be beneficial to visualize the structure and integrity of the kidneys, allowing us to identify any potential abnormalities such as stones or cysts. Lactate levels should be measured to evaluate tissue oxygenation and assess for conditions like sepsis. Obtaining a CBC with a focus on White Blood Cell count is essential for assessing the body’s immune response and detecting any signs of infection or inflammation. A CMP to assess kidney function, dehydration indicators and electrolyte balances (McCance & Huether, 2019)..
Case #2: A 23-year-old woman was married a year ago. Since then, she has experienced five attacks of acute cystitis, all characterized by dysuria, increased frequency, and urgency. Each infection responded to short-term treatment with trimethoprim sulfamethoxazole. The recurrences occurred at intervals of 3 weeks to 3 months following completion of antibiotic therapy. For the past two days, the woman has been experiencing acute flank pain, microscopic hematuria, dysuria, increased frequency, and urgency.
Her vital signs are T = 37.9°C, P = 106, R = 22, and BP = 130/75 mm Hg. Physical examination reveals costovertebral tenderness, mild tenderness to palpation in the suprapubic area, but no other abnormalities.
What are possible reasons for this woman’s pain? List possible differential diagnosis and explain each?
Acute Cystitis refers to a bacterial infection of the bladder, commonly caused by E. coli bacteria. Symptoms typically include urinary urgency, frequency, burning with urination, and lower abdominal discomfort or pain. It’s more common in women and can be triggered by factors like sexual activity, certain contraceptives, or urinary tract abnormalities (McCance & Huether, 2019).
STDs such as gonorrhea or chlamydia can cause pelvic pain in women. These infections are often transmitted through sexual contact and can lead to symptoms such as vaginal discharge, burning with urination, pelvic pain, and in some cases, fever or abnormal vaginal bleeding (McCance & Huether, 2019)..
Vaginitis is inflammation of the vagina, commonly caused by infections such as yeast infection, bacterial vaginosis or irritants (e.g., soaps, perfumes). Symptoms may include vaginal itching, burning, abnormal discharge, and discomfort or pain during sexual intercourse or urination. Vaginitis can also lead to pelvic discomfort or pain (McCance & Huether, 2019).
What diagnostic tests should you order to confirm diagnosis? STD panel typically includes tests for common sexually transmitted infections uch as chlamydia, gonorrhea, syphilis, and HIV. It may also include tests for other STIs depending on the patient’s sexual history and risk factors. These tests are essential for identifying any underlying STIs that could be causing the symptoms of vaginitis or contributing to pelvic pain. A urinalysis is a common test used to assess the physical and chemical properties of urine. It can help detect urinary tract infections (UTIs), kidney problems, and other systemic conditions. In the context of pelvic pain, a UA can provide valuable information about the presence of infection or inflammation in the urinary tract. A urine culture is a laboratory test used to identify and determine the susceptibility of bacteria or other pathogens present in the urine. It is particularly useful for diagnosing urinary tract infections (UTIs) and determining the appropriate antibiotic treatment. A UC can help confirm the presence of a UTI if suspected based on symptoms such as urinary urgency, frequency, or burning. A vaginal wet mount is a microscopic examination of vaginal discharge obtained from the patient’s vagina. It involves placing a sample of the discharge on a microscope slide with a small amount of saline or potassium hydroxide. This test can help identify the presence of yeast cells (indicative of candidiasis), clue cells (indicative of bacterial vaginosis), or motile trichomonads (indicative of trichomoniasis). The results of the wet mount can provide valuable information for diagnosing the specific cause of vaginitis or other vaginal infections.
What are the possible causes of recurrent lower UTIs? Risk factors for recurrent urinary tract infections (UTIs) include various factors such as the use of spermicides, especially when used with a diaphragm, atrophic vaginitis, bladder diverticula, chronic diarrhea, cystocele, diabetes, experiencing the first UTI before 16 years of age, genetic predisposition, frequent sexual intercourse (more than twice a week), history of five or more UTIs, inadequate fluid intake, increased post-void residual urine, family history of frequent or multiple UTIs, new or multiple sexual partners, short distance between the anus and urethral meatus, urethral diverticula, urinary incontinence, and use of spermicide-coated condoms(Aggarwal et al, 2024). Personal hygiene factors also play a role, such as improper washing techniques, not using vaginal estrogen when appropriate, and not practicing proper hand hygiene(Aggarwal et al, 2024). These factors contribute to an increased risk of recurrent UTIs and should be considered in management and prevention strategies.
What are the differences when comparing prerenal acute renal failure, intrarenal acute renal failure, and postrenal acute renal failure? Give examples of each. Prerenal renal failure is the result of a mechanism before the kidneys cause the failure. It may be a result of heart failure, hypovolemia, blood loss, hypotension, or electrolyte loss. Intrarenal failure is the result of a failure inside of the kidney itself. This may be caused by tubular necrosis, glomerulonephritis, vascular disease or interstitial diseases such as drug allergy, infection or tumor. Postrental failure is a failure in the mechanisms of your kidneys. This is usually caused by urinary bladder obstruction (McCance & Huether, 2019).
