Renal/Genitourinary

Rapid Review

• Background
  • Inflammation of the prostate due to ascending infection of gram-negative rods into the prostatic ducts.
  • Most commonly caused C. trachomatis and N. gonorrhoeae patients <35 years old; E. coli for patients >35 years old.
• Signs/Symptoms
  • Symptoms: Fever, chills, low back pain, irritative bladder symptoms (frequency, urgency, dysuria)
  • Signs: Tender, enlarged prostate
• Diagnosis
  • Clinical diagnosis
  • UA will show pyuria and hematuria
• Treatment
  • If < 35 years old, treat for chlamydia and gonorrhea (Ceftriaxone + Doxycycline)
  • If > 35 years old, treat for E. coli and pseudomonas (fluoroquinolones or TMP-SMZ)

Pearls

Deep Dive

• Prostatitis (emDOCs)

Rapid Review

• Background
  • Acute reduction in renal function over hours to days. Previously referred to as “acute renal failure”.
  • Causes may be prerenal (CHF,  hemorrhage, hypovolemia), intrarenal (ATN, vasculitis, glomerulonephritis), or postrenal (nephrolithiasis, BPH)
• Signs/Symptoms
  • Usually asymptomatic; may have nausea/vomiting or skin changes (purpura)
  • May show signs of fluid overload. Seizures and coma may occur if untreated.
• Diagnosis
  • Laboratory diagnosis; defined as increase in serum creatinine 1.5x presumed baseline or an increase in serum creatinine by 0.3 mg/dL over 48 hours 
  • Imaging, biopsy, and other labs (FENa, urine osmolality, etc.) will help determine cause. 
• Treatment
  • Overall goal is to treat the underlying cause.
  • IV fluids, correct electrolyte deficiencies, dialysis if needed

Pearls

Deep Dive

• Acute Kidney Injury – A Simple Emergency Approach to AKI (EM Cases)

Rapid Review

• Background
  • Infection of the kidney by a urinary tract infection ascending from the bladder. 
  • Most commonly caused by E. coli
• Signs/Symptoms
  • Symptoms: Flank pain, dysuria, nausea/vomiting
  • Signs: (+) CVA tenderness, (+) Fever
• Diagnosis
  • Urinalysis will likely show pyuria, hematuria, bacteriuria, and/or WBC casts
  • Diagnosis confirmed with urine culture
• Treatment
  • Antibiotics
    • Outpatient: Ciprofloxacin or bactrim
    • Inpatient: Gentamicin or 3rd/4th gen cephalosporin

Pearls

Deep Dive

• Pyelonephritis: It’s not always so straightforward… (emDOCs)

Rapid Review

• Background
  • Urologic emergency involving rotation of the testicle around the spermatic cord, causing compromised blood flow and ischemia that can quickly lead to permanent effects on fertility within 4-6 hours.
• Signs/Symptoms
  • Symptoms: sudden, severe pain in testicle. May have nausea/vomiting
  • Signs: (-) Cremaster reflex, (-) Prehn’s sign. Very tender to palpation
• Diagnosis
  • Ultrasound w/ doppler
• Treatment
  • Manual detorsion (open-book method)
  • If unsuccessful, will require emergent surgery

Pearls

Deep Dive

• Testicular Torsion (Core EM)