1. Lee, Lucero, Macalintal, Magallanes, Maningas, Ombao, Pacifico

2. Initial Laboratory Tests  CBC  leukocytosis  Low Hgb, low Hct – bleeding (obstructive uropathy)  ESR  CRP

3. Urinalysis  Pyuria  With bacteriuria (≥10 5 /ml): highly sensitive indicator of UTI  Sterile pyuria  Atypical organisms: C. Trachomatis, U. Urealyticum, M. Tuberculosis  Non-infectious urologic conditions: calculi, anatomic abnormality, nephrocalcinosis, VUR, interstitial nephritis, polycystic disease  Gram-stained uncentrifuged urine (for empiric choice of antibiotic)  Leukocyte casts which form casts – characteristic of acute pyelonephritis  Hematuria – urolithiasis

4. Serum BUN and Creatinine  determine (reversible) renal damage

5. Two 24-h urine collections  calcium, sodium, phosphorus, magnesium, oxalate, uric acid, citrate, sulfate, creatinine, pH, and total volume

6. Comprehensive Metabolic Panel  serum calcium, uric acid, and phosphorus; parathyroid hormone level

7. Urine culture and sensitivity  No longer requested for uncomplicated acute cystitis  criterion standard for evaluation of a urinary tract infection (UTI) during pregnancy  results are often unavailable at the time of treatment

8. Blood culture  Severely ill patients

9. Imaging  The total dosage of ionizing radiation should not exceed 3-5 rads during the course of pregnancy

10. UTZ  cheap; no exposure to radiation or dyes  stones may not be identified due to hydronephrosis in pregnancy  typical acoustic shadowing

11. X-ray  one-shot pyelogram (ie KUB)  to identify stones obscured in renal ultrasound  can deliver 0.4-1 rad

12. Helical CT scan  gold standard for urolithiasis in non- pregnant patients

13. Other Procedures  evaluation of fetal status: FHT

14. Thank you!