15. Infections And Kidney Disease

Question 1

What can cause chronic pyelonephritis?

Answer 1

Repeated pyelonephritis in childhood.

Question 2

How does TB spread to the urinary tract?

Answer 2

Haematogenous spread.

Question 3

What is seen on examination of urine in patients with urinary tract TB infection?

Answer 3

Sterile pyuria.

Haematuria.

Question 4

Where does TB infection of the urinary tract usually start and where can it spread to?

Answer 4

Kidneys, eventually causing calcification of the kidneys, and occasionally spreading to the ureters and bladder.

Question 5

Name a type of blood flukes that can cause UTI which can then lead to calcification of the bladder and bladder cancer.

Answer 5

Schistosoma haematobium.

Question 6

Name a species of schistosomiasis that causes hepatosplenic/GI disease and can eventually cause glomerulonephritis but not bladder cancer.

Answer 6

Shistosoma mansonii and Shistosoma japonicum.

Question 7

Name 2 systemic infections in the UK that can cause glomerulonephritis.

Answer 7

Post-infectious glomerulonephritis.
Endocarditis.
Hep B.
Hep C.
HIV.

Question 8

What causes post-infectious glomerulonephritis?

Answer 8

Group A streptococcus.
1-4 weeks after throat infection.
Children and elderly.

Question 9

How can post-infectious glomerulonephritis present?

Answer 9

Acute nephritis syndrome.

Question 10

What 2 bacteria can cause endocarditis associated glomerulonephritis?

Answer 10

Streptococcus viridans.

Staphylococcus aureus.

Question 11

How do patients with endocarditis associated glomerulonephritis tend to present?

Answer 11

AKI with non-visible haematuria.

Systemic symptoms and signs of endocarditis eg fever, arthralgia.

Question 12

How can patients with endocarditis develop AKI other than from direct kidney infection?

Answer 12

Septic emboli.

Question 13

How can patients with endocarditis develop renal infarction?

Answer 13

From septic emboli.

Question 14

Give 3 factors that can increase the risk of infection in chronic kidney disease.

Answer 14

Co-morbidity especially diabetes mellitus.
Decreased immune response.
Immunosuppression.
Decreased vaccine responsiveness.
Malnutrition.
Nephrotic syndrome.
Lots of hospital visits (increased infection exposure).
Increasing age.

Question 15

What do patients with end-stage renal disease have an enhanced risk of developing?

Answer 15

TB - extrapulmonary involvement common.