Clinical UTI

Question 1

What is an infection of the kidney called?

Answer 1

Acute/Chronic Pyelonephritis

Question 2

What is an infection of the bladder called?

Answer 2

Cystitis

Question 3

What is an infection of the urethra called

Answer 3

Urethritis

Question 4

Infection of prostate?

Answer 4

Prostatitis

Question 5

Infection of testes/epididymis?

Answer 5

Epididymo-orchitis

Question 6

What are the general predisposing factors making someone more prone to UTIS/

Answer 6

Immunosuppression
Steroids
Malnutrition
Diabetes

Question 7

What organisms usually cause UTIs?

Answer 7

Usually bowel organisms

E. Coli
Proteus
Klebsiella
Enterococcus

Question 8

What can cause urethra to bladder transmission of bacteria?

Answer 8

Intercourse for females

Catheterisation

Question 9

Clinical features of UTI in kids?

Answer 9

Diarrhoea
Excessive crying
Fever
Nausea and vomiting
Not eating

Question 10

Clinical features of UTI in adults?

Answer 10

Flank pain
Dysuria - like passing broken glass
Cloudy urine
Strangury 
Confusion in very elderly

Question 11

What is strangury ?

Answer 11

Severe pain and a strong desire to urinate.

Question 12

Clinical features of acute pyelonephritis?

Answer 12

Pyrexia
Poor localisation
Loin tenderness (renal angle)
Signs of dehydration
Turbid urine

Question 13

UTI investigations?

Answer 13

MSSU

Urine analysis in ward - blood, leukocytes, protein and nitrates

Microbiology - microscopy and gram-staining, culture and sensitivity

Question 14

In children, men or when UTIs are frequent what investigations can be useful?

Answer 14

Ultrasound/IVU

Isotope studies to rule out reflux and scarring

Question 15

Treatment?

Answer 15

Fluids
Antibiotics - amoxicillin

For severe infections - IV antibiotics

Question 16

What is Reflux Nephropathy?

Answer 16

Kidney damage due to urine flowing backwards and causing repeat UTIs

Question 17

Investigations for Reflux Nephropathy? Treatment?

Answer 17

Micturating cystogram

Assess progression by ultrasound scan & biochemistry

Treated via surgery

Question 18

Indwelling Urinary Catheters considerations?

Answer 18

Aseptic technique
Fluid intake

Colonisation is inevitable but antibiotics only if patient symptomatic - just replace catheter

Question 19

What is Bacteriuria?

Answer 19

Bacteria level of >10^5 in urine

But also depends on clinical symptoms as you can get asymptomatic bacteriuria and bacteriuria of pregnancy

Question 20

What does chronic pyelonephritis look like radiologically? What sign will often accompany it?

Answer 20

Radiology - scarring and clubbing of calyces

Also has HTN and can progress to chronic renal failure