CLMD UTI, Pyelonephritis, Sepsis

Question 1

1. Non-pregnant female
2. No anatomic abnormalities
3. No instrumentation of the urinary tract
4. frequent sexual intercourse
5. nonoxadole 9 spermicide (contraception diaphragm)

Answer 1

Uncomplicated UTI

Question 2

What are two predisposing risk factors for males causing uncomplicated UTI?

Answer 2

• Prostatic hypertrophy
• non-circumcised (E coli & Staph under foreskin)

Question 3

What are the major pathogens causing cervicitis in females? Infection of the cervix.

Answer 3

• Chlamydia
• Neisseria gonorrhea

Question 4

What are the possible differential diagnoses that may present in female cases of UTI?

Answer 4

1. cystitis (bladder infection)
2. cervicitis (cervix Infection) - chlamydia, N gonorrhea
3. Vaginitis - candida, Trichomonas
4. Urethritis - herpes
5. Interstitial cystitis (chronic, recurrent infection of bladder)
6. Non-infectious vaginal or vulvar irritation

Question 5

What defines a complicated UTI in a female?

Answer 5

Any pregnant female

• This is because you have “two” patients and UTIs can lead to premature labor and/or low birth-weight babies
• mom is more immune suppressed to stop rejection of the baby and more at risk of developing sepsis than she would be if she wasn’t pregnant

Question 6

What consideration must be taken into account when treating men with prostatitis type UTI?

Answer 6

A prolonged antibiotic course of 4-6 weeks is necessary

Question 7

Bacteremia develops in __________ of cases of pyelonephritis

Answer 7

20-30%

Question 8

What pathogens may spread hematogenously from the blood to the kidneys causing pyelonephritis?

Answer 8

• Candida
• Salmonella
• Staph aureus

this tends to be very rare

Question 9

What are the three major complications of Pyelonephritis?

Answer 9

1. Papillary necrosis (think analgesics)
2. Emphysematous pyelonephritis
3. Xanthogranulomatous pyelonephritis

Question 10

Patients with what conditions would show papillary necrosis (sluffing/dying of papilla) of the kidney?

Answer 10

• Obstruction
• diabetes
• sickle cell
• analgesic nephropathy

Question 11

What is emphysematous pyelonephritis?

Answer 11

gas production within the nephric and perinephric area

Occurs almost exclusively in diabetic patients

Question 12

A subtype/complication of pyelonephritis seen in chronic obstruction, chronic infection that causes suppurative destruction of renal tissue and can lead to abscess formation.

Answer 12

Xanthogranulomatous pyelonephritis

Question 13

Differentiate bacteremia from sepsis (Septicemia)

Answer 13

Bacteremia - bacteria in the blood stream, positive blood cultures

Sepsis (septicemia):

• Suspected/documented infection
• volume redistribution —> peripheral vasodilation —> inadequate perfusion to organs —> organ failure

Question 14

What serum lactate defines septic shock?

Answer 14

Serum lactate greater than 2 mmol/L (18 mg/dL)

Question 15

(True/False) Septic shock can be reveresed with infusion of fluids

Answer 15

False

patient will need vasopressors of some sort

Question 17

Acute Kidney Injury (AKI) as a result of hypoxia causing ischemia results in microvascular (glomerulus, medullary) changes. Describe these changes

Answer 17

• Increased vasoconstriction (endothelin, angiotensin II, sympathetics)
• decreased vasodilation (NO, PGE2, ACh, bradykinin)
• increased endothelin and vascular SM structural damage
• leukocyte-endothelial adhesion —> leukocyte activation —> inflammation —> vascular obstruction

Question 18

What is the primary treatment for sepsis/septic shock

Answer 18

• Volume resuscitation (IV fluids)
• Pressors (NE, vasopressin)
• Cultures (blood, urine, CSF)
• Antibiotics

Question 19

What labs do you see in sepsis and ischemia AKI?

Answer 19

• Increased BUN and Cr (BUN:Cr > 20:1)
• muddy brown casts on microscopy (tubular epithelial damage)
• FENa < 1% (fractional excretion of Na)
• hematuria
• proteinuria

Question 20

How might you prevent recurrence of UTIs in a patient who experiences multiple UTIs?

Answer 20

• Continues antibiotic therapy
• post-coital antibiotic therapy
• patient-initated antibiotic therapy (if they feel symptoms)