Infections of Kidney and Urinary Tract Flashcards
What regions of the urinary tract do upper UTIs and lower UTIs affect?
=> Upper UTIs:
- Kidneys
- Ureters
=> Lower UTIs
- Bladder
- Urethra
What is Cystitis?
Inflammation of the bladder as a result of bacterial infection
What are the 2 routes of infection of the bladder?
=> Ascending infection - bacteria from rectal area makes its way up to bladder
=> Descending infection - bacteria in the blood or lymph nodes makes its way down to the bladder
What are the risk factors of Cystitis?
- Sexual intercourse
- Female gender
- Catheter insertion
- Diabetes
- Infant boys with foreskin
- Impaired bladder emptying (urinary stasis)
What are females more likely to develop UTIs?
- Shorter urethra
- Low oestrogen levels in post menopausal women
What are the clinical features of Cystitis?
- Supra-pubic pain
- Dysuria
- Pyuria
- Frequent urination
- Urgency
=> Infants may develop a fever
=> Elderly may become fatigued and develop delirium
TYPICALLY NO SYSTEMIC SYMPTOMS
What are the causes of Cystitis?
=> Gram -ve bacteria
- E. Coli
- Klebsiella
- Proteus
- Enterobacter
- Citrobacter
=> Gram +ve bacteria
- Enterococcus
- Staphylococcus Saprophyticus
=> Non infectious causes
- BPH
- Stones
- Bladder cancer
- Prostate cancer
=> E. Coli is the most common causative organism
What are the investigations in suspected Cystitis?
=> Urine culture - gold standard
CFUs/ml > 100,000
=> Urinanalysis
Pyuria - cloudy urine
Nitrites in urine
=> Imaging
- Ultrasound
- Voiding Cystourethrogram
- DMSA Scan
Imaging is only considered in men with upper UTI, failure to respond to treatment, recurrent UTIs, unusual organisms, persistent haematuria
What is the management of Cystitis?
=> High fluid intake
=> Analgesia
=> Antibiotics
- Trimethoprim should be avoided in pregnancy
- Nitrofurantoin (unless 3rd trimester), amoxicillin or cefalexin in cases of lower UTI
- If symptoms suggest prostatitis in men, give Ciprofloxacin
Preventative measures involve bladder emptying after sex and good hygiene
What is Acute Pyelonephritis?
Infection of the kidney
What are the risk factors of Acute Pyelonephritis?
- Female gender
- Sexual intercourse
- Catheter insertion
- Diabetes
- Urinary tract obstruction
- Vesicouretral reflux (failure of the valve between the bladder and ureters, making ascending infection more likely)
What are the clinical features of Acute Pyelonephritis?
- Fevers and Rigors
- Vomiting
- Loin pain
- White cell casts in urine
What are the causes of Acute Pyelonephritis?
=> Causative organsims in ascending infection:
- E. Coli
- Proteus
- Enterobacter
=> Causative organisms in descending infection:
- E. Coli
- Staphylococcus
What are the investigations in suspected Acute Pyelonephritis?
=> Urine dipstick
- Leukocytes
What is the management of Acute Pyelonephritis?
Co-amoxiclav and Gentamicin
