Kidney and Bladder Infections Flashcards by Garrett Oberst

Cystitis and pyelonpehritis mechanisms

Cystitis - pathogenic bacteria colonize the vagina…bacteria ascend from vagina to bladder…bacteria remain in bladder

Pyelo - start with cystitis then bacteria ascend from bladder to kidneys

How well did you know this?

Not at all

Perfectly

Normal host defense

Normal flora compete with pathogenic bacteria - help maintain acidic pH..also secretory IgA

Eliminate bacteria that do not get into bladder by normal voiding and bactericidal components

How well did you know this?

Not at all

Perfectly

Risk facotrs for bacterial cytisis

Anything that increase colonization, ascent, or decreases eliminaton

How well did you know this?

Not at all

Perfectly

Pt risk factors for colonization

Genetic - epithelial glycoproteins

Dec normal flora - dec estrogen after menopause, spermicide, coitus, ABs

Increased vaginal contact iwth feces

How well did you know this?

Not at all

Perfectly

Bacteria ascend into bladder

Can be spontenaous

Pt risk factors - coitus and urehtral instrumentation and catheters

How well did you know this?

Not at all

Perfectly

DEc eliminatioin from bladder

Abnormal voiding

Diabetes - dec immune function in diabets…glucose in urine is energy for bacteria

Immunosuppression

How well did you know this?

Not at all

Perfectly

Pt risk for bacterial pyelonephritis

Any of the cystitis risk factors

Increased ascent is BY far the mst fcommon mech…vesicouretral reflux, stasis of urine (pregnancy)

bacteremia due to IV drug use, infected central line, etc.

How well did you know this?

Not at all

Perfectly

Type 1 E coli pili

FimH adhesion protein binds to mannose residues on luminal bladder surface

Free floating mannose inhibits this binding so oral mannose can dec UTI frwquency

How well did you know this?

Not at all

Perfectly

Bac risk factor for pyelonephritis

P pili with papG adhesion protein..allows ascension into the kidneys

How well did you know this?

Not at all

Perfectly

PapG

Binds glycolipid moiety on P blood group antigens…all the way up to kidneys

Mannose resistant

Gene is PAP operon for pyeloneprhitis associated pili

How well did you know this?

Not at all

Perfectly

Female urethral diverticulum

Outpuching or urethra fills as pt urinartes…stagnant urine —-infections and some urine dribbles out

DDD - dysuria, dyspareunia, dribbling

Dx - tender mass and MRI

How well did you know this?

Not at all

Perfectly

Asx bactriuria

No sx or PE

Urinalysis shows nitrites and/or bact

How well did you know this?

Not at all

Perfectly

Urinalysis relevant to infection

Chemstrip - nitrites and leukocyte esterase

Microscope - WBCs and bacteria

How well did you know this?

Not at all

Perfectly

Nitrites

Many gram neg bacteria…turns bind

Gram + do NOT do this conversion…neg nitrites does NOT rule out bacteria

How well did you know this?

Not at all

Perfectly

Leukocyte esterase

Enzyme in granulocytes catalyzes color change to purple

How well did you know this?

Not at all

Perfectly

When to tx asx bacteriuria

Tx if preg or planning surgery and need sterile urine

How well did you know this?

Not at all

Perfectly

Comm acquired bac cystitis

Not recently in healthy care facility

Acute dysuria..no fever and not il

No angle tenderness, bladder may be tender

Urinalysis - Positive LE< WBC, nitrites or bact

US - acute dysuria UA and LE but no nitrites

Pseudomonas - nitrite neg
Staph - nitrite neg
Enterococcus - nitrtie neg

Tx of comm acquired cystitis

Tx based on scenario

Empiric tx for cystitis

Oral ABs - E coli or staph

Oral phenaopyrdine for the sx - analgesic to bladder and turns urine orange

Cystitis expected outcome with AB

Usually resolves in 1-3 days

If does not resolve, then may be resistant or not from a UTI in the first place…send a urine culture

Urine culture report

No growth - usually means no infection

Bacteria name with# CFU

Mixed flora - genital skin bacteria included in urine specimen

Usual urine collection methods

Midstream clean catch - could include bacteria

IN and out cath - pure urine and no skin flora

If clean cathc mixed flora- need to do a catheter

Recurrent UTI

More than 1 in 6 mos or 2 in 12

Change contraception
Vaginal estrogen in post menopausal
Oral d-mannose
Oral methenamine

Vaginal estorgen

After menopause, vaginal pH increase...normal lactobacillus dec...easier for uropathogens to colonize...estrogen reverses

Oral mannose

Binds pili so they can't bidn to urothelium

Methenamine

Antiseptic...decomposes to formaldehyde and ammonia No resistance Contraindiciated if hepatic insuffiencet or renal

Comm acquired pyelo

Flank pain, fever, malaise, may or may not have dysuria WIll have fever/CVAT Labs - high WBC, may have high BUN/Cr Usually positive as for cystitis

Tx of comm acq pyelo - outpatient

Okay to tx outpatient if comm, not preg, spetic, and compliant Outpatient choices - cipro, bactrim PLUS cef or amino NOT NITROfurantoin

Pyelo inpatient

Cephalo 3rd gen with AG OR carbapenem Change to oral drug when stable ----continue 10-14 days

Expected pyelo outcome with AB

Temp should dec 1 degree a day If fever does NOT dec....ureteral obsruction - lifethreatneing and get a CT scan!!!!!!! Others - areas doesn't penetrate, resistat

INfection with ureteral obstruction

MUST rule out the obstruction...get CT scan

CLinical scenario of obstruction plus infection

Same as pyelo but more severe Relevant med hx with risk of obstruction - hx of stones, diabetes, radiation

Renal and perinephric abscess

Renal - within kidney parenchyma Perineprhic - more severe and can airse from source adjacent to kidne y

Renal and perineprhic mechs

Starts as pyelo but not completely cleared Seeding from bacteremia, usually gram+ from skin source or IV drug users Presents like pyelo but does not improve...if you suspect a stone, get CT>..CT shows abscesses

Pyoneprhosis and XGP

Pyo - end stage hydroneprhotic kdiney with no functiong parenchyma XGP - nonfuncitong enlarged kidney with stones and inflammatory phlegmon...lipid-laden macrophages Dx process similar...get CT

Renal TB

If immunocompetent- ---long latency Often go down itno bladder and lead to scarring

Renal TB dx

Sx may be minimal Urinalysis - WBC but no growht...sterile pyuria Skin and blood tests don't prove renal involvement Best is 1st morning voided urine for acid-fast for 3-5 consecutive days

Renal Tb imaging

Ureter scarring - adjacent to bladder is classic...dilated ureter proximal to stricture Kdiney - hydroneprhosis due to dilated ureter Individual calyces idlated due to scarred infundibulae, parenchymal destruction, severe autoneprhectomy

Pseudomonas

Nitrite negative Difficult to tx...maybe FQs? Ciommon in bioflms on urinary catheters...secrete PSs and antibiotics can't penetrate biofilms

Proteus

Has urease enzyme that converts urine urea to ammonia Alkaline urine pH

Enterococcus

Gram+ so + LE and neg nitrites Some resistant to vanc...all sensitive to linezolid