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Renal and Urinary 3 > Kidney and Bladder Infections > Flashcards

Kidney and Bladder Infections Flashcards

1
Q

Cystitis and pyelonpehritis mechanisms

A

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

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2
Q

Normal host defense

A

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

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3
Q

Risk facotrs for bacterial cytisis

A

Anything that increase colonization, ascent, or decreases eliminaton

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4
Q

Pt risk factors for colonization

A

Genetic - epithelial glycoproteins

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

Increased vaginal contact iwth feces

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5
Q

Bacteria ascend into bladder

A

Can be spontenaous

Pt risk factors - coitus and urehtral instrumentation and catheters

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6
Q

DEc eliminatioin from bladder

A

Abnormal voiding

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

Immunosuppression

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7
Q

Pt risk for bacterial pyelonephritis

A

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.

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8
Q

Type 1 E coli pili

A

FimH adhesion protein binds to mannose residues on luminal bladder surface

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

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9
Q

Bac risk factor for pyelonephritis

A

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

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10
Q

PapG

A

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

Mannose resistant

Gene is PAP operon for pyeloneprhitis associated pili

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11
Q

Female urethral diverticulum

A

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

DDD - dysuria, dyspareunia, dribbling

Dx - tender mass and MRI

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12
Q

Asx bactriuria

A

No sx or PE

Urinalysis shows nitrites and/or bact

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13
Q

Urinalysis relevant to infection

A

Chemstrip - nitrites and leukocyte esterase

Microscope - WBCs and bacteria

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14
Q

Nitrites

A

Many gram neg bacteria…turns bind

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

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15
Q

Leukocyte esterase

A

Enzyme in granulocytes catalyzes color change to purple

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16
Q

When to tx asx bacteriuria

A

Tx if preg or planning surgery and need sterile urine

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17
Q

Comm acquired bac cystitis

A

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

18
Q

US - acute dysuria UA and LE but no nitrites

A

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

19
Q

Tx of comm acquired cystitis

A

Tx based on scenario

20
Q

Empiric tx for cystitis

A

Oral ABs - E coli or staph

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

21
Q

Cystitis expected outcome with AB

A

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

22
Q

Urine culture report

A

No growth - usually means no infection

Bacteria name with# CFU

Mixed flora - genital skin bacteria included in urine specimen

23
Q

Usual urine collection methods

A

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

24
Q

Recurrent UTI

A

More than 1 in 6 mos or 2 in 12

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

25
Q

Vaginal estorgen

A

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

26
Q

Oral mannose

A

Binds pili so they can’t bidn to urothelium

27
Q

Methenamine

A

Antiseptic…decomposes to formaldehyde and ammonia

No resistance

Contraindiciated if hepatic insuffiencet or renal

28
Q

Comm acquired pyelo

A

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

29
Q

Tx of comm acq pyelo - outpatient

A

Okay to tx outpatient if comm, not preg, spetic, and compliant

Outpatient choices - cipro, bactrim PLUS cef or amino

NOT NITROfurantoin

30
Q

Pyelo inpatient

A

Cephalo 3rd gen with AG OR carbapenem

Change to oral drug when stable —-continue 10-14 days

31
Q

Expected pyelo outcome with AB

A

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

32
Q

INfection with ureteral obstruction

A

MUST rule out the obstruction…get CT scan

33
Q

CLinical scenario of obstruction plus infection

A

Same as pyelo but more severe

Relevant med hx with risk of obstruction - hx of stones, diabetes, radiation

34
Q

Renal and perinephric abscess

A

Renal - within kidney parenchyma

Perineprhic - more severe and can airse from source adjacent to kidne y

35
Q

Renal and perineprhic mechs

A

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

36
Q

Pyoneprhosis and XGP

A

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

37
Q

Renal TB

A

If immunocompetent- —long latency

Often go down itno bladder and lead to scarring

38
Q

Renal TB dx

A

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

39
Q

Renal Tb imaging

A

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

40
Q

Pseudomonas

A

Nitrite negative

Difficult to tx…maybe FQs?

Ciommon in bioflms on urinary catheters…secrete PSs and antibiotics can’t penetrate biofilms

41
Q

Proteus

A

Has urease enzyme that converts urine urea to ammonia

Alkaline urine pH

42
Q

Enterococcus

A

Gram+ so + LE and neg nitrites

Some resistant to vanc…all sensitive to linezolid

Renal and Urinary 3 (22 decks)

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