L 33 Renal Flashcards
Is the urinary tract sterile?
Usually
What are the defense mechanisms of Urinary tract infection ?
Immune system and passing urine
What is the proportion of UTI for women?
Common in female around 50%
Womens are 30x more likely get a UTI
Why women has higher infection rate of UTI than male?
Shorter urethra,Opening near vagina and anas.
Predisposing factors for UTIs?
- Gender (women)
- Age like below 1yr of age why ? cause of napkin
- Obstructions of UT (e.g by using catheter,)
- Pregnancy (hormone alteration)
- Diabetes (increased glucose and micorbes like it)
- Immunocompromisation
- Urine composition (microbes present?)
- Vaginal and faecal microflora (protective)
Types of UTI?
Uncomplicated & complicated
Uncomplicated UTIs occur in people with …. and they respond to….
Recurrence is due to a …..
Uncomplicated UTIs occur in people with normal immunity and normal urinary tracts and they respond to antibiotic therapy.
Recurrence is due to a new infection.
Complicated UTIs occur in people with …. and they …. respond to….
Recurrence is due to a …..
Complicated UTIs occur in people with abnormal immunity and abnormal urinary tracts, and they do not respond to antibiotics.
Recurrence is due to a relapse of earlier infection (not cleared well enough/at all)
What is urethritis?
Infection of the urethra causing inflammation
What are the common infectious causes of urethritis? What would be 2x examples of a non-infectious cuase?
- From Sexually Transmitted disease (chlamydia, gonorrhoea)
- GI oragnisms (e.g E.coli)
- Candida infections
Non infectious: trauma, washing detergents/irritants,
What are the Symptoms of urethritis?
Dysuria, increased urination urgency and frequency
- None of these are particularly unusual symptoms)
What is cystitis?
Infection of the bladder (leading to inflammation)
What are the most common causes of cystitis? x4
- E.coli
- Uropathogenic E.coli (UPEC) for recurrent infections
- Other GI organisms (Staph, Enterobacter)
- Fungal (candida), or viral (adenovirus)
What are the risk factors for cystitis?
Same as urethritis/other UTIs
What is UPEC?
Uropathogenic E. coli
Where do UPEC normally come from? How can UPEC survive in the UT? (Specialised factors x5)
UPEC are usually from the GIT.
Specialised factors:
1. Adhesion factors -pili/fimbriae (help to stick)
2. Toxins - haemolysin, cytotoxic factor (peak immune system and damage walls)
3. Capsules (help evade immune response)
4. Iron acquisition (nutrients to grow in urine (urine = nutrient-lacking environment for bacteria)
5. Urease activity (accumulates ammonia to change pH of urine, and can lead to kidney stones = decreased flow)
Symptoms of cystitis (uncomplicated and complicated)?
Uncomplicated: dysuria, urine urgency or frequency
Complicated: dysuria, urine urgency or frequency, incontinence, abdominal pain, low grade fever, foul smelling, discharge (blood or pus)
Recurrent cystitis is usually due to…
Recurrences are linked to host…..?
Usually due to a new organism
Recurrences are linked to host risk factors
Treatment aim for recurrent cystitis?
To keep patient symptom free and prevent renal damage
How do you diagnose UTIs?
How do you diagnose recurrent UTIs?
UTIs: symptomatic diagnosis (e.g dysuria, urgency/frequency, no discharge)
Recurrent UTIs: Self diagnosis has over 90% accuracy. Very reliable.
What is a bad way to diagnose for UTIs? Why?
OTC test kits.
If get negative result but have symptoms = go to doctors
If get positive result = go to doctors anyway
Are lab tests/swabs recommended for UTI diagnosis?
No, they don’t often provide much more information. 90% of time is E.coli
UTI prevention steps (x5)?
- Drink lots of water and urinate when you feel the need.
- Wipe from front to back
- Take showers instead of baths
- Clean genital area before and after sex
- Avoid using feminine hygiene sprays.
Does drinking cranberry juice work?
Weak evidence, but works in some
Do D-mannose tablets work for prevention?
(a sugar tablet)
Variable evidence
Does infection by an asymptomatic bacteria prevent UTIs?
Variable evidence. Quite potentially.
What groups should you screen for a UTI and which should you not screen?
Screen: pregnant women
Don’t screen: anyone else
What is pyelonephritis?
Inflammation of the kidneys and ureters
Is pyelonephritis common in the community?
No, it is a common hospital infection though.
What causes pyelonephritis? x4
- recurrent cystitis
- obstructed urine flow
- immune compromisation
4 congenital abnormalities (e.g ureteral reflux)
What is ureteral reflux?
Back flow of urine from the bladder up to the kidneys caused by abnormal valves.
What is the common causative agents of pyelonephritis?
E.coli (also candida but much less common)
Symptoms of acute pyelonephritis
Flank/back pain, fever, nausea/vomiting, fatigue, dysuria, frequency/urgency, foul smelling urine, blood/pus in urine
Symptoms of chronic pyelonephritis
Low grade pain, fever, urinary symptoms, weight loss, general ill feeling, fatigue
Diagnosis of pyelonephritis
Urinalysis, abdominal examination
What is Prostatitis?
Infection or inflammation of the prostate
What is the most common urological diagnosis in men under 50?
Prostatitis
Where is the prostate gland located compared to the bladder and urethra?
The prostate gland is located below the bladder and wraps around the urethra.
How is the prostate infected in prostatitis?
Through the back flow of urine from the bladder.
Risk factors for prostatitis. What are they the same as?
Recurrent cystitis
Obstructed urine flow
Immune compromisation
Congenital abnormalities
This is the same as for pyelonephritis
Acute prostatitis is a …. infection and can be ….
Is a severe infection and can be life threatening
What are causative agents of acute prostatitis? (x2)
What are the symptoms?
E.coli, Klebsiella spp (GI agents usually)
Symptoms:
- Lower abdominal pain, fever, frequency, urgency, pain on urination, foul smelling urine
Diagnosis of acute prostatitis. How will the prostate appear?
Urinanalysis and digital rectal exam. Prostate will be enlarged and exquisitely tender
Treatment for acute and chronic prostatitis
Acute: oral or IV antibiotics + monitor
Chronic: antibiotics but high relapse rate so use low dose prophylaxis or surgery
Prevention for chronic prostatitis
Using condoms - reduced GI exposure
What is the issue with using antibiotics for the prostate?
It is hard for antibiotics to penetrate the prostate.
What is the risk of surgery for chronic prostatitis?
Risk of dry ejaculation
Symptoms of chronic prostatitis
Intermittent cystitis, urinary symptoms (+/-), painful ejaculation (+/-)
What are kidney stones caused by?
The accumulation of mineral salts forming in the kidney and ureters
What are the types of kidney stones (e.g minerals), and what is their prevalence?
75-85% calcium stones
10-15% struvite (caused by infection)
5-8% uric acid
<1% cysteine
What causes struvite kidney stones?
What is struvite made of?
Bacterial infection –> bacteria produce ammonia giving a change in pH leading to struvite production and crystallisation.
Struvite = magnesium ammonium phosphate
Risk factors for kidney stones
Recurrent cystitis, women, antibiotics, other medications, etc
Symptoms of kidney stones
N,V, fever, abdominal tenderness, blood in urine, frequency/urgency, pain during urination
Diagnosis of kidney stones
Urinalysis, imagine (e.g ultrasound, CT)
Many are asymptomatic
Treatment of kidney stones:
- 86% actually pass spontaneously.
- Pain relief may be required.
- Treat infections and prevent recurrent cystitis (so no more struvite stones)
- Rehydration
- Surgery
When may surgery be required for kidney stones?
What is the surgical procedure?
- A painful stone doesn’t pass after a reasonable period of time
- Too large to pass on its own/block urine flow
- Causes ongoing UTI
- Damages kidney tissue/causes bleeding
Procedure: can range from open surgery to non-invasive measures (shockwave therapy to shatter stone)
