Lecture 1: UTI-Pyelonephritis-Sepsis Flashcards
What are the 3 criteria for a UTI to be considered uncomplicated?
- Non-pregnant female
- No anatomic abnormalities
- No instrumentation of the urinary tract
Use of what contraceptive method increases the risk for UTI?
Spermicide as w/ diaphragm
What are 4 common predisposing factors for UTI?
- Diabetes
- Frequent sexual intercourse
- Frequent UTI’s
- Incontinence
What are 2 predisposing factors for UTI in men?
- Prostatic hypertrophy
- Non-circumcised
2 organisms implicated as causes of cervicitis in female w/ dysuria?
- Chlamydia
- Neisseria
2 organisms implicated as causes of vaginitis in female w/ dysuria?
- Candida
- Trichomonas
Most likely infectious cause of urethritis in female w/ dysuria?
Herpetic
What 2 things can a complicated UTI lead to in a pregnant female?
- Premature labor
- Low birth-weight infants
Untreated asymptomatic bacteriuria is likely to result in what in a pregnant patient?
Pregnant pts are at increased risk for developing what complication?
- Likely to result in symptomatic pyelonephritis
- MORE likely to develop sepsis
Complicated UTI can present as a symptomatic disease in a man or woman and may be due to what 4 underlying conditions?
- Anatomic variant —> i.e., PCKD
- Foreign body in urinary tract –> stones, catheter, stents/tubes
- Extrinsic compression –> tumors, profound constipation
- Immunosuppressive conditions –> diabetes, drug-induced, HIV
When making the diagnosis of a complicated UTI what is the most important piece of info?
HISTORY
Prostatitis may be chronic when associated with what?
Prostatic hypertrophy
Chronic bacterial prostatits often requires a course of therapy (Abx) for how long?
4-6 weeks
When a urine sample is obtained for a reason unrelated to GU tract (i.e., health screen or diabetes follow-up) and shows bacteria on microscopic evaluation, this is known as what?
Asymptomatic bactriuria (ABU)
Recurrence of UTI in post-menopausal females may be due to what 3 factors?
- Pre-menopausal UTI’s
- Anatomic factors affecting bladder emptying –> cystoceles, urinary incontinence and/or residual urine
- Tissue effect of estrogen depletion
3 major subtypes/complications of Pyelonephritis?
- Papillary Necrosis
- Emphysematous pyelonephritis
- Xanthogranulomatous pyelonephritis
Bacteremia is a common finding associated with what type of UTI?
Pyelonephritis
Papillary necrosis can occur in pts with what 4 underlying conditions?
- Obstruction
- Diabetes
- Sickle cell
- Analgesic nephropathy
Emphysematous pyelonephritis occurs almost excusively in which patients?
Diabetics
Xanthogranulomatous pyelonephritis occurs when what 2 pre-disposing factors lead to suppurative destruction of renal tissue?
Can lead to formation of what?
- Chronic obstruction (often by staghorn calculi) + Chronic infection
- Can lead to abscess formation
How does bacteremia (often seen in pyelonephritis), differ from sepsis?
- Bacteremia simply means blood cultures are +
- Sepsis is suspected or documented infection and an acute increase in organ failure + dysregulated host response to infection
Septic shock is defined as serum lactate >?
>2 mmol/L (18 mg/dL)
Sepsis with hypotension that cannot be reversed with infusion of fluids or there is need for vasopressors to maintain BP, is known as?
Septic shock
In acute ischemia there is decreased O2 delivery and impaired removal of cellular waste leading to the upregulation of what factors that can cause direct tubular damage?
Endotoxins and inflammatory cytokines
What are the possibly harmful systemic responses to sepsis/septic shock (i.e., HR, BP, temperature…)?
- Fever or Hypothermia
- Tachypnea
- Tachycardia
- Leukocytosis, leukopenia, or >10% bands
What is the FENa associated with sepsis/ischemia leading to pre-renal azotemia?
<1%
What is the BUN/Cr ratio associated with sepsis/iscehmia indicating pre-renal azotemia?
>20:1
What is the urine osmolality associated with pre-renal azotemia (i.e., ischemia/sepsis)?
>500 mOsmol/Kg H2O
What type of casts associated with pre-renal azotemia?
Granular casts
