Med - core topics: Nephrology

Question 0

Acute urethral syndrome

Answer 0

• sx of dysuria, urgency, and frequency w/out significant bacteriuria
• not really urethral, actually a bladder infection

Question 1

Ddx of UTI

Answer 1

• growth of > or = 10^5 organisms per milliliter from properly collected “clean-catch” urine sample
• but can be less too

Question 2

Chronic pyelonephritis

Answer 2

• chronic interstitial nephritis
• results from bacterial infection of the kidney (this distinguishes it from the many other possible causes of chronic interstitial nephritis)

Question 3

Most common bug to cause UTI?

Answer 3

• gram-neg bacilli E. coli

Question 4

Common cause of catheter-associated UTI?

Answer 4

-staph epidermis

Question 5

3 common causes of sterile pyuria?

Answer 5

• sexually-transmitted urethritis-producing agents:
  1. Chlamydia trachomatis
  2. N. gonorrhea
  3. Herpes simplex virus

Question 6

What 2 features of urine of a normal healthy person protects them from UTIs?

Answer 6

1. High urea concentration of the urine
2. High osmolarity of the urine
   - inhibit or kill the bacteria

Question 7

What do males have that can protect them from UTIs?

Answer 7

-prostatic secretions posses antibacterial properties

Question 8

3 reasons why pregnant women are more susceptible to upper urinary tract infections?

Answer 8

1. Decreased urethral tone
2. Decreased urethral peristalsis
3. Temporary incompetence of the vesicoureteral valves

Question 9

3 Risks of UTIs and pregnancy?

Answer 9

• increased incidences of:
  1. Low birth rate
  2. Premature delivery
  3. Neonatal death –> esp upper tract UTIs

Question 10

What virus can cause a UTI? Who is it commonly seen in?

Answer 10

• adenovirus

- kids and some young adults

Question 11

How can immobilization lead to UTIs?

Answer 11

-immobilization –> demineralization –> hypercalciuria –> calculus formation –> obstructive uropathy –> infection

Question 12

Virulence factors of bacteria and UTIs?

Answer 12

• most of the E.coli strains that cause UTIs in healthy non-cath pts have to have virulence factors to be able to cause and infection
• most contain fimbrea &/or produce cytotoxins
• BUT in patients who have structural or functional abnormalities the bacteria do not need the virulence factors to cause infections , becuase the urinary tract is already compromised

Question 13

Tx of asymptomatic bacteriuria in patients catheterized for >2 weeks?

Answer 13

-Dont tx unless symptomatic

Question 14

4 most common causes of sterile pyuria?

Answer 14

1. C. trachomatis
2. U.urealyticum
3. Mycobacterium tuberculosis
4. fungi

Question 15

Pregnancy and bacturia?

Answer 15

-all pregnant women should be screened for bacteriuria in the first trimester and should be treated if bacteriuria is detected

Question 16

What diet should stone-forming hypercalciuria patients follow?

Answer 16

• low -sodium and low-protein diets

- low-calcium diets have NOT been found to be helpful!