Nephro: Urinary Tract Infections Flashcards
in which population are UTIs common
sexually-active women
what are UTIs in men and children associated with
abnormalities in the urinary tract
pathogenesis of UTI
colonic flora migrates into the perivaginal and perineal and transurethral regions, causing infection there
complications of UTIs
gram negative septicaemia and renal scarring
risk factors for UTIs
- changes in vaginal pH (more acidic)
- antibiotic prophylaxis
- recent/frequent intercourse
- highly concentrated urine
- urinary stasis or incomplete bladder emptying
- older age
- eradication of
- vaginal commensal organisms
- renal/bladder stones
what are the most common organisms to cause UTIs
- E.coli
- Staph sapro
- Klebsiella
- Enterococcus faecalis
- Proteus mirabilis
genetic predisposition to UTIs
some women have expressed receptors which aid the fimbriae of E.coli to stick to the urothelium
what is virulence?
how severe or harmful a disease is
how can you classify UTI
upper and lower urinary tract infections
signs and symptoms of lower urinary tract infection
- dysuria
- frequency
- urgency
- nocturia
- suprapubic pain/tenderness
- offensive urine/frank haematuria
what should you ask in a history of UTI
- sexual history
- new partners
- use of contraceptives and if so, which
- recent antibiotic use
- previous UTIs
signs and symptoms of a UTI in the elderly
- confusion
- incontinence
which symptoms make vaginitis more likely to be the case
- vaginal irritation
- discharge
signs and symptoms of an upper urinary tract infection
- fever
- chills
- rigors
- nightsweats
- N&V
- loin pain
- costovertebral angle tenderness
- septic shock
in which populations are symptoms of an upper urinary tract infection less likely to be present
immunocompromised and children
investigations for UTI
- urine dipstick
- microscopy
- culture and sensitivity
what to look out for in a urine dipstick
- positive leucocyte esterase
- positive nitrite reductase
- some proteinuria
what type of casts are suggestive of pyelonephritis?
WBC casts
what is the window of time where samples should be cultured?
there is a 2hr window; if you cannot culture by that time, refridgerate it, it will buy some time (around 2 days)
what to check from a clean catch MSU
- microscopy
- pyuria
- organisms
criteria for a positive diagnosis of a UTI
- culture of a urinary pathogen (10^5 units/mL is standard)
- lower in young women, men and pyelonephritis
what should you exclude if there are persistent symptoms despite treatment
- urethritis
- vaginitis
which populations need close attention?
- symptoms lasting more than 2 weeks
- recurrent UTis
- men
- children
- pregnant women
- diabetics
- immunocompromised
- associated stones
- known abnormal urinary tract
- indwelling catheter
radiological investigations for UTI
- plain AXR
- US kidneys
- CTKUB
- DMSA scanning
- prostate assessment
- cystoscopy
- CT scanning w/w/o contrast
