Pathology 2

Question 1

Presentation of UTI in children

Answer 1

Sepsis
Irritability
VOmiting
Failure to thrive

Question 2

Differentials for pus in the urine (pyuria)

Answer 2

UTI (includes TB)
Interstitial nephropathy (e.g. diabetes)
Acute glomerulonephritis
Tumours
Post surgery 
Catheter
fevers in children
Contamination from vagina

Question 3

Can bacteriuria be asymptomatic

Answer 3

Yes

Question 4

Does asymptomatic bacteriuria require treatment

Answer 4

Generally no
-May cause harm e.g. resistance or side effects of antibiotics

However exceptions: pregnancy, prior to invasive urologic procedures

Question 5

Risk factors for UTI

Answer 5

Pregnancy
Kidney stones
Enlarged prostate gland 
COnstipation in children
Catheters
T2D
Chemo
HIV
Sex
Diaphragms as Contraceptives 
Spinal injury
Vesicle-ureteric reflux

Question 6

Why does pregnancy increase chance of UTI

Answer 6

High progesterone levels elevate risk of decreased muscle tone of ureter and bladder

Leads to a greater likelihood of reflux, where urine flows back up the ureters and towards the kidneys

Question 7

Complications of diabetes

Answer 7

-End stage renal failure

stems from

• ->Diabetic vascular disease
• Increased atherosclerosis of small, medium and large arteries and so renal ischaemia
• Hyaline arteriosclerosis of afferent arterioles: ischaemic glomerular damage
• ->Diabetic glomerular damage
• Thickened glomerular capillary BM (proteinuria)
• Thick Basement membrane + abnormal mesangium; fibrin like material; diffuse or nodular pattern (KM lesions)
• ->Susceptibility to infection
• Pyelonephritis
• Renal papillary necrosis

Bladder dysfunction

Question 8

Risk factors for UTI in childhood

Answer 8

COngenital causes

• Horseshoe kidney
• COngenical
• ureteropelvic obstruction
• Partial duplicated ureter
• COmplete duplicated ureter
• Extopic insertion of duplicated ureter

Question 9

Organisms involved in UTI

Answer 9

E.Coli
Klebsiella
Staph Saprophyticus

Question 10

Treatment of UTI

Answer 10

Treat those at more risk of pyelonephritis and renal damage

• Young
• Pregnant
• Underlying renal tract abnormalities

Cystitis in healthy young women may resolve with increased fluid intake alone

ABx

Question 11

Red flags for UTI

Answer 11

Sepsis 
-Fever and shaking chills
-Tachycardia
Reduced mental alertness
-LBP
-Increased RR
-High or low WBC count 
-GI symptoms such as nausea/diarhoea 
-Altered kidney or liver function

Question 12

Why are postmenopausal women more likely to get UTI

Answer 12

Lower levels of oestrogen causes decreased amounts of lactobacilli which leads to increased pH therefore perfect conditions for E.coli colonisation

Question 13

Main for markers for UTI on dipstick

Answer 13

Leucocytes and nitrites

Question 14

What is used to confirm UTI in men and older women and pregnant women, recurrent UTI, catheterised pts, have risk factors for complicated UTIs, visible or non visible haematuria

Answer 14

Urine culture

Question 15

When is renal tract imagine used

Answer 15

Persistent symptoms
Recurrent symptoms
Suspected urinary tract obstruction or severe illness such as septic shock

Question 16

Abx for UTIs

Answer 16

Trimethoprim

Nitrofurantoin

Question 17

Upper UTI investigations

Answer 17

Urine dip and culture
Bloods- FBC (raised WCC) and CRP. U&E

Blood cultures

Imaging - USS KUB (obstruction, inflammatory changes nd hydronephrosis). CT reserved for deteriorating pts or treatment resistant

Dimercaptosuccinic Acid (DMSA) scan- clarifies areas of poor renal function and scarring

Question 18

Upper UTI treatment

Answer 18

Severe- IV Cefuroxamine or Ciprofloxacin

Not severely unwell- Ciprofloxacin, trimethoprim or co-amoxiclav

Fluids, Imaging to look for structural damage or changes

Question 19

Complications of Upper UTI

Answer 19

Sepsis
AKI>CKD
Perinephric abscess
Renal papillary necrosis