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Nephro > Pyelonephritis > Flashcards

Pyelonephritis Flashcards

1
Q

What are the symptoms of a urinary tract infection?

A 
Cystitis (bladder infection)
- dysuria 
- frequency 
- urgency
- suprapubic pain
- haematuria 
Pyelonephritis (infection of the kidney)
- fever (>38)
- chills/rigor
- flank pain
- costo-vertebral angle tenderness
- nausea and vomiting
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2
Q

What are the risk factors for a UTI?

A 
Infancy (under 1 year)
Abnormal urinary tract (congenital/acquired)
Females
- anatomy
- sexual intercourse
- pregnancy
Bladder dysfunction/incomplete emptying 
- constipation
- neurogenic bladder
- prostate enlargement 
Diabetes 
- glycosuria promotes bacterial growth 
Renal transplant 
Immunosuppression
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3
Q

Why are UTIs in childhood relevant?

A

More likely to indicate a structural abnormality
- congenital renal tract abnormality in up to 50% (vesico-ureteric reflux)
Can reduce risk of further damage
- renal scarring (irreversible)
- chronic kidney disease
- risk of hypertension increases with burden of scarring

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4
Q

What are the differential symptoms of an upper and lower tract UTI in children?

A 
Upper tract
- lethargy 
- general malaise
- vomiting 
- loin pain
- fever
Lower tract
- non specific abdominal pain
- urgency 
- frequency 
- bed wetting 
- frank haematuria
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5
Q

What clinical signs indicate a UTI might be acute pyelonephritis or an upper urinary tract infection?

A

Bacteriuria and fever with a temperature of 38 or above

Bacteriuria, loin pain/tenderness and fever of less than 38

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6
Q

What clinical signs indicate a UTI might be cystitis or a lower urinary tract infection?

A

Bacteruria and signs and symptoms of UTI that aren’t systemic

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7
Q

How are UTIs diagnosed?

A

Multistix (leucocyte esterase and nitrite)
- useful in children >3 years
- positive for LE and nitrate indicates UTI
Microscopy and flow cytometry
- used when urine dipstick test is negative
- flow cytometry positive for pus cells and bacteria indicates a UTI
Urine culture

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8
Q

When are urine cultures done, and what would they show in a UTI?

A

Done in all children <3 years if there is clinical suspicion
- before antibiotics
Shows growth of a single organism
- be aware of contamination risk

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9
Q

How are UTIs managed?

A 
Identification 
- test urine
Antibiotic treatment 
- best guess while awaiting cultures 
- oral unless severely ill, vomiting or <3 months
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10
Q

What is the antibiotic treatment for a UTI?

A 
Oral
- trimethroprim 
- cephalosporin 
- co-amoxiclav 
- nitrofurantoin
IV
- 3rd gen cephalosporin (ceftriaxone)
- gentamicin
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11
Q

What antibiotics can be used as prophylaxis in children with vesicoureteral reflux?

A

Nitrofurantoin
Trimethoprim
Co-amoxiclav

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12
Q

What are the pros and cons of US use in UTIs?

A

Pros
- radiation free
- readily available
- good for dilated drainage tracts and cysts
Cons
- operator dependent
- less sensitive for scarring and parenchymal change

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13
Q

What are the pros and cons of MCUG in diagnosing the cause of UTIs?

A 
Pros
- gold standard for VUR and PUV
Cons
- radiation
- invasive (UTI risk)
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14
Q

What are the pros and cons of DMSA in diagnosing the cause of UTIs?

A 
Pros
- gold star for scars (decreased isoptope uptake)
- differential function
Cons
- timing (acute or chronic)
- differentiating a scar from dysplasia 
- radiation
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15
Q

What are the pros and cons of an MAG3 indirect cystogram in diagnosing the cause of UTIs?

A

Pros
- used for VUR study with no catheter needed
- differential function
Cons
- need continence and co-operation on bladder emptying
- no PUV information
- misses low grade VUR

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16
Q

What are the pros and cons of an MAG3 diuresis renogram in diagnosing the cause of UTIs?

A 
Pros
- gold standard for obstruction 
Cons
- furosemide also needed to standardise the technique 
- operator interpretation
17
Q

What are the risk factors for renal scarring?

A 
Age
High grade VUR
Anatomical obstruction
Dysfunctional voiding 
Frequent episodes of APN
Therapeutic delay
Bacterial virulence factors 
Host response 
Low birth weight 
Prenatal dysplasia
18
Q

What are the most common congenital abnormalities of the kidney and urinary tract?

A

Vesico-ureteric reflux (VUR)
- retrograde passage of urine from the bladder into the upper urinary tract
Obstruction of the urinary drainage tracts

19
Q

What can US pick up antenatally?

A

Dilated drainage tracts
Renal parenchyma (bright kidneys)
Oligohydramnios (not enough amniotic fluid surrounding the baby - fluid is feotus urine)

20
Q

What is an MCUG?

A

Micturating cysto-urethrogram

  • catheterisation in order to fill the bladder with a radiocontrast agent
  • dye is watched under fluroscopy
  • in VUR, the dye moves back up into the ureters and renal pelvi-calyceal systems
21
Q

Describe VUR.

A

Presents
- in utero as hydro-uretero-nephrosis
- postnatally as UTIs and pyelonephritis
Can cause renal scarring (most dysplasia done prenatally)
Can be low or high grade
- low grade very likely to spontaneously resolve

22
Q

How is VUR and a UTI managed?

A

Medical
- antibiotic propylaxis for high grade VUR until they are toilet trained
Surgical
- when medical management fails (recurrent, febrile UTI or new scarring)
- STING procedure
- open ureteric re-implantation

23
Q

At what levels can there be obstruction in the urinary tract?

A 
Pelvis/ureter
Ureter
Ureter/bladder
Bladder 
Urethra
24
Q

How can there be an obstruction within the bladder?

A 
Posterior urethral valve
- common congential cause among male infants 
Prostatic hypertrophy 
Function obstruction 
(neurogenic)
- spina bifida
- transverse myelitis 
- trauma
 (prune belly syndrome - congenital absence of abdominal muscles)
25
Q

What is a posterior urethral valve?

A

An obstructing membrane in the posterior urethra

- valve leaflets of circumferential diaphragm

26
Q

What is the presentation of posterior urethral valve?

A

Antenatal hydronephrosis
Urinary tract infection
Poor urinary stream
Renal dysfunction - if missed for a long time

27
Q

How is a PUV managed?

A

Valve resection
Antibiotic prophylaxis
Chronic kidney disease care

28
Q

How do pelvi-ureteric junction obstruction present?

A

Abdominal mass
Pain
Haematuria
UTI

29
Q

How do vesico-ureteric junction obstructions present?

A 
Anatomical narrowing vs functional obstruction 
Antenatal dilation
UTI
Abdominal mass
Pain
Haematuria
30
Q

How are ureteric obstructions managed?

A 
PUJO
- observant (USS and DMSA)
- pyeloplasty 
VUJO
- observant (most resolve)
- surgery for symptoms or due to increasing dilation)
- resection and re-implantation

Nephro (10 decks)

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