Pyelonephritis & UTI Flashcards
What is pyelonephritis?
Infection of the renal cortex and medulla
What are the two routes through which the kidney can be infected?
Which patients are at risk of each?
Ascending route: via urethra, bladder and ureter.
Patients with UTI are at risk of this.
Haematogenous route: from infection in the blood.
IVDU, patients with infective endocarditis, frail, immunocompromised are at risk.
Which organisms cause pyelonephritis?
From the ascending route same bugs that cause UTIs:
- E. coli
- Klebsiella
- Proteus species
- Enterococcus species
- Pseudomonas
From the haematogenous route:
- S. aureus
Clinical features of pyelonephritis?
Rapid onset: 1-2 days
Pain
- loin
- suprapubic
- back pain
Fever (high and swinging)
Rigors
Nausea
Vomiting
LUTS (frequency, dysuria, haematuria, cloudy, offensive smell)
Renal angle tenderness
Investigations of pyelonephritis?
Bedside:
- Obs
- BM
- Urine dip
- ABG, VBG
Routine:
- FBC, UE, CRP, LFT, clotting
- Blood cultures
- Urine MCS
- USS KUB: look for morphological abnormalities, stones
Specialist:
- Contrast enhanced spiral CT
- MRI
- Renal biopsy (occasionally)
What would urine dip show in pyelonephritis?
Leukocytes
Blood
Protein
Nitrite
Management of pyelonephritis?
Supportive: fluids, rest, analgesia
Antibiotics:
- ciprofloxacin
- gentamicin
- whatever MC+S shows up
Admission if at risk of complications or pregnancy
Surgery: rarely, if needed to drain abscesses or relieve obstructions
Complications of pyelonephritis?
Sepsis
Perinephric abscess
Renal abscess
Emphysematous pyelonephritis
Acute papillary necrosis
In pregnancy - significant risk of premature labour
AKI or CKD
Which patients are at risk of complications?
Comorbidities such as diabetes
Severe disease
Age over 65
Renal tract structural abnormality: strictures, stones
Pregnancy
Immunocompromised
What are these?
- Pyonephrosis
- Perinephric abscess
- Renal abscess
- Emphysematous pyelonephritis
- Acute papillary necrosis
Pyonephrosis: pus in the renal calyces which can cause obstruction
Perinephric abscess: abscess in the perinephric region, which is a division of the retroperitoneum containing kidneys
Renal abscess: abscess in kidney itself
Emphysematous pyelonephritis: rare and life threatening, tissue necrosis and gas accumulation in renal parenchyma, perinephric space and collecting duct
Acute papillary necrosis: toxin damage to papillae (where the renal pyramids empty into minor calyx)
What are:
- papillae
- perinephric region?
Where the renal pyramids meet the minor calyx
Perinephric region is the area of the retroperitoneal area containing the kidneys
What is SIRS?
Systemic inflammatory response syndrome
Systemic inflammation: abnormal regulation of cytokines
Organ dysfunction and failure
Which bacteria cause UTIs?
E. coli Staph saprophyticus Enterococci Klebsiella Proteus vulgaris Pseudomonas
What makes a UTI complicated?
Abnormal GU tract
Decreased immune system
Renal dysfunction
Virulent organism
Risk factors for UTI?
Abnormal renal tract
Incomplete bladder emptying
Sexual activity
New sexual partner
Diabetes
Catheter
Institutionalisation
Presentation of UTI?
Urinary frequency
Passing small amounts frequently
Dysuria
Haematuria
Foul-smelling, cloudy
Urgency
Incontinence
Suprapubic or loin pain
Pyrexia
Rigors
N+V
Delirium
Investigations of UTI?
Urine dip: +ve for nitrites, leukocytes
Urine microscopy and culture
USS of KUB
Management of UTI?
Reduce risk factors:
- spermicide
- frequent, new sexual partners
Antibiotics:
- nitrofurantoin (1st) 50mg QDS 3-7 days
- trimethoprim 200mg BD
Who shouldn’t take trimethoprim?
It is not safe in pregnancy, particularly first trimester as its a folate antagonist
Complications of UTI?
Pyelonephritis
Perinephric or intrarenal abscess
Hydronephrosis
Pyonephrosis
AKI
Sepsis
If a man has a UTI, what other infection should you check for?
Prostatitis
Many have both
What is cystitis?
Infection in the bladder
Presentation of cystitis?
Urgency
Frequency, small amounts
Dysuria
Haematuria
Suprapubic pain
Pyrexia
Management of cystitis?
Reduce risk factors
Antibiotics: nitrofurantoin, trimethoprim
What is prostatitis?
Inflammation of prostate
Infection
BPH, cancer
Which bacteria cause prostatitis?
Gram -ve: E coli, Enterobacter, Pseudomonas
STIs: N. gonorrhoea, Chlamydia
Risk factors for prostatitis?
STIs UTIs Indwelling catheters Age Post-biopsy
Clinical features of prostatitis?
OE?
Pyrexia Malaise LUTS Painful ejaculation Pain in pelvis, back
PR: enlarged boggy prostate, tender
Management of prostatitis?
Fluroquinolones are first line: cirprofloxacin
Second line trimethoprim, nitro
