Pyelonephritis + UTI + Glomerular Disease Flashcards
Pyo = ?
Pyelo = ?
Pyo = pus Pyelo = refers to renal pelvis
What is pyelonephritis?
Acute or chronic?
- Upper UTI (in kidney…lower is in bladder)
- Inflm of renal pelvis & parenchyma
- Acute + chronic forms
Etiology of pyeloneph?
- D/t various bacteria infection (Usually E. Coli)
- Risks
- Suppressed immunity
- Catheterization
- Urinary reflux d/t things like BPH
- DM – infections common
Patho of pyeloneph?
• Ascending infection and inflm
o Urethra→ bladder→ ureter→ kidney
• Fibrosis and scar tissue? –> Dec renal Fx
Why scar tissue with pyeloneph? What is this unlike other bacterial infections?
• Being bacterial the progression is what we would normally see in the body, with one exception. As it progresses there is scarring within the kidney (dependent on the duration of the infection); often times scarring is NOT fully reversible. This is an issue bc we are replacing fx’al tissue w non-fx’al tissue. If this happens we will have a problem w renal fx
What are the two ways that you end up with the chronic form of pyeloneph?
either infection persists, or chronic inflm
Patho of chronic form of PN?
- Recurrent inflm→ obstruction or reflux (reflux from ureter into renal pelvis)
- Renal damage (irreversible)→renal failure?
- Remember: infection in a VITAL organ→serious concerns if not treated (Think- scar tissue in heart/liver…big freakin deal!)
Manifestations of PN?
- Bc bacterial→local and systemic mnfst
- Acute onset
- Lower back pain
- Fever
- Dysuria, freq, and urgency: typical urinary mnfst that appear bc of irritation wi urinary tract
- Pyuria (pus in the urine from the purulent exudate)
- Severe HTN (chronic form)
Tx of PN?
- Abx (10-14 days) slightly longer than normal (2x) to ensure all bacteria is eradicated
- Chronic? Inflm needs to be addressed- anti-inflm
Is URT or LRT infection more common?
URT is the most common
LRT second most common infection
of all infections???…
What are the defenses against lower UTI’s?
1) Local IR
2) Mucin layer
3) Wash out
4) Prostatic fluid in men
5) Microbial antagonism in women
Mucin layer as protective mechanism against L UTI?
bladder wall is made of transitional epi tissue, cells there secrete a glycoprotein that coats the inner layer of epi tissue and forms barrier between urine and epi tissue; prevents direct contract of bacteria
“wash out” as protective measure?
voiding urine is a consequential defense mechanism (voiding bacteria as well)
Prostatic fluid + microbial antagonism as mechanisms of protection against l UTI’s.
o Prostatic fluid: Men-contains components that anti-microbial (anti-bacterial)
o Microbial antagonism: Women- NF are already occupying the niche in the peri-urethral area
Risks for lower UTI?
• Catheterization
• Obstruction
- Stasis- avoiding washout
- Reflux- urine form distal part into bladder carrying microbes along w it