Renal Medicine Core Conditions ALL Flashcards
Epidemiology of UTI
Most common type of infection Most common form: infectious cystitis 20% of all UTIs in men Risk in men increases w/age Rarely develop in men <50 10% of >18yo will have 1 every 12 months 20-40% of women develop recurrent UTI problems
Most common causative agent of UTIs
E. coli
Other causative agents of UTIs in men
Klebsiella
Proteus
Enterococcus
Staphylococcus
Other causative agents of UTIs in women
Staphylococcus Saprophyticus Proteus Klebsiella Pseudomonas
Pathophysiology of UTIs in men
<50 - possible due to sexual intercourse or alteration to host defence
> 50 - due to structural or functional abnormalities of the urinary tract or alteration to host defence
- prostate disease
- stones
- external/intrinsic devices
- catheters
Pathophysiology of UTIs in women
Ascending pathway vagina>urethral meatus>urethra
Classification of UTIs
Nosocomial or comment acquired
Complicated or uncomplicated
Recurrent
Relapse
Who should be tested for asymptomatic bacteriuria?
pregnant women
RFs for UTI in men
Prostate hypertrophy Stones Urological surgery Age >50 Catheterisation Previous UTI
RFs for UTI in women
Sexual activity Use of spermicide Positive FHx Post menopause Previous UTI
Clinical presentation of UTIs
Dysuria Urgency Frequency In men: suprapubic pain In women: back/flank pain
Investigations to consider in UTI
Urine dipstick + MCS
Imaging to rule out obstruction
Management of UTIs
Trimethoprim or quinolone such as cipro/levofloxacin
What is acute pyelonephritis?
Inflammatory disease of the renal parenchyma, chalices and pelvis, caused by enteric bacteria that ascend from the lower urinary tract or haematogenous spread
Aetiology of pylenophritis
Major causative pathogen = gram -ve bacteria
- E.coli 60-80%
- Others: proteus, klebsiella, enterobacter, pseduo
RFs for pyelonephritis
Frequent sexual intercourse Prev/ongoing UTI DM Occlusion to urinary tract Anatomical/functionaal abnormality Immunosuppressed state Pregnancy
Clinical presentation of pyelonephritis?
Flank/costovertebral angle pain + fever
Investigations to order in pyelonephritis
Urine MCS FBC ESR CRP Imaging Cultures
Management of pyelonephritis
Cephalosporin such as Cefiximine
What is hydronephrosis?
Dilation of the renal pelvis with or with our obstruction. Obstructions can be obstructive nephropathy or uropathy
Epidemiology of hydronephrosis
Increasing prev. in whites
Peak 30-50yo
Aetiology
Anything that can interrupt urine flow by narrowing or blocking the tract:
- stones
- BPH
- Ca
- Bladder tumours
Pathophysiology of hydropnephrosis
Obstructive condition > back pressure on kidney > decreased renal blood flow = decreased GFR = increased RAS pathway = atrophy and apoptosis of renal tubule cells
RFs for hydronephrosis
BPH Constipation Medication: antichols., narcotics, alpha recap. agonists Spinal cord injury Malignancy