RENAL U5 Flashcards
By what three routes organisms might reach the urinary tract?
- The ascending (most freq. route)
- Blood-borne (spread to the kidney can occur in bacteraemic diseases)
- Lymphatic routes (little evidence for this route)
why are UTIs more common in females?
urethra is shorter and the urethral meatus is closer to the anus ALSO sexual intercourse is important in forcing bacteria into the female bladder
what virulence factors of organisms cause an individual to become susceptible to UTIs?
P fimbrae (attach to cells) , K antigens (resistant to phagocytosis) , iron scavenging aerobactin system
symptoms of UTIs in babies and infants?
- Failure to thrive
- Vomiting and diarrhoea
- Fever and apathy
what does the national guidance published in UKs say about children with unexplained fever?
they should have thier urine tested within 24h and attention is given to avoid over/under diagnosis and prompt start of A/B.
what is urethral syndrome?
women with dysuria the urine sample contains less than 100,000 bacteria/ml
how would you investigate for UTIs in Uncircumcised men?
retract foreskin followed by controlled micturition in which 20ml of urine from only the midportion of the stream is collected (initial and final components being voided)
what is the griess test?
Nitrate test - detects urinary nitrite made by bacteria that can convert dietary nitrate used to nitrite also, the test depends on enough nitrate in the diet and on allowing at least 4h for conversion
Criteria for diagnosing UTIs in different groups
Even though the criteria is >100,000 in some groups it is less for example;
• Men >1000ml
• Women with symptoms of UTI >100/ml
when is nitrofurantoin active?
only at acidic pH
what are the agents of choice in the presence of renal failure?
cephlasporins and penicillins
what is fosfomycin?
broad spectrum A/B that favours its use for treatment of cystitis with a single oral dose
why are quinolones contraindicated in children?
risk of causing joint problems
what is first line treatment for acute pyelonephritis?
cefuroxime, gentamicin or ciprofloxacin. for 10-14 days
which drugs have been implicated with clostridium difficile?
cephlasporins and quinolones
what is recurrent cystitis defined as?
defined as 3 episodes in past 12 months or 2 episodes in the past 6 months
when is nitrofurantoin contraindicated?
<45ml
what is prophylaxis for recurrent UTI management?
Trimethoprim 200mg single dose when exposed to a trigger or 100mg at night
Nitrofurantoin 100mg single dose when exposed or 50mg-100mg at night
what is the most likely cause of urethritis?
STD
Management for urethritis if referral to GUM clinic is denied?
- Doxycycline 100mg BD for 7 days or
- Azithromycin 1g, single dose for 1 day then 500mg for 2 days or
- Ofloxacin 200mg BD or 400mg daily for 7 days
what are risk factors for prostatitis?
- STIs and UTIs
- Indwelling catheters
- Acute bacterial prostatitis
- Increases with age
- Following manipulation of the gland – e.g. post-biopsy
symptoms of prostatitis?
- Fever, malaise, myalgia
- Urinary frequency, urgency, dysuria and nocturia
- Low back pain, low abdominal pain
- Pain on ejaculation is commonly reported
- Urethral discharge
treatment for acute prostatitis?
1st line – fluoroquinolones (e.g. ciprofloxacin or ofloxacin) for 4 weeks for 14 days then review
when should you not prescribe an alpha blocker?
if the person has postural hypotension, bladder stones
