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Small Animal Medicine > Renal - Urinary Tract Infections > Flashcards

Renal - Urinary Tract Infections Flashcards

1
Q

What is a urinary tract infection?

A

Persistent colonization of any point of the urinary tract (except for the distal portion) by microorganisms

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2
Q

What usually is the origin of UTIs?

A

Migration (ascending) enteric bacteria from the lower urinary tract

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3
Q

What makes up the upper urinary tract?

A

Kidneys and ureters

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4
Q

What makes up the lower urinary tract?

A

The bladder and urethra

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5
Q

What part of the urinary tract is not sterile?

A

The distal urethra/prepuce

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6
Q

What is the normal flora of the male dog urinary tract?

A

Mixed population (Gram +/-, aerobic/anaerobic)

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7
Q

What is the normal flora of the male cat urinary tract?

A

Mixed population (gram +/-), mostly aerobic, some anerobic - Pasterurellaceae, E. coli, and Staph/strep

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8
Q

What is the normal flora of the female dog urinary tract?

A

Mixed population (Gram +/-, aerobic/anaerobic)

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9
Q

What is the normal flora of the female cat urinary tract?

A

Almost exclusively aerobic

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10
Q

What is bacterial cystitis?

A

bacterial infection of the bladder

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11
Q

What is bacterial pyelonephritis?

A

Bacterial infection of the renal pelvis and kidney

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12
Q

What is small volumes of urine known as?

A

pollakiuria

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13
Q

What sex are UTIs most common in?

A

females

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14
Q

Are dogs or cats more likely to get UTIs?

A

Dogs - up to 14% of dogs will have a UTI in their lifetime

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15
Q

Less than _____ of cats with lower urinary tract signs have UTIs.

A

Less than 10%

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16
Q

What percentage of cats below the age of 10 with urinary tract signs have UTIs?

A

less than 2 %

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17
Q

What percentage of cats above the age of 10 with urinary tract signs have UTIs?

A

10-20 % of cats

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18
Q

What are the lower urinary tract signs?

A

Pollakiuria, dysuria, and hematuria

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19
Q

Lower urinary tract signs are associated with what urinary disease process?

A

cystitis

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20
Q

Pyelonephritis is associated with ________ signs +/- lower urinary tract signs.

A

systemic signs

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21
Q

What systemic signs are associated with pyelonephritis?

A

fever, depression, vomiting, renal pain, and PU/PD

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22
Q

True or False: Subclinical bacteriuria is associated with no symptoms.

A

TRUE

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23
Q

How are subclinical bacteriuria infections found?

A

Bacteria are identified on routine urine cultures with no lower urinary tract signs

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24
Q

Subclinical bacteriuria is higher in patients with comorbidities. What comorbidities is it associated with?

A

Diabetes mellitus, obesity, chronic kidney disease, acute intervertebral disk disease, and chronic immunosuppression

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25
Q

What are the most common orgamisms associated with subclinical bacteriuria?

A

E. coli and Enterococcus faecalis

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26
Q

What CBC/Serum chemistry signs are associated with pyelonephritis?

A

neutrophilic leukocytosis, azotemia, and hyperphosphatemia

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27
Q

What will you see on urinalysis in patients with urinary tract infections?

A

Increased pH with urease producing bacteria, pyuria WBC presence, hematuria, proteinuria, bacteriuria, and granular/cellular casts (pyelonephritis)

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28
Q

What is the gold standard diagnosis for urinary tract infections?

A

urine culture

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29
Q

What sample should be used for urine culture?

A

sterile urine sample - cystocentesis

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30
Q

Does urine culture confirm the location of a urinary tract infection?

31
Q

How do you determine the location of a urinary tract infection?

A

Abdiminal radiographs, ultrasound, and prostatic wash

32
Q

What are the mechanisms of defense of the urinary tract?

A

Anatomy, urine chemical/physical characteristics, normal urine flow and voiding, local (mucosal) defenses, and systemic immunity

33
Q

What anatomical mechanisms defend the urinary tract?

A

Proper anatomy prevents retrograde flow of urine/bacteria, ureteral peristalsis, ureterovesicular valve, high urethral pressure, and well exposed vulva

34
Q

What antatomical disorders can cause impaired host defenses against UTIs?

A

Recessed (hooded) vulva, vestubulovaginal septal remnant, ectopic ureters, hydroureter, incomplete urethral sphincter mechanism, and indwelling catheter

35
Q

What urine characteristics provide defense from UTIs?

A

Hyperosmolality, lack of bacterial substrate, organic acids, and urea

36
Q

At what pH is the urine a good defense mechanism?

A

<5 so it is likely not a physiologic mechanism of defense

37
Q

What pathologic conditions can effect urine as a defense mechanism?

A

Loss of hyperosmolality and presence of bacterial substrate

38
Q

What can cause loss of hyperosmolality?

A

Chronic kidney disease, hyperadrenocorticism, and hyperthyroidism

39
Q

What can cause the presence of bacterial substrate in urine?

A

Diabetes mellitus

40
Q

What are the components of urine flow that can aid in defense?

A

adequate volume of flow, frequent voiding, and complete voiding

41
Q

What pathological conditions can effect normal flow of urine?

A

Spinal cord injury (most common), urethral/ureteral obstruction by a tumor or stone, detrusor muscle atony

42
Q

What are the mucosal defenses of the urinary tract?

A

Glucoaminoglycans, cellular exfoliation, and resident flora

43
Q

What type of molecules are glucosaminoglycans?

A

hydrophilic molecules

44
Q

What do glucosaminoglycans do?

A

They protect the epithelium from urine and bacteria attaching to them

45
Q

How can glucosaminoglycans become damaged?

A

tumors and stones

46
Q

What do resident flora of the distal urinary tract do?

A

They block migration

47
Q

What antibodies are present in the urine?

A

IgG and IgA

48
Q

Increased prevalence of UTIs are seen in patients receiving _______ and ________ as well as patients with ___________ __________ that affect systemic immunity.

A

Glucocorticoids, immunosuppressives, and endocrine diseases

49
Q

True or False: 70-90% of UTIs involve only one type of bacteria.

50
Q

Are most urinary tract infections gram positive or gram negative?

A

Gram negative

51
Q

What virulence factors aid in bacterial pathogenesis?

A

Hemolysin, urease, and P fimbria

52
Q

What does hemolysin do?

A

It lyses RBCs, WBC, and epithelial cells and then releases iron for bacteria

53
Q

What does urease do?

A

It degrades urea into CO2 and NH3 which increases pH and causes epithelial damage and aids bacterial attachment

54
Q

What is urease produced by?

A

Proteus, Staphylococcus, and Klebsiella

55
Q

What does urease promote the formation of?

56
Q

What do P fimbria allow for?

A

adhesion to the epithelium and some allow intracellular uptake of E. coli

57
Q

What factors must you consider when choosing appropriate antimicrobial therapy?

A

What are the most common bacteria? Which antibodies are concentrated in urine? Where is the nidus of infection? Does the patient have comorbidities?

58
Q

What antibodics are good for emperical therapy of UTIs?

A

1st generation cephalosporins and tetracyclines

59
Q

What are the antibiotics that have the best activity against urinary tract infections?

A

Penicillin, TMS, later generation cephalosporins, fluoroquinolones, and amnioglycosides

60
Q

What antibiotics are secreted in high concentrations in the urine?

A

Sulfonamides, beta-lactams, fluoroquinolones, and aminoglycosides

61
Q

What should you assume that is going on simultaneously in 90% of intact males that have bladder infections?

A

prostatitis

62
Q

What antibiotics are best for prostatitis (general)?

A

Antibiotics that are weak bases and/or lipophilic

63
Q

What antibiotics are best for prostatitis (specific)?

A

fluoroquinolones, trimethoprim, and clindamycin/macrolides

64
Q

Typically, how long is prostatitis treatment?

A

6 weeks long

65
Q

What should you always do in cases of pyelonephritis?

A

culture/sensitivity

66
Q

What antibiotics are best for pyelonephritis?

A

Fluoroquinolones and Nitrfurantoin (not if bacteremia)

67
Q

How long should treatment be for pyelonephritis?

A

at least 6 weeks

68
Q

What is a sporadic UTI?

A

Sporadic bacterial infection of the bladder in an otherwise healthy individual with a normal urinary tract anatomy and function

69
Q

What classifies as a recurrent UTI?

A

When there are more than 3 UTIs in a year

70
Q

What is a recurrent UTI?

A

Infection that occurs in the presence of an anatomic or finctional abnormality or comorbidity that [redisposes the patient to persistent or recurrent infections

71
Q

What is the recommended length of treatment for a sporadic UTI?

72
Q

What is the recommended length of treatment for a recurrent UTI?

A

minumum of 3-5 days and can be up to 2 weeks

73
Q

When should reevaluation occur for recurrent UTIs?

A

Culture urine 5-7 days into treatment and 7 days after treatment

74
Q

What abnormalities and comorbidities are associated with UTIs?

A

Prostatitis, pyelonephritis, uroliths, urinary tract neoplasia, anatomic/functional abnormalities, endocrine diseases, and immunocompromise

Small Animal Medicine (100 decks)

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