Revision - UTIs & Pyelonephritis Flashcards
In what 3 situations should urine DIPSTICKS not be used in the diagnosis of a UTI in (as less reliable)?
1) Women ≥65 y/o
2) Men
3) Catheterised patients
Who is an MSU important in lower UTI (9 circumstances)?
1) Visible or non-visible haematuria
2) Pregnant women
3) Immunocompromised
4) Atypical symptoms
5) Patients with recurrent UTIs (2 episodes in 6 months or 3 in 12 months)
6) When symptoms are persistent or don’t improve with Abx
7) Men
8) Have a urinary catheter in situ or have recently been catheterised
9) Risk factors for resistance or complicated UTI e.g. abnormalities of genitourinary tract, renal impairment, residence in a long term care facility, previous resistant UTI
Who is nitrofurantoin avoided in (in non-pregnant women)? (think renal function)
Avoid in eGFR <45
Length of abx for UTI in men, pregnant women & catheter-related?
7 days
When should nitrofurantoin be avoided in pregnancy?
3rd term –> risk of neonatal haemolysis
Should asymptomatic bacteriuria be treated in pregnant women?
Yes:
1) Send MSU
2) Immediate 7 day Abx prescription (nitrofurantoin, amoxicillin cefalexin)
What are the 3 Abx typically used for UTIs in pregnancy?
1) Nitrofurantoin
2) Amoxicillin
3) Cefalexin (typical choice)
Should asymptomatic bacteriuria be treated in catheterised patients?
NO
Up until what age in childhood are UTIs more common in boys than girls?
3m
What are the indications for urine dipstick in children?
1) symptoms or signs suggestive of a UTI
2) unexplained fever of 38°C or higher (test urine after 24 hours at the latest)
3) an alternative site of infection but who remain unwell (consider urine test after 24 hours at the latest)
Management of UTIs in infants less than 3 months old?
Refer immediately to paediatrician
Management of lower UTIs in children >3 months?
Oral abx for 3 days
What investigation is recommended in ALL patients with suspected pyelonephritis?
MSU / catheter specimen urine (CSU)
Taken BEFORE starting empirical abx
Does a negative MSU exclude the diagnosis of pyelonephritis?
No
When is imaging recommended in pyelonephritis?
In recurrent pyelonephritis
What is imaging of choice in children with recurrent pyelonephritis?
US
Length of abx in pyelonephritis?
7-10d
What two things should you keep in mind with patients that have significant symptoms or do not respond well to treatment (pyelonephritis)?
1) renal abscess
2) kidney stones obstructing the ureter, causing pyelonephritis
How can pyelonephritis affect pregnancy?
Premature labour
What is found at the renal angle?
The lower part of the kidneys
What is a neurogenic bladder?
Refers to abnormal function of the nerves innervating the bladder and urethra.
This can result in overactivity or underactivity in the detrusor muscle of the bladder and the sphincter muscles of the urethra.
What are the key causes of a neurogenic bladder?
1) MS
2) Stroke
3) Diabetes
4) Parkinson’s
5) Brain or spinal cord injury
6) Spina bifida
3 options in management of obstructive uropathy?
1) nephrostomy
3) suprapubic catheter
3) urethral catheter
What is idiopathic hydronephrosis a result of?
This is the result of a narrowing at the pelviureteric junction (PUJ): the site where the renal pelvic becomes the ureter.
This narrowing may be congenital or develop later.
What medications can cause urinary retention?
1) anticholinergics
2) opioids
3) TCAs
4) benzos
5) antihistamines
What bladder volume on US confirms diagnosis of acute urinary retention?
> 300c
High pressure vs low pressure chronic urinary retention?
The terms “high” and “low” refer to the bladder pressure at the end of voiding.
High:
- abnormal renal function and/or bilateral hydronephrosis
Low:
- normal renal function
- normal kidneys (i.e. no hydronephrosis)
What commonly occurs after catheterisation for chronic retention?
Decompression haematuria –> due to the rapid decrease in the pressure in the bladder.
Does not require any further treatment.
What post-void volumes are normal in patients:
a) <65
b) >65
a) <50ml
b) <100ml
What post-void volume defines chronic urinary retention?
> 500ml
When should a test of cure MSU be sent in a UTI?
In pregnant women treated for a UTI
When should amoxicillin only be prescribed in pregnancy?
If culture results indicate susceptibility
What can women who suffer regular UTIs following sexual intercourse be offered?
Post-coital abx prophylaxis
