Revision - UTIs & Pyelonephritis

Question 1

In what 3 situations should urine DIPSTICKS not be used in the diagnosis of a UTI in (as less reliable)?

Answer 1

1) Women ≥65 y/o

2) Men

3) Catheterised patients

Question 2

Who is an MSU important in lower UTI (9 circumstances)?

Answer 2

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

Question 3

Who is nitrofurantoin avoided in (in non-pregnant women)? (think renal function)

Answer 3

Avoid in eGFR <45

Question 4

Length of abx for UTI in men, pregnant women & catheter-related?

Answer 4

7 days

Question 5

When should nitrofurantoin be avoided in pregnancy?

Answer 5

3rd term –> risk of neonatal haemolysis

Question 6

Should asymptomatic bacteriuria be treated in pregnant women?

Answer 6

Yes:

1) Send MSU

2) Immediate 7 day Abx prescription (nitrofurantoin, amoxicillin cefalexin)

Question 7

What are the 3 Abx typically used for UTIs in pregnancy?

Answer 7

1) Nitrofurantoin

2) Amoxicillin

3) Cefalexin (typical choice)

Question 8

Should asymptomatic bacteriuria be treated in catheterised patients?

Answer 8

NO

Question 9

Up until what age in childhood are UTIs more common in boys than girls?

Answer 9

3m

Question 10

What are the indications for urine dipstick in children?

Answer 10

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)

Question 11

Management of UTIs in infants less than 3 months old?

Answer 11

Refer immediately to paediatrician

Question 12

Management of lower UTIs in children >3 months?

Answer 12

Oral abx for 3 days

Question 13

What investigation is recommended in ALL patients with suspected pyelonephritis?

Answer 13

MSU / catheter specimen urine (CSU)

Taken BEFORE starting empirical abx

Question 14

Does a negative MSU exclude the diagnosis of pyelonephritis?

Answer 14

No

Question 15

When is imaging recommended in pyelonephritis?

Answer 15

In recurrent pyelonephritis

Question 16

What is imaging of choice in children with recurrent pyelonephritis?

Answer 16

US

Question 17

Length of abx in pyelonephritis?

Answer 17

7-10d

Question 18

What two things should you keep in mind with patients that have significant symptoms or do not respond well to treatment (pyelonephritis)?

Answer 18

1) renal abscess

2) kidney stones obstructing the ureter, causing pyelonephritis

Question 19

How can pyelonephritis affect pregnancy?

Answer 19

Premature labour

Question 20

What is found at the renal angle?

Answer 20

The lower part of the kidneys

Question 21

What is a neurogenic bladder?

Answer 21

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.

Question 22

What are the key causes of a neurogenic bladder?

Answer 22

1) MS

2) Stroke

3) Diabetes

4) Parkinson’s

5) Brain or spinal cord injury

6) Spina bifida

Question 23

3 options in management of obstructive uropathy?

Answer 23

1) nephrostomy

3) suprapubic catheter

3) urethral catheter

Question 24

What is idiopathic hydronephrosis a result of?

Answer 24

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.

Question 25

What medications can cause urinary retention?

Answer 25

1) anticholinergics

2) opioids

3) TCAs

4) benzos

5) antihistamines

Question 26

What bladder volume on US confirms diagnosis of acute urinary retention?

Answer 26

> 300c

Question 27

High pressure vs low pressure chronic urinary retention?

Answer 27

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)

Question 28

What commonly occurs after catheterisation for chronic retention?

Answer 28

Decompression haematuria –> due to the rapid decrease in the pressure in the bladder.

Does not require any further treatment.

Question 29

What post-void volumes are normal in patients:

a) <65
b) >65

Answer 29

a) <50ml
b) <100ml

Question 30

What post-void volume defines chronic urinary retention?

Answer 30

> 500ml

Question 31

When should a test of cure MSU be sent in a UTI?

Answer 31

In pregnant women treated for a UTI

Question 32

When should amoxicillin only be prescribed in pregnancy?

Answer 32

If culture results indicate susceptibility

Question 33

What can women who suffer regular UTIs following sexual intercourse be offered?

Answer 33

Post-coital abx prophylaxis