S9) Infection in People with Renal Disease Flashcards
Abnormalities of the urinary tract predispose people to UTI.
Identify 5 conditions where this is observed
- Pregnancy
- Transplant kidney
- Renal tract stones
- Obstruction
- Indwelling catheter / ureteric stents
When UTIs are observed in children, structural issues are more likely.
Identify three examples
- Posterior urethral valves (boys)
- Vesicoureteric reflux (± hypoplasia)
- Duplex ureters
Define and illustrate vesicoureteric reflux
Vesicoureteric reflux is the backflow of blood from the bladder into the ureters due to urinary dysfunction
Explain how TB in the urinary tract spreads
Haematogenous spread:
- Start in kidneys (can cause calcification)
- Occasionally spreads to ureters and bladders
Identify 2 presentations of TB in the urinary tract
- Sterile pyuria
- Haematuria
Identify 5 consequences of TB in the urinary tract
- Calcification
- Caseous mass
- Strictures & beading of ureters
- Thickened small capacity bladder
- Urethral stricture
What is schistosomiasis?
- Schistosomiasis (aka bilharzia) is a disease affecting the urinary tract and intestines caused by parasitic flatworms called schistosomes
- It presents with abdominal pain, diarrhea, bloody stool and/or haematuria
Identify 4 complications of schistosomiasis
- Chronic cystitis
- Bladder calcification
- VUJ fibrosis & stenosis
- Bladder cancer
Which species of schistosomiasis cause lower urinary tract disease?
Schistosoma haematobium
Which species of schistosomiasis cause hepatosplenic / GI disease?
- Schistosoma mansonii
- Schistosoma japonicum
Identify one complication of schistosomiasis
Glomerulonephritis (not bladder cancer)
Identify 4 systemic infections which cause GN
- Post-infectious glomerulonephritis
- Endocarditis
- Hepatitis B
- Hepatitis C
- HIV
Which organism causes post-infectious GN?
Group A streptococcus
How does post-infectious GN present?
- Occurs 1-4 weeks after throat infection
- Occurs in children (5-12) and > 60 year olds
- Can present with acute nephritic syndrome
Endocarditis associated GN occurs in up to 20% of endocarditis cases.
What is the causative organism?
Streptococcus viridans / Staphylococcus aureus
How do patients with endocarditis associated GN present?
- AKI with non-visible haematuria
- Systemic symptoms & signs of endocarditis e.g. fever, arthralgia
Identify 5 risk factors which increase risk of infection in CKD
- Immunosuppression
- Increased age
- Malnutrition
- Co-morbidity e.g. DM
- Nephrotic Syndrome
Identify 3 types of infections which are common in haemodialysis patients
- Metastatic infections (disciitis, osteomyelitis, heart valves)
- Chest infections
- GI infections
Identify 5 infections which are common in peritoneal dialysis patients
- Peritonitis
- Cellulitis
- Chest infection
- GI infections
- UTI
Transplant patients are at their greatest immunosuppression in first 3 months, hence they are at great risk of infection.
Identify 4 sources of infection for transplant patients
- Hospital-acquired (nosocomial)
- Community-acquired
- Reactivation of infection (HSV, TB, Hep B, Hep C)
- Donor-derived
Transplant patients are immunosuppressed therefore at risk of all the normal infections plus opportunistic infections.
What is the commonest infection they get?
Urinary tract infections
Infections in transplant patients might not be picked up as immunosuppression can mask some signs of infection.
Identify three
- Reduced inflammatory response
- Temperature may be normal
- May not have a raised WCC
- Ab response often delayed
Transplant patients with infections may have less common presentations.
Identify three
- Altered mental state
- Hypotension without fever
- Raised LFTs
How is infection prevented in transplant patients?
- Prophylactic anti-microbials given during initial period after transplant:
I. Co-trimoxazole (Pneumocystis pneumoniae)
II. Valganciclovir (CMV)
- Aim to use lowest dose of immunosuppression possible and never stop the immunosuppressant
Identify 6 infections which are screened for in donors by transplant programmes in developed countries
- HSV
- EBV
- HIV
- Hepatitis B&C
- TB
Which vaccinations are recommended in people with renal disease?
- Patients with advanced CKD – influenza vaccine
- Patients likely to reach ESRD – Hepatitis B vaccine
- Transplant patients – pneumococcal and meningococcal vaccine
