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(LUSUMA) Urinary System > S9) Infection in People with Renal Disease > Flashcards

S9) Infection in People with Renal Disease Flashcards

1
Q

Abnormalities of the urinary tract predispose people to UTI.

Identify 5 conditions where this is observed

A
  • Pregnancy
  • Transplant kidney
  • Renal tract stones
  • Obstruction
  • Indwelling catheter / ureteric stents
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2
Q

When UTIs are observed in children, structural issues are more likely.

Identify three examples

A
  • Posterior urethral valves (boys)
  • Vesicoureteric reflux (± hypoplasia)
  • Duplex ureters
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3
Q

Define and illustrate vesicoureteric reflux

A

Vesicoureteric reflux is the backflow of blood from the bladder into the ureters due to urinary dysfunction

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4
Q

Explain how TB in the urinary tract spreads

A

Haematogenous spread:

  • Start in kidneys (can cause calcification)
  • Occasionally spreads to ureters and bladders
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5
Q

Identify 2 presentations of TB in the urinary tract

A
  • Sterile pyuria
  • Haematuria
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6
Q

Identify 5 consequences of TB in the urinary tract

A
  • Calcification
  • Caseous mass
  • Strictures & beading of ureters
  • Thickened small capacity bladder
  • Urethral stricture
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7
Q

What is schistosomiasis?

A

- 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
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8
Q

Identify 4 complications of schistosomiasis

A
  • Chronic cystitis
  • Bladder calcification
  • VUJ fibrosis & stenosis
  • Bladder cancer
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9
Q

Which species of schistosomiasis cause lower urinary tract disease?

A

Schistosoma haematobium

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10
Q

Which species of schistosomiasis cause hepatosplenic / GI disease?

A
  • Schistosoma mansonii
  • Schistosoma japonicum
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11
Q

Identify one complication of schistosomiasis

A

Glomerulonephritis (not bladder cancer)

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12
Q

Identify 4 systemic infections which cause GN

A
  • Post-infectious glomerulonephritis
  • Endocarditis
  • Hepatitis B
  • Hepatitis C
  • HIV
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13
Q

Which organism causes post-infectious GN?

A

Group A streptococcus

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14
Q

How does post-infectious GN present?

A
  • Occurs 1-4 weeks after throat infection
  • Occurs in children (5-12) and > 60 year olds
  • Can present with acute nephritic syndrome
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15
Q

Endocarditis associated GN occurs in up to 20% of endocarditis cases.

What is the causative organism?

A

Streptococcus viridans / Staphylococcus aureus

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16
Q

How do patients with endocarditis associated GN present?

A
  • AKI with non-visible haematuria
  • Systemic symptoms & signs of endocarditis e.g. fever, arthralgia
17
Q

Identify 5 risk factors which increase risk of infection in CKD

A
  • Immunosuppression
  • Increased age
  • Malnutrition
  • Co-morbidity e.g. DM
  • Nephrotic Syndrome
18
Q

Identify 3 types of infections which are common in haemodialysis patients

A
  • Metastatic infections (disciitis, osteomyelitis, heart valves)
  • Chest infections
  • GI infections
19
Q

Identify 5 infections which are common in peritoneal dialysis patients

A
  • Peritonitis
  • Cellulitis
  • Chest infection
  • GI infections
  • UTI
20
Q

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

A
  • Hospital-acquired (nosocomial)
  • Community-acquired
  • Reactivation of infection (HSV, TB, Hep B, Hep C)
  • Donor-derived
21
Q

Transplant patients are immunosuppressed therefore at risk of all the normal infections plus opportunistic infections.

What is the commonest infection they get?

A

Urinary tract infections

22
Q

Infections in transplant patients might not be picked up as immunosuppression can mask some signs of infection.

Identify three

A
  • Reduced inflammatory response
  • Temperature may be normal
  • May not have a raised WCC
  • Ab response often delayed
23
Q

Transplant patients with infections may have less common presentations.

Identify three

A
  • Altered mental state
  • Hypotension without fever
  • Raised LFTs
24
Q

How is infection prevented in transplant patients?

A
  • 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
25
Q

Identify 6 infections which are screened for in donors by transplant programmes in developed countries

A
  • HSV
  • EBV
  • HIV
  • Hepatitis B&C
  • TB
26
Q

Which vaccinations are recommended in people with renal disease?

A
  • Patients with advanced CKD – influenza vaccine
  • Patients likely to reach ESRD – Hepatitis B vaccine
  • Transplant patients – pneumococcal and meningococcal vaccine

(LUSUMA) Urinary System (23 decks)

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