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Semester 3 > Urinary Session 7 > Flashcards

Urinary Session 7 Flashcards

1
Q

What can cause obstruction of the renal tract and increase the risk of developing a UTI?

A 
BPH
Pregnancy
Uterine prolapse
Stones
Tumours
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2
Q

What is commonly seen as a cause of ascending infection in children with UTIs?

A

Ureteric reflux

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3
Q

What is ureteric reflux?

A

Abnormal or dysfunctional bladder valves, particularly seen in children

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4
Q

How should all children with a UTI be investigated?

A

Ultrasound

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5
Q

Which valves are likely to be involved in males and females with ureteric reflux?

A

Males: posterior urethral
Females: vesico-ureteric

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6
Q

What are bacterial factors which increase the likelihood of developing a UTI?

A

Fimbriae
K-antigen
Urease
Haemolysins

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7
Q

How does K-antigen allow a bacterium to cause a UTI?

A

Allows production of a polysaccharide capsule

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8
Q

How do haemolysins aid in the pathogenesis of UTI?

A

Damage host cell membranes and cause renal damage

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9
Q

Which two bacterial factors do G-ve UTI causative agents utilise to cause infection?

A

K-antigen

Haemolysins

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10
Q

What are coliforms?

A

G-ve, non spore forming bacilli that can ferment lactose

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11
Q

How do the majority of UTIs develop?

A

Transmission of coliforms across the perineum

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12
Q

What is secreted in between episodes of bladder voiding in order to reduce the risk of UTI?

A

Antibacterial secretions

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13
Q

After coliforms, what is a common causative agent of UTI in young women and hospitalised pts?

A

Coagulase -ve staph

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14
Q

What demonstrates irritation of the bladder in lower UTI?

A

Frequency and dysuria +/- low grade fever and urgency with a typical burning sensation

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15
Q

How does acute polynephritis present?

A

Fever, loin pain or pain in renal angle +/- dysuria and frequency

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16
Q

How can bacteraemia lead to acute polynephritis?

A

Becomes localised by filtration in the glomerular tuft

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17
Q

When is asymptomatic UTI significant and why?

A

In the mother during pregnancy –> premature birth

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18
Q

Can UTI progress to septicaemia +/- shock?

A

Yes, large cause of G-ve septicaemia in secondary care

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19
Q

Who fits into the uncomplicated UTI group?

A

Healthy women of child-bearing age

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20
Q

How are UTIs diagnosed in the uncomplicated UTI group?

A

Clinical diagnosis + dipstick

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21
Q

Who fits into the complicated UTI group?

A

Females of non-child bearing age
Males
Pregnant females
Pts who have failed to respond to UTI Tx

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22
Q

How are UTIs diagnosed in the complicated UTI group?

A

Dipstick and culture

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23
Q

What host factors promote the development of a UTI?

A

Shorter urethra in females
Obstruction
Neurological problems
Ureteric reflux

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24
Q

How can urine specimens be collected in diagnosis of UTI?

A 
Mid stream urine (MSU)
Clean catch (children)
Collection bags
Catheter sample
Supra-pubic aspiration
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25
Q

Why do MSU samples have to be taken mid-stream?

A

So the first void can wash out flora

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26
Q

How are urine samples transported to the lab and why are these methods used?

A

@ 4 degrees Celsius to represent having just left bladder

+/- boric acid to preserve and restrict multiplication so a falsely raised pathogen count is not detected

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27
Q

What causes turbidity of urine to change in UTI?

A

WBC response to pathogen

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28
Q

Is using turbidity if urine to identify UTIs a good investigation to use?

A

Yes, it has high sensitivity so will identify +vex if you know there is an infection somewhere but you don’t know where

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29
Q

What is measured in dipstick testing?

A

Leucocyte esterase
Nitrite
Haematuria
Proteinuria

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30
Q

What do high levels of nitrite on a urine dipstick indicate?

A

Bacterial metabolism of urea

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31
Q

Which components of the urine dipstick test are good indicators for infection but do not specify the reason for WBCs in the urine?

A

Leucocyte esterase

Nitrite

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32
Q

Why do the haematuria and proteinuria components of a urine dipstick have low specifity?

A

There are a range of causes for both

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33
Q

When will microscopy be used to examine a urine sample?

A

Kidney disease
Suspected endocarditis
Children

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34
Q

What is examined during microscopy of a urine sample?

A

WBCs
RBCs
Bacteria
Casts

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35
Q

What are seen on microscopy of contaminated urine samples?

A

Squames

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36
Q

What is carried out if microscopy of a urine sample is +ve?

A

Culture

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37
Q

What can cause a non-significant culture following a +ve microscopy investigation for UTI?

A 
Abx treatment for another infection e.g. URTI
Urethritis
Vaginal infection
TB
Appendicitis
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38
Q

59% of adult women with a UTI have urethral syndrome. What can cause this?

A 
Low count bacteriuria
Fastidious organisms
Vaginal infection/inflammation
STIs --> urethritis
Mechanical/physical/chemical e.g. Soaps
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39
Q

Why are only symptomatic catheterised pts treated for UTI?

A

They will always have a level of bacteriuria

40
Q

What is the treatment for an uncomplicated UTI?

A

3-day trimethoprim/nitrofurantoin

41
Q

What is the treatment for a complicated UTI?

A

7-day trimethoprim/nitrofurantoin with follow up for clearance of S/S and bacteriuria

42
Q

What is the treatment for pyelonephritis and septicaemia due to UTI?

A

14-day ciprofloxacin/cefuroxime of IV gentamicin if necessary

43
Q

What prophylactic treatment can be used for pts who experience 3 or more episodes of UTI per year?

A

Single nightly dose of trimethoprim/nitrofurantoin

44
Q

Why is amoxicillin not used to treat complicated UTI?

A

Has 50% resistance

45
Q

What general management strategies can be used for all UTIs?

A

Ensure voiding mechanism is correctly functioning

Stay hydrated

46
Q

What is diuresis?

A

Increased formation of urine by the kidney

47
Q

What is the symptom of diuresis?

A

Polyuria= >3l per day urine output

48
Q

What is a diuretic?

A

A substance/drug that promotes a diuresis by increasing renal excretion of water and sodium (increased fraction excretion) and thus reducing ECF volume

49
Q

What do diuretics that block sodium reabsorption by acting on ENaC also decrease?

A

K+ secretion

50
Q

How can diuretics have a direct action on cells in the nephron?

A

Via secretion into the lumen of PCT –> flow downstream and directly bind to transporters

51
Q

How do aldosterone antagonists work as diuretics?

A

Competitively inhibit aldosterone action therefore decrease ENaC sodium reabsorption and K+ sparing

52
Q

How do osmotic diuretics work?

A

Modify filtrate content so small molecules are filtered by not reabsorbed and hence increase the osmolarity of filtrate

53
Q

Are osmotic diuretics currently used clinically?

A

No

54
Q

How does inhibiting carbonic anhydrase act as a diuretic?

A

Prevents CA activity on brush border of PCT therefore altering Na+ and HCO3- reabsorption

55
Q

Are carbonic anhydrase inhibitors currently used clinically as diuretics?

A

No

56
Q

Which drugs can be classified as K+ sparing diuretics?

A

Inhibitors of renal sodium channels - Amiloride

Aldosterone antagonists - Spironolactone

57
Q

Why are loop diuretics very potent diuretics?

A

25-30% of filtered Na+ is reabsorbed in the loop of Henle and segments distal to this have limited capacity to reabsorb sodium resultant increase in sodium and water

58
Q

Which diuretics act on the filtration barrier?

A

Osmotic diuretics

59
Q

Which diuretics act on the PCT?

A

CA inhibitors

60
Q

Where in the loop of Henle do loop diuretics act?

A

Thick ascending limb

61
Q

What does the efficacy of CA inhibitors for diuresis in the PCT depend on?

A

HCO3- filtration, a lower lumen +ve potential causes decreased cation reabsorption

62
Q

Where do thiazides act on the nephron to cause diuresis?

A

Distal tubule

63
Q

What ion movements do thiazides cause?

A

Increases sodium loss and increases calcium reabsorption

64
Q

Where do potassium sparing diuretics act in the nephron?

A

Collecting duct

65
Q

Why are loop diuretics used to treat heart failure?

A

Due to diuretic, vaso- and venodilation effects to decrease after and preload

66
Q

When are loop diuretics used to treat fluid retention and oedema?

A

In nephrotic syndrome, renal failure and cirrhosis of the liver if Spironolactone is not sufficient

67
Q

How are loop diuretics used in the management of hypercalcaemia?

A

Furosemide and IV fluids are given to prevent dehydration

68
Q

What is the clinical application of thiazide diuretics?

A

Used to treat hypertension due to vasodilation effects

69
Q

Why are thiazide diuretics not used in renal failure?

A

Lack potency

70
Q

What is a possible side effect of thiazide treatment?

A

Erectile dysfunction

71
Q

What are the clinical applications of aldosterone antagonists?

A

Primary hyperaldosteronism
Ascites and oedema in cirrhosis
Survival benefit in chronic heart failure
Additional Tx for hypertension not controlled by ACEI, CCB and thiazide

72
Q

What is the clinical application of ENaC blockers?

A

Used with loop diuretics/thiazide to minimise potassium loss

73
Q

What is the clinical application of CA inhibitors?

A

Used in glaucoma to decrease aqueous humour in the eye

74
Q

What is a possible side effect of carbonic anhydrase inhibitors?

A

Can cause metabolic acidosis due to decreased HCO3-

75
Q

What is the clinical application of osmotic diuretics?

A

IV mannitol in cerebral oedema to increase plasma osmolarity

76
Q

What is the pathogensis of nephrotic syndrome which leads to a condition requiring diuretic Tx?

A

Glomerular disease –> increase in GbM permeability –> proteins lost in urine –> decreased plasma albumin which liver cannot compensate –> decreased plasma p(oncotic) –> peripheral oedema –> decreased circulating volume –> RAAS stimulation –> ECF expansion

77
Q

How does cirrhosis of the liver lead to a condition requiring diuretic Tx?

A

Decreased albumin synthesis –> RAAS stimulation –> ECF expansion
Portal hypertension –> increased p(venous) in GI –> decreased an
p(oncotic) –> transudation from peritoneal capillaries to cavity –> ascites

78
Q

Why is Spironolactone Tx preferred for cirrhosis of the liver?

A

Does not cause hypokalaemia

79
Q

Why can Spironolactone Tx lead to gynaecomastia?

A

Oestrogen-like molecule

80
Q

How are the different adverse effects of diuretics monitored?

A

K+ disturbances - monitor electrolytes
Hypovolaemia - monitor weight and postural BP
Hyponatraemia - monitor electrolytes

81
Q

What are the possible adverse effects shared by loop and thiazide diuretics?

A

Increased uric acid levels due to competition of transporters –> gout
Glucose intolerance due to insulin release interference
Raised LDL levels

82
Q

How can cirrhosis of the liver lead to hepatic encephalopathy?

A

Liver cannot detoxify ammonia –> increased levels in blood

83
Q

How does hepatic encephalopathy present?

A

Constructional apraxia (can’t draw a star) –> flapping tremors –> confusion –> coma

84
Q

What creates a favourable lumen -ve potential for passive K+ secretion in the DCT and CD?

A

Rate of sodium reabsorption

85
Q

How can loop and thiazide diuretics cause hypokalaemia?

A

Block sodium and water reabsorption in loop/early DT –> increased delivery to distal parts –> faster washing away of secreted K+ and increased reabsorption of sodium by principal cells creating favourable gradient –> more K+ in urine

86
Q

How does the effect of diuretics on the RAAS lead to hypokalaemia?

A

Decrease ECF –> RAAS activation –> increased aldosterone –> increased sodium reabsorption and K+ secretion

87
Q

How can diuretics lead to hyperkalaemia?

A

Aldosterone antagonists decrease activity of Na-K-ATPase and ENaC –> less sodium reabsorption –> less K+ secretion
ENaC inhibitors cause less sodium reabsorption –> less K+ secretion

88
Q

What management strategies can be used to when choosing diuretics to minimise K+ changes whilst maintaining diuretic action?

A

Loop/thiazide with K+ sparing diuretic

Loop/thiazide with K+ supplement

89
Q

What other substances not used for Tx have diuretic action?

A

Alcohol
Coffee
Lithium
Demeclocycline

90
Q

How does alcohol act as a diuretic?

A

Inhibits ADH release

91
Q

How does coffee act as a diuretic?

A

Increases GFR –> decreases tubular sodium reabsorption

92
Q

How do lithium and demeclocycline act as diuretics?

A

Inhibit ADH action on CD

93
Q

Which substances with diuretic action but are not Tx have pure water effects by changing osmolarity, not volume?

A

Alcohol

Lithium

94
Q

Explain how some named diseases can cause diuresis.

A

DM: glucose in filtrate –> osmotic diuresis
DI (cranial): decreased ADH release –> high pure water loss
DI (neohrogenic): poor CD ADH repsonse –> high pure water loss
Psychogenic polysdipsia: high fluid intake

95
Q

Give an example of each type of diuretic with the following mechanism of action: direct action on cells, aldosterone antagonists, osmotic diuretics, CA inhibitor.

A

Bendroflumethiazide
Spironolactone
Mannitol
Acetazolamide

Semester 3 (50 decks)

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