Urinary tract infection 12/21 Flashcards
4 symptoms of cystitis?
Suprapubic pain, dysuria, urinary frequency, urgency. No systemic signs, e.g. high fever, chills.
Risk factors for cystitis?
Female sex (short urethra), sexual intercourse, indwelling catheter, diabeted mellitus, impaired bladder emptying.
Most common cause of cystiti?
E. coli.
5 m/o of cystitis?
E. coli, Staph. saprophyticus, Klebsiella, Proteus mirabilis, Enterococcus faecalis.
Which m/o is common in sexually active young women?
Staph. saprophyticus.
Which m/o is MORE common in sexually active young women?
E. coli.
What disease can cause sexual intercourse?
Cystitis.
> 10 WBC/hpf and leukocyte esterase, negative urine culture. What suggested m/o? What suggested urinary tract infection?
STI –> Chamydia trachomatis and Neisseria gonorrhoeae. Urethritis.
Cystitis 3 lab. findings? (Not culture)
> 10 WBC/hpf, positive leukocyte esterase, nitrites.
Gold standart for cystitis diagnostics?
Culture - greater than 100 000 colony forming units.
Why there is leukocyte esterase in urine in cystitis?
Due to pyuria.
Why there is nitrites in urine in cystitis? What m/o indicates?
Gram negative bacteria convert nitrates to nitrites.
Nitrites in urine in cystitis. What m/o are indicated?
Gram negative bacteria.
Acute pyelonephritis predisposing factors?
Urinary obstruction, vesicoureteral reflux, pregnancy, diabetes mellitus, benign prostatic hyperpasia, indwelling catheter.
Acute pyelonephritis symptoms?
Flank pain (costovertebral angle tenderness), chills, fever, dysuria, frequency and urgency.
Costovertebral angle tenderness is common in ……
Acute pyelonephritis
What parts of kidney are involved in acute pyelonephritis?
Renal pelvis, tubules, interstitium.
What are the most common inflammatory cells in acute pyelonephritis?
Neutrophils.
What are 3 m/os, that cause acute pyelonephritis?
E.coli, Klebsiella, Enterococcus faecalis.
What is the most common m/o in acute pyelonephritis?
E. coli.
What are the ways that m/os reach kidney in acute pyelonephritis?
Ascending via urethers, hematogenous spread to kidneys.
What changes are in kidney parts, affected by acute pyelonephritis?
Interstitium - neutrophils infiltration.
Tubules - neutrophil casts.
May be presented parenchymal abcesses/abcesses in cortical surface.
Urinalysis in acute pyelonephritis?
Pyuria (WBC in urine) and WBC casts.
Why occurs chronic pyelonephritis?
Because of reccurent or inadequately treated episodes of ACUTE PYELONEPHRITIS.
What causes chronic pyelonephritis?
Vesicoureteral reflux (kids) or obstruction (BPH or cervical carcinoma.
Scarring of CORTEX at upper and lower poles of kidney indicates ……… (what pathology?) What disease it indicates?
Vesicoureteral reflux. Chronic pyelonephritis.
Corticomedullary scarring and blunted calyxes are associated with ………
Chronic pyelonephritis.
What is thyroidization of kidney?
It’s eosinophilic casts in kidney tubules, that looks like thyroid tissue in LM (H&E).
Diabetes mellitus can cause …….
Acute pyelonephritis.
Xanthogranulomatous pyelonephritis is associated with …….(m/o)…….. infection.
Proteus
Xanthogranulomatous pyelonephritis is characterised by …………………………………………….
widespread kideny damage due to granulomatous tissue containing foamy macrophages.
What macrophages are found in xanthogranulomatous pyelonephritis?
Foamy.
Xanthogranulomatous pyelonephritis is acute or chronic?
Chronic.
What nodules are seen in xanthogranulomatous pyelonephritis?
Orange nodules, that can mimic tumor nodules.
There are seen nodules in kidney. What chronic disease should be considered to differenciate from tumor?
Xanthogranulomatous pyelonephritis.
Cystitis. Urinalysis?
cloudy urine with >10 WBC/high power field (hpf)
Cystitis. Dipstick?
positive leukocyte esterase (due to pyuria) and nitrites (bacteria convert nitrates to nitrites
Cystitis. Culture?
greater than 100 000 colony formin units (GOLD STANDARD)
Cystitis. Proteus - what urine?
alkaline urine with ammonia scent (-> amonium magnesiu phosphate stones)
what is dominant presenting sign of urethritis?
dysuria
Chronic pyelonephritis. Definition?
INTERSTITIAL fibrosis and ATROPHY of tubules due to mulptiple bouts of acute pyelonephritis.
INTERSTITIAL fibrosis and ATROPHY of tubules due to mulptiple bouts of acute pyelonephritis?
Chronic pyelonephritis.
Chronic pyelonephritis. morphology due to reflux?
Cortical scarring with blunted calyces; scarring at the upper and lower poles
Chronic pyelonephritis. in general what morphology?
atrophic tubules containing eosinophilic material (resembles thyroid follicles)
Waxy casts may be in urine
