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Renal Pathology > Urinary Tract Infection > Flashcards

Urinary Tract Infection Flashcards

1
Q

Definition of micturition

A

Urination

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2
Q

Presentation of UTI

A 
Dysuria
Frequency 
Smelly urine
Cloudy urine 
Flank pain 
Urgency 
Chills
Strangury 
Very young
- unwell 
- failure to thrive
Very old
- incontinence
- off their feet
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3
Q

Definition of dysuria

A

Pain (usually suprapubic) on micturition

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4
Q

How much of the CO does the renal blood flow get?

A

20 - 25%

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5
Q

What does urine output change with?

A

Oral intake of fluids

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6
Q

If increased fluid intake, how does that lead to increased urine output?

A

Resorption of fluid is diminished

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7
Q

Do ureters store urine?

A

NO - they have a continuous flow of it

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8
Q

What stops the reflux of urine up the ureter from the bladder?

A

Increasing pressure from the bladder as it fills, which closes off the ureter

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9
Q

What are the normal properties urine?

A

Low pH
High osmolarity
High ammonia (NH3)

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10
Q

What properties do prostatic secretions have?

A

Bacteriostatic

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11
Q

What parts of the urinary tract are sterile?

A

All of it except from the terminal urethra

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12
Q

Would a suprapubic aspirate of urine be non-sterile or sterile?

A

Sterile

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13
Q

What is a urinated specimen always contaminated with? What may get rid of this?

A

Terminal urethral flora

Initial voiding will flush out any terminal urethral floral bacteria

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14
Q

What does MSSU stand for?

A

Mid stream specimen of urine

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15
Q

How does a MSSU work?

A

Patient voids and then stops mid stream, discarding urine, then collects next volume of urine

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16
Q

In a MSSU, will there still be urethral flora present?

A

YES - it is diminished but always present

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17
Q

What level of bacteria on MSSU usually shows an infection?

A

10 ^ 5

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18
Q

If the MSSU shows bacteria of 10^3 to 10^4, what may this indicate?

A

Sometimes an infection is present

  • probably if have symptoms
  • 50% chance of infection if no symptoms
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19
Q

If the MSSU culture has bacteria <10^3, what does this indicate?

A

Usually NO symptoms

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20
Q

Who is a MSSU difficult to collect in?

A

Elderly

Young children

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21
Q

What is the most common organism to cause UTI?

A

Bacteria - E coli

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22
Q

How common is it to get a viral infection that causes a UTI?

A

Rare

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23
Q

What route of infection of a UTI is it almost always?

A

Ascending

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24
Q

Name of inflammation of urethra

A

Urethritis

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25
Q

Name of inflammation of the bladder

A

Cystitis

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26
Q

Name of inflammation of the ureter

A

Ureteritis

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27
Q

Name of inflammation of the kidneys

A

Acute pyelonephritis

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28
Q

What does acute pyelonephritis if recurrent/prolonged infection lead to?

A

Chronic pyelonephritis

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29
Q

Predisposing factors to UTI (Pathology)

A

Stasis of urine
Pushing bacteria up urethra from below
Generalised predisposition to infection

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30
Q

Causes of stasis of urine

A

Obstruction

Loss of feeling of full bladder (spinal cord/brain injury)

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31
Q

Causes of bacteria being pushed up from urethra from below

A

Sexual activity in females

Catheterisation and other urological procedures

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32
Q

What is an example of a generalised predisposition to infection?

A

DM

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33
Q

What would obstruction at the level of the urethra lead to?

A

Upper urethral and bladder dilation

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34
Q

What would upper urethral and bladder dilatation lead to?

A

Bilateral hydroureter

35
Q

What can bilateral hydroureter lead to?

A

Bladder dilatation ->
Bilateral hydroureter ->
Bilateral hydronephrosis ->
Chronic renal failure

36
Q

If there was obstruction in one ureter only, what would this lead to?

A

Unilateral hydroureter

37
Q

What would unilateral hydroureter lead to?

A

Unilateral hydronephrosis

38
Q

Consequences of obstruction

A

Proximal dilatation
Slowed urine -> cannot flush out bacteria -> infection
Slowed urine flow -> sediments form -> calculous (stone) formation -> obstruction
More and more of these

39
Q

What is the triad of the consequences of obstruction?

A

Infection
Calculi
Obstruction

40
Q

Pathology of vesicoureteric reflux

A

Decreased angulation of insertion of ureter at an angle into the bladder

41
Q

Most common cause of obstruction in children

A

Vesicoureteric reflux

42
Q

Causes of male adult obstruction

A

Benign prostatic hyperplasia of prostate
Tumours
Calculi

43
Q

Causes of female adult obstruction

A

Uterine prolapse
Tumours
Calculi

44
Q

Predisposing factors for UTI in females

A

Female - short urethra
Lack of prostatic bacteriostatic secretion
Sexual activity
Pregnancy

45
Q

What reduces chance of UTI after sexual activity in females?

A

Voiding after intercourse

46
Q

Why does pregnancy predispose you to UTIs?

A

Pressure on the ureters and the bladder

47
Q

Complications of UTI

A

Severe sepsis and septic shock
Chronic damage to the kidneys if repeated infections (chronic pyelonephritis) leading to HTN and chronic renal failure
Calculi causing obstruction leading to hydronephrosis leading to HTN and CRF

48
Q

Name if inflammation of the prostate

A

Prostatitis

49
Q

Name if inflammation of the epididymis/testis

A

Epididymo-orchitis

50
Q

Which gender gets UTIs more?

A

F > M 3:1

51
Q

What % of women are affected by a UTI at somepoint in their lives?

A

30%

52
Q

Why is UTI common in pregnancy?

A

Progesterones lead to relaxation of smooth muscle of the uretus - incidence of reflux is high

53
Q

Why are urine infections very common in hospitals?

A

Catheters

Immunocompromised

54
Q

Risk factors for UTI

A 
Immunosuppression 
Steriods
Malnutrition 
Diabetes 
CKD
Female
Age
55
Q

Predisposing factors for UTI

A

Female - short urethra
Sexual intercourse and poor voiding habits
Congenital abnormalities e.g. duplex kidney
Stasis of urine due to poor bladder emptying
Foreign bodies e.g. catheters, stones
Oestrogen deficiency in post menopausal women
Fistula between bladder and bowel
Spermicide coated condoms and diaphragms

56
Q

Why does a short urethra predispose you to UTIs?

A

Easier for microorganisms to transfer from the perineum/rectum

57
Q

Why are oestrogen deficient post menopausal women at risk of UTIs?

A

Lack of oestrogen leads to a dry perineal area

58
Q

What can help prevent UTIs in any age of women?

A

General toilet hygiene - wiping from front to back

59
Q

Causative organisms of UTI

A 
E coli 
Proteus mirabilis
Klebsella 
Enterobacter 
Pseudonomonas aeruginosa
Coagulase negative staphylococci 
Enterococci 
Group B strep 
Staph aureus
60
Q

Which of gram -ve or gram +ve bacteria are more common to cause UTIs?

A

Gram positive

61
Q

Where do the organisms usually originate from in UTI?

A

Bowel

62
Q

How do the organisms spread to the Urinary tract system?

A

Transurethral route
- preurethral area contaminated (recurrent UTIs, diaphragms, bubble baths)
- urethra to bladder (intercourse, catheter)
- bladder and up ureters
Bloodstream
- certain parasites can attack the bladder via the blood e.g. schistosomiasis
Lymphatics

63
Q

Can UTIs eventually cause AKIs?

A

Yes

64
Q

Presentation of UTI in children

A 
Diarrhoea
Excessive crying
Fever
N + V 
Not eating
65
Q

What is strangury?

A

The uncomfortable feeling of wanting to void but not being able to
Need to pee and a small amount comes out - then need to pee and nothing comes out - this is due to cystitis

66
Q

Presentation of acute pyelonephritis

A 
Pyrexia
Poor localisation 
Loin tenderness at the renal angle
Signs of dehydration 
Turbid urine
67
Q

Investigations of UTI

A 
MSSU
Urinalysis
- blood, leucocytes, protein, nitrites 
Microbiology in lab
In children, men or frequent UTIs
- USS
- IVU
68
Q

What does MSSU stand for?

A

Mid stream specimen of urine

69
Q

What are the principles of management of a UTI?

A
  1. Identify the infecting organism and treat

2. Identify predisposing factor and treat if possible

70
Q

Treatment of UTI

A

Oral fluids

Antibiotics

71
Q

Why does oral fluids treat a UTI?

A

Flushes out the system

72
Q

What antibiotics are used to treat UTI?

A

Amoxicillin
Cephalosporin
Trimethoprim

73
Q

What abnormally urinary tract causes could cause UTI?

A

Anatomical/neurological abnormalities
Stones
DM

74
Q

What can reflux nephropathy present with in children?

A

UTIs

75
Q

How is reflux nephropathy assessed?

A

USS

Biochemistry

76
Q

Treatment of reflux nephropathy

A

Surgery

77
Q

Treatment of recurrent UTI infections

A 
Fluid intake 2L/day 
Void every 2-3 hours by day
Void before bedtime
Void before and after intercourse
Sometimes advised to not micturate in one go 
- stop and continue
78
Q

Treatment of a catheter induced UTI

A

Antibiotics

Replace catheter

79
Q

Presentation of chronic pyelonephrtiis

A

Scarring and clubbing
HTN
CRF
Reflux

80
Q

What % of people with chronic pyelonephritis progress to renal failure?

A

15%

81
Q

Complication of nitrofurantoin

A

Lung fibrosis

82
Q

What causes sterile pyuria?

A 
Antibiotics
Renal TB
Appendicitis
Prostate
Chlamydia
Renal calculi 
PCKD
Pregnancy 
Catheter
83
Q

Investigation of choice for reflux nephropathy

A

Micturating cystography

Renal Pathology (13 decks)

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