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Renal > Urinary Tract Infection/Interstitial Disease > Flashcards

Urinary Tract Infection/Interstitial Disease Flashcards

1
Q

What is a UTI?

A

Urinary tract infection is an infection in the bladder, ureter, or kidneys

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2
Q

Most UTIs are confined to the _____ GU tract. These are called _____

A

Lower.

Cystitis

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3
Q

What is a UTI that involves the upper GU tract?

A

Pyelonephritis

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4
Q

True or False: Pyelonephritis can be acute or chronic

A

True

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5
Q

What are the 2 routes of infection for UTIs?

A

Ascending (more common) and hematogenous

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6
Q

Hematogenous UTI is from a distant source like _____ or _____

A

septicemia or infective endocarditis

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7
Q

Hematogenous UTIs are likely in the presence of ______, _____, or ______.

A

ureteral obstructions

debilitated patients

or patients on immunosuppressive therapy

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8
Q

Hematogenous UTIs are caused by non enteric agents such as ______, and certain ____ and ____.

A

Staphylococci, fungi, viruses

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9
Q

The ascending route of UTI is most common and it involves _____ flora such as _____ (most common), _____, _____, and _____.

A

Fecal.

E. coli

Proteus

Klebsiella

Enterobacter

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10
Q

What are 3 virulance factors that help in pathogenesis?

A
  1. Bacterial adhesion (adhesive molecules on Pili aka P or Fimbria)
  2. “O” Antigens (more resistant to treatment)
  3. Endotoxins (decrease ureteric peristalsis decreasing urine flow)
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11
Q

What’s around this bacteria?

A

Pili aka fimbria aka P

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12
Q

What are host defenses against UTIs?

A
  • Mechanical (hydrokinetic)
    • Bladder emptying/urine flow
  • Chemical
    • Prostatic secretions (antibacterial)
    • Urine osmolality, pH, and ammonia
    • Blood Group Antigens
  • Immunologic
    • IgA
    • Complement
  • Cellular
    • PMNs
    • Shedding of urothelial cells
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13
Q

Certain blood group antigens are known to carry uropathogenic strains more often than others. What antigen increases risk of UTI by about 11%?

A

P1

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14
Q

Why are UTIs more common in females?

A

Shorter urethra

Bacterial colonization because there is a lack of antibacterial factors like prostatic fluid and estrogen and progesterone increase adherence of bacteria.

Urethral trauma from sex

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15
Q

How can pregnancy predispose UTIs?

A

The uterus sits right on the bladder and during pregnancy when the uterus expands it causes compression which can increase incidence of UTI

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16
Q

True or False: Instrumentation like catheters entering the bladder from the urethra can predispose UTIs

A

True

17
Q

Decreased urine flow or urine stasis can cause UTIs. What are 4 things that can cause this?

A
  1. Incomplete voiding
  2. Obstruction (Benign prostatic hypertrophy, stones, tumors)
  3. Neurogenic bladder (diabetes m., spinal cord injury)
  4. Diverticulum
18
Q

What is vesicoureteral reflux? Primary and secondary?

A

There is no valve where the ureter enters the bladder but it has a short course within the bladder which acts effectively as a valve. So, when the bladder fills with urine, the walls push outward which closes the effective valve. This prevents urine from going back up. When this functionality is lost (e.g. ureter entering perpendicularly), retrograde flow of urine from the bladder to the ureter and renal pelvis occurs.

Primary: a congenital abnormality of VU anatomy that’s common in infants and decreases in severity during childhood. It’s usually mild and has spontaneous remission.

Secondary: Neurogenic bladder (paraplegia, spina bifida) or bladder atony. This typically occurs in older children or adults.

19
Q

What are the grades of vesicoureteric reflux?

A
20
Q

What’s going on here?

A

This is a urethrogram where they inject dye into the bladder. You shouldn’t be seeing dye going upwards through the ureters so this is an example of vesicoureteral reflux (VUR)

21
Q

What do polar scars on the kidney suggest?

A

Chronic pyelonephritis associated with vesicoureteral reflux. The scars are polar because they are associated with underlying blunted calyces at the poles.

22
Q

When obstruction causes UTI, what must be treated to prevent recurrence?

A

The obstruction

23
Q

Nephrolithiasis is categorized into 3 different groups by opacity. What are the 3 categories and what makes up the stones in each category?

A
  • Radio-opaque (70% - most common)
    • Calcium oxalate and phosphate
  • Semiopaque (15-20%)
    • Magnesium, ammonium, phosphate
  • Not usually opaque
    • Uric acid, cystine, other
24
Q

What % of americans are effected by nephrolithiasis? Is it more common in males or females? What is the peak age incidence?

A

5-10%

Men more common than women

20-30 y/o

25
Q

What factors predispose nephrolithiasis? (5)

A
  1. Hypercalcemia
  2. Increased uric acid
  3. Low pH
  4. Decreased volume
  5. Bactera
26
Q

Where can you find kidney stones?

A

Tubules, calyces, renal pelvis, ureter, bladder

27
Q

What are struvite stones?

A

They are stones that are associated with bacterial infections by proteus or staphylococcus. These bacteria convert urea into ammonia which makes the urine more alkaline which causes precipitation of the salts.

28
Q

What is a staghorn calculus?

A

Big ass stone that’s filling up the renal pelvis and calyces.

These cannot be fixed. Can only transplant

29
Q

What is hydronephrosis and hydroureter?

A

These are consequences of urinary tract obstruction

Hydronephrosis - enlarged calyces

Hydroureter - enlarged ureter

30
Q

What are 5 consequences of urinary tract obstruction?

A
  1. Hydronephritis, hydroureter
  2. Infection
  3. Chronic obstructive pyelonephritis
  4. Renal Failure
  5. Hypertension
31
Q

What are symptoms of lower tract infections? (8)

A
  1. Dysuria
  2. Frequency
  3. Hematuria
  4. Cloudy offensive urine
  5. Nocturia
  6. Suprapubic pain
  7. Strangury
  8. Urgency
32
Q

What are symptoms of acute pyelonephritis? (5)

A
  1. Fever
  2. Malaise
  3. Nausea
  4. Vomiting
  5. Abdominal pain
33
Q

What are symptoms of pyonephrosis or perinephritic abscess? (6)

A
  1. Rigors
  2. Loin pain
  3. Scoliosis
  4. Loin swelling
  5. Weight loss
  6. Night sweats
34
Q

True or False: When children get UTIs, the symptoms can be nonspecific and just general irritability.

A

True

35
Q

True or False: Chronic pyelonephritis is a common cause of ESRD

A

True

36
Q

True or False: Chronic pyelonephritis is never asymptomatic

A

False.

It is usually asymptomatic.

However, it can also present with dysuria, flank pain, and hypertension

Renal (36 decks)

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