Urinary Tract Infection/Interstitial Disease Flashcards
What is a UTI?
Urinary tract infection is an infection in the bladder, ureter, or kidneys
Most UTIs are confined to the _____ GU tract. These are called _____
Lower.
Cystitis
What is a UTI that involves the upper GU tract?
Pyelonephritis
True or False: Pyelonephritis can be acute or chronic
True
What are the 2 routes of infection for UTIs?
Ascending (more common) and hematogenous
Hematogenous UTI is from a distant source like _____ or _____
septicemia or infective endocarditis
Hematogenous UTIs are likely in the presence of ______, _____, or ______.
ureteral obstructions
debilitated patients
or patients on immunosuppressive therapy
Hematogenous UTIs are caused by non enteric agents such as ______, and certain ____ and ____.
Staphylococci, fungi, viruses
The ascending route of UTI is most common and it involves _____ flora such as _____ (most common), _____, _____, and _____.
Fecal.
E. coli
Proteus
Klebsiella
Enterobacter
What are 3 virulance factors that help in pathogenesis?
- Bacterial adhesion (adhesive molecules on Pili aka P or Fimbria)
- “O” Antigens (more resistant to treatment)
- Endotoxins (decrease ureteric peristalsis decreasing urine flow)
What’s around this bacteria?
Pili aka fimbria aka P
What are host defenses against UTIs?
- 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
Certain blood group antigens are known to carry uropathogenic strains more often than others. What antigen increases risk of UTI by about 11%?
P1
Why are UTIs more common in females?
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
How can pregnancy predispose UTIs?
The uterus sits right on the bladder and during pregnancy when the uterus expands it causes compression which can increase incidence of UTI
True or False: Instrumentation like catheters entering the bladder from the urethra can predispose UTIs
True
Decreased urine flow or urine stasis can cause UTIs. What are 4 things that can cause this?
- Incomplete voiding
- Obstruction (Benign prostatic hypertrophy, stones, tumors)
- Neurogenic bladder (diabetes m., spinal cord injury)
- Diverticulum
What is vesicoureteral reflux? Primary and secondary?
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.
What are the grades of vesicoureteric reflux?
What’s going on here?
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)
What do polar scars on the kidney suggest?
Chronic pyelonephritis associated with vesicoureteral reflux. The scars are polar because they are associated with underlying blunted calyces at the poles.
When obstruction causes UTI, what must be treated to prevent recurrence?
The obstruction
Nephrolithiasis is categorized into 3 different groups by opacity. What are the 3 categories and what makes up the stones in each category?
- Radio-opaque (70% - most common)
- Calcium oxalate and phosphate
- Semiopaque (15-20%)
- Magnesium, ammonium, phosphate
- Not usually opaque
- Uric acid, cystine, other
What % of americans are effected by nephrolithiasis? Is it more common in males or females? What is the peak age incidence?
5-10%
Men more common than women
20-30 y/o
What factors predispose nephrolithiasis? (5)
- Hypercalcemia
- Increased uric acid
- Low pH
- Decreased volume
- Bactera
Where can you find kidney stones?
Tubules, calyces, renal pelvis, ureter, bladder
What are struvite stones?
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.
What is a staghorn calculus?
Big ass stone that’s filling up the renal pelvis and calyces.
These cannot be fixed. Can only transplant
What is hydronephrosis and hydroureter?
These are consequences of urinary tract obstruction
Hydronephrosis - enlarged calyces
Hydroureter - enlarged ureter
What are 5 consequences of urinary tract obstruction?
- Hydronephritis, hydroureter
- Infection
- Chronic obstructive pyelonephritis
- Renal Failure
- Hypertension
What are symptoms of lower tract infections? (8)
- Dysuria
- Frequency
- Hematuria
- Cloudy offensive urine
- Nocturia
- Suprapubic pain
- Strangury
- Urgency
What are symptoms of acute pyelonephritis? (5)
- Fever
- Malaise
- Nausea
- Vomiting
- Abdominal pain
What are symptoms of pyonephrosis or perinephritic abscess? (6)
- Rigors
- Loin pain
- Scoliosis
- Loin swelling
- Weight loss
- Night sweats
True or False: When children get UTIs, the symptoms can be nonspecific and just general irritability.
True
True or False: Chronic pyelonephritis is a common cause of ESRD
True
True or False: Chronic pyelonephritis is never asymptomatic
False.
It is usually asymptomatic.
However, it can also present with dysuria, flank pain, and hypertension
