Urinary Tract Infections Flashcards
What are the investigations for a UTI?
Urine dipstick in women < age 65. Not used in men, women > 65 and catheterized patients.
When should a urine culture be sent?
In women > 65 years,
Recurrent UTIs (2 in 6m or 3 in 12 months)
Pregnant women,
Men,
Visible or non visible haematuria
What is the management of a UTI in non-pregnant women?
Trimethoprim or nitrofurantoin.
Send sample if >65 years old or has visible/non visible haematuria
What is the management of a UTI in a symptomatic pregnant woman?
First send urine culture.
First line = Nitrofurantoin (avoid near term)
Second line = amoxicillin or cefalexin
What is the management of a UTI in an asymptomatic pregnant woman?
Urine culture sent routinely at first antenatal visit because bacturia in pregnancy has high risk of developing into pyelonephritis.
Treat with nitrofurantoin, amoxicillin or cefalexin for 7 days
What is the management of a UTI in men?
Send urine culture.
First line = trimethoprim or nitrofurantoin for 7 days
What is the management of a UTI in catheterised patients?
Do not treat asymptomatic bacteruria.
If symptomatic then given 7 days of abx and consider changing catheter.
What is the management of acute pyelonephritis?
Non-pregnant women and men:
Oral 1st line = cefalexin or ciprofloxacin.
IV first line = Gentamicin
Pregnant women:
Oral 1st line = cefalexin
IV firstline = cefuroxime
What is the presentation of pyelonephritis?
Flank pain,
Costovertebral angle tenderness,
Myalgia (flu-like symptoms),
Presence of risk factors,
Nausea,
Vomiting,
Tachycardia,
Hypotension
What are some complications of pyelonephritis?
Renal failure,
Sepsis,
Renal abscess formation,
Emphysematous pyelonephritis,
Parenchymal renal scarring,
Recurrent UTIs
What is renal tubular acidosis associated with?
Hyperchloraemic metabolic acidosis (normal anion gap)
What is type 1 renal tubular acidosis?
Inability to secrete H+ in the distal tubule.
Complications = Hypokalaemia, high urine pH and renal stones
Can be genetic, SLE, Sjogren’s
What is type 2 renal tubular acidosis?
Decreased reabsorption of HCo3. Complications = hypokalaemia, high urine pH and osteomalacia.
Causes: fanconi syndrome (others: wilson’s disease)
What is type four renal tubular acidosis?
Occurs due to reduction in aldosterone which leads to reduced ammonia excretion.
Results in hyperkalaemia, high chloride and low urine pH.
caused by Addison’s disease, Spironolactone
What are the investigations for renal tubular acidosis?
ABG: Hyperchloraemic metabolic acidosis with normal anion gap.
U&Es: Low K+ in T1 and T2, high K+ in T4.
Urinalysis: Alkalotic urine in T1,2. Acidotic urine in T4
