Urinary Tract Infections Flashcards
What are the types of urinary tract infections?
Kidney - acute and chronic pyelonephritis
Bladder - Cystitis
Urethra - Urethritis
Prostate - prostatitis
Epididymis/ Testis - edidymo-orchitis
Explain the incidence of UTIs
Common, 3:1 females to males, in adults is a rare cause of CRF but more important cause in children
Cystitis in young sexually active women is 0.5 per year
What are some general predisposing factors for UTIs or another infection?
Immunosuppression, steroids, malnutrition and diabetes
What are some predisposing factors specific to the urinary tract?
Female sex (shorter urethra), sexual intercourse and poor voiding habits, congenital abnormalities, stasis of urine, foreign bodies (catheters and stones), oestrogen deficiency and fistula between bowel and bladder
Describe the pathogenesis of UTIs
Usually bowel organisms - E. coli, Proteus, Klebsiella and enterococcus
Transfer - transurethral route (perurethral area contaminated, urethra to bladder and bladder)
Blood stream
Lymphatics
What are the 2 categories of UTIs?
Complicated and Uncompleted
What are the clinical features of a UTI in children?
Diarrhoea, excessive crying, fever, nausea and vomiting, and not eating
What are the clinical features of a UTI in adults?
Flank pain, dysuria (like passing broken glass), cloudy offensive urine, urgency, chills, strangury (feel like still needing to go after voiding), and confusion
What is dysuria?
Pain occurring from urination and is associated with urinary frequency and urgency
If pain at start of urination then urethra pathology but if at end then more bladder pathology
What are the clinical features of acute pyelonephritis?
Pyrexia, poor localisation, loin tenderness, signs of dehydration and turbid urine
What does acute pyelonephritis look like on biopsy?
Renal tissue shows a dilated tubule with neutrophils enmeshed in proteinaceous debris with adjacent interstitial damage
What investigations are used?
Mid stream sample of urine
Urinalysis in ward - blood, leucocytes, protein and nitrites
Microbiology in lab - microscopy and gram staining, bacteriuria > 10^5 CFU/ml
What investigation are used in children, men or when UTIs are frequent?
US or IVU (IV urography) may be helpful
Isotope studies to rule out reflux and scarring
What are the principles of management for UTIs?
Identify infecting organism and institute appropriate treatment
Identify predisposing factors and treat if possible
What is the treatment for UTIs?
Fluids
Antibiotics - amoxicillin (3-5 day course), cephalosporin or trimethoprim
Severe infections - IV antibiotics
What can lead to an abnormal urinary tract?
Anatomical/ neurological abnormalities
Stones
Diabetes
All cause infections and sometimes lead to renal impairment
Describe reflux nephropathy
UTIs in children
Damage is caused by reflux and infection
Micturating cystogram
Assess progression by US and biochemistry
Surgery
What can help avoid recurrent infections?
Fluid intake of 2l/day, void every 2-3hrs a day, void before bedtime and after intercourse, and avoid constipation
Describe indwelling urinary catheters
Aseptic technique
Catheter in bladder for longer period of time
Colonisation is inevitable
Antibiotics only if patient is symptomatic and replace catheter
Describe asymptomatic bacteriuria
> 10^5 CFU per ml of urine
Does not need treatment if catheter related
Should be treated in pregnant women as 30% progress to symptomatic illness
Describe chronic pyelonephritis
Radiological diagnosis, scarring and clubbing seen, hypertension and 15% lead to renal failure
What is emphysematous pyelonephritis?
Formation of gas in kidneys or around
If left untreated then can lead to fulminant sepsis and high mortality rates
What is the treatment for Gonorrhoea?
Ceftriaxone
