Urinary Tract Infections

Question 1

What are the types of urinary tract infections?

Answer 1

Kidney - acute and chronic pyelonephritis
Bladder - Cystitis
Urethra - Urethritis
Prostate - prostatitis
Epididymis/ Testis - edidymo-orchitis

Question 2

Explain the incidence of UTIs

Answer 2

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

Question 3

What are some general predisposing factors for UTIs or another infection?

Answer 3

Immunosuppression, steroids, malnutrition and diabetes

Question 4

What are some predisposing factors specific to the urinary tract?

Answer 4

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

Question 5

Describe the pathogenesis of UTIs

Answer 5

Usually bowel organisms - E. coli, Proteus, Klebsiella and enterococcus
Transfer - transurethral route (perurethral area contaminated, urethra to bladder and bladder)
Blood stream
Lymphatics

Question 6

What are the 2 categories of UTIs?

Answer 6

Complicated and Uncompleted

Question 7

What are the clinical features of a UTI in children?

Answer 7

Diarrhoea, excessive crying, fever, nausea and vomiting, and not eating

Question 8

What are the clinical features of a UTI in adults?

Answer 8

Flank pain, dysuria (like passing broken glass), cloudy offensive urine, urgency, chills, strangury (feel like still needing to go after voiding), and confusion

Question 9

What is dysuria?

Answer 9

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

Question 10

What are the clinical features of acute pyelonephritis?

Answer 10

Pyrexia, poor localisation, loin tenderness, signs of dehydration and turbid urine

Question 11

What does acute pyelonephritis look like on biopsy?

Answer 11

Renal tissue shows a dilated tubule with neutrophils enmeshed in proteinaceous debris with adjacent interstitial damage

Question 12

What investigations are used?

Answer 12

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

Question 13

What investigation are used in children, men or when UTIs are frequent?

Answer 13

US or IVU (IV urography) may be helpful
Isotope studies to rule out reflux and scarring

Question 14

What are the principles of management for UTIs?

Answer 14

Identify infecting organism and institute appropriate treatment
Identify predisposing factors and treat if possible

Question 15

What is the treatment for UTIs?

Answer 15

Fluids
Antibiotics - amoxicillin (3-5 day course), cephalosporin or trimethoprim
Severe infections - IV antibiotics

Question 16

What can lead to an abnormal urinary tract?

Answer 16

Anatomical/ neurological abnormalities
Stones
Diabetes
All cause infections and sometimes lead to renal impairment

Question 17

Describe reflux nephropathy

Answer 17

UTIs in children
Damage is caused by reflux and infection
Micturating cystogram
Assess progression by US and biochemistry
Surgery

Question 18

What can help avoid recurrent infections?

Answer 18

Fluid intake of 2l/day, void every 2-3hrs a day, void before bedtime and after intercourse, and avoid constipation

Question 19

Describe indwelling urinary catheters

Answer 19

Aseptic technique
Catheter in bladder for longer period of time
Colonisation is inevitable
Antibiotics only if patient is symptomatic and replace catheter

Question 20

Describe asymptomatic bacteriuria

Answer 20

> 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

Question 21

Describe chronic pyelonephritis

Answer 21

Radiological diagnosis, scarring and clubbing seen, hypertension and 15% lead to renal failure

Question 22

What is emphysematous pyelonephritis?

Answer 22

Formation of gas in kidneys or around
If left untreated then can lead to fulminant sepsis and high mortality rates

Question 23

What is the treatment for Gonorrhoea?

Answer 23

Ceftriaxone