urinary tract infections (UTI) Flashcards
when is asymptomatic bacteria considered normal ?
considered normal in the >65 year old age group
what is the function of bacterial biofilms ?
urogenital cells are covered by dense bacterial biofilms which lactobacilli predominate, preventing pathogens from attaching and forming adhesions onto epithelial cells
what factors affect and influence the composition of the biofilms ?
estrogen levels oral contraception glycogen content and vaginal pH steroid therapy Diseases (e.g DM)
are UTIs more common in makes or females and why ?
more common in women because of the shorter urethra
what are the factors that increase the incidence of UTIs?
sexual intercourse use of spermicides increased incidence in postmenopausal women abnormal renal tracts (anatomically) urinary catheters in situ
what are the routes of infection for UTIs?
ascending in females ( colonized bacteria)
haematogenous routes
what are the factors influencing UTI in npathogenesis ?
virulence of the bacteria
host defense system
what are organisms that are commonly associated with UTI’s?
E.coli
enterococci
Group b streptococcus
Candida albicans
what is the clinical presentation of the UTI if the kidneys are affected ?
acute pyelonephritis is associated with upper back and side pain
high fever
shaking and chills
nausea and vomiting
what is the clinical presentation if the bladder is affected in UTIs?
with cystitis there is - pelvic pressure lower abdomen pressure frequent and painful urination blood in urine
what is the clinical presentation if the urethra is affected ?
with urethritis -
burning with urination
discharge
when do we consider an uncomplicated UTI ?
cystitis or pyelonephritis that occurs in premenopausal women with no functional or structural abnormalities of the urinary tract , who are not pregnant and no
significant comorbidities
when do we consider a complicated UTI ?
when the patient is :
-a child or is pregnant
-if the patient has any of the following:
.structural or functional abnormality
.comorbidity increasing the risk of acquired infection
.recent instrumentation
what are the diseases of renal interstitial tissue broadly divided into ?
- non specific suppurative inflammation
2. specific infectionss
what are the non specific suppurative inflammation
pyelonephritis
pyonephrosis
pyemic abscess
what are the routes of infections of pyelonephritis ?
hematogenous
ascending infection
what is the most common causative organism causing heamtogenous pyelonephritis ?
E coli
how can heamtogenous pyelonephritis spread
from septicemia
infective endocarditiss
how can ascending infection pyelonephritis be caused ?
intra renal reflux
incompetence of the vesico ureter valve
colonization of the distal urethra
what is the morphology of acute pyelonephritis ?
tubular necrosis
patchy interstitial suppurative inflammation
what are the complications of acute pyelonephritis ?
pyelonephrosis
papillary necrosis
perinephric abscess
chronic pyelonephritis
what is the clinical course of acute pyelonephritis ?
- pain at renal angle
- systemic evidence of inflammation
- pyuria and bacteriuria
- dysuria
what is chronic pyelonephritis grossly characterized by ?
grossly: visible scarring and deformity of the pelvicalcyeal systemm
what is chronic pyelonephritis morphologically characterised by ?
interstitial inflammation and parenchymal scars
what are the types of chromic pyelonephritis ?
chronic obstructivee
chronic reflux
what are the nature of the scars in chronic reflux associated pyelonephritis ?
the scars are polar
what os the arbitrary cut off value for significant bacteruria ?
> 105 colony forming
what bacteria are more commonly spread hematogenoulsy causing a UTI ?
s. aureus
TB
what is the pathway in which UTIs cann cause AKI ?
colonizationn uroepithelium penetration ascension pyelonephritis acute kidney injury
what is an example of a specific infection of the renal interstitial tissues ?
TB
what are the presence of colloid casts evidence of ?
tubular damage
