UTI Flashcards
2 major causes of chronis pyelonephritis
UTI obstruction
- obstruction + infxn = chronic pyelo
Vesicoureteral reflux
Most UTIs are confined to upper or lower GU tract?
Lower
- note that upper can be due to pyelonephritis
What is the most common route of infxn for UTI?
Ascending infxn from lower GI tract
- Gram - E. Coli (70%) from poo
- 30% proteus, pseudomonas, klebsiella
Hematogenous (blood) route of infxn
think:
- debilitated pts w/ immunodeficiency
- kidney injury
- Gram + bacteria, GAS
- Septicemia, endocarditis
Virulence factors that are uropathogenic
Bacterial adhesion: Pilio
“O” antigens: certain strains more resistant
Endotoxins (impairs flow)
“O” antigens
think . . .
Special virulence factor
gram -
O157: sugar on pili that attch to shit
E.coli
Errors in these mechanical factors can lead to pathogenesis
- bladder emptying
- ureteric peristalsis
- mucus
Why do females have a higher change of getting UTIs?
1 men: 5 women
- short urethra
- easier bacterial colonization
- urethral trauma (honeymoon cystitis)
- pregnancy
- instrumentation
Diverticulum
outpouching of hole (can induce decreased urine flow)
Lower UTI symptoms
dysuria frequency hematuria cloudy urine nocturia suprapubic pain urgency
(look for nonspecific symptoms in kids - they cant verbalize well)
staghorn calculi caused by which bacteria?
proteus (but it can happen w/o it too)
- triple stone
- occurs where minor calyces dump to major calyces and molds to its shape
UTI complications
recurrence
- Acute/ chronic pyelonephritis
- renal/perinephric abscess
- papillary necrosis (diabetes) “perfect storm”
- Staghorn calculi (proteus)
Stone composition
75% calcium phosphate
12% Mg ammonium phosphate
6% uric acid
other
Vesicoureteral reflux (VUR)
the ureter that drains into the bladder is not angled down, but rather perpendicular
- grades can differ with the wider the orifice
