UTI and Urolithiases

Question 1

What is a UTI?

Answer 1

Inflammatory response of urothelium from bacterial invasion (Normally bacteriuria or pyuria)

Question 2

What are 3 main UTI causative organisms?

Answer 2

1) Uropathogenic strains of E.Coli
2) CN Staph
3) Proteus mirabilis
4) Klebsiella Pneumoniae
5) Enterococci

Question 3

What is the general epidemiological trend of UTI’s?

Answer 3

More common in women from short urethra and proximity to the anus

Question 4

What is the PP of UTI’s?

Answer 4

Urethral meatus colonised by organisms and ascend via transurethral route

Question 5

What facilitates bacteria ascent into the urinary tract via the urethra and how does this become a problem?

Answer 5

1) Catheter
2) Sex
- Means can get into the bloodstream and systemically enter the body

Question 6

What are the main virulence factors of bacteria to aid them in causing UTI’s?

Answer 6

1) Pili/Fimbrae adhesion to the urothelium
2) Acid polysaccharide coat resistant to phagocytosis
3) Toxins
4) Enzyme production e.g. urease

Question 7

Define Pyuria

Answer 7

Presence of WBC (Leucocytes) in the urine

Question 8

What are the main host defensive mechanisms against a UTI?

Answer 8

1) Urinary IgA
2) Commensal flora
3) Low urine pH
4) GAG layer
5) Antegrade flushing of urine and Tamm-horsfall protein

Question 9

What are the UTI’s of the LUT?

Answer 9

1) Cystitis
2) Prostatitis
3) Epididymitis
4) Urethritis

Question 10

What is the UTI of the UUT?

Answer 10

Pyelonephritis

Question 11

What are the main investigations for a suspected UTI individual?

Answer 11

1) Take good history
2) Urinalysis (Dipstick except for Catheter!)
3) Microscopy: Culture and sensitivity of mid-stream urine
4) Renal imaging (Recurrent/Complicated)

Question 12

How do you distinguish between a complicated and uncomplicated UTI?

Answer 12

Uncomplicated: Non-pregnant young women
Complicated: Abnormal UT, man, pregnancy, children and Immunocompromised

Question 13

What is the first line treatment for an uncomplicated UTI?

Answer 13

Nitrofurantoin/Trimethoprim for at least 3 days (Increased fluid intake and regular voiding)

Question 14

How does managing a complicated UTI differ?

Answer 14

-MCS MSU essential with a longer antibiotics reflective of the sensitivity of the individual

Question 15

What is the definition and main causes of a recurrent UTI?

Answer 15

• > 2 episodes in 6/3 in 12 months

Re-infection, Unresolved infection or bacterial persistence

Question 16

How are recurrent UTI’s managed?

Answer 16

1) Increased fluid intake
2) Regular voiding
3) Void pre and post intercourse
4) Abx prophylaxis
5) Vaginal oestrogen replacement

Question 17

What pathogen is most commonly associated with the cause of UTI’s?

Answer 17

E. Coli

Question 18

What is one of the most common causes of a UTI?

Answer 18

Catheter (15-20% of inpatients have one)

Question 19

What is pyelonephritis?

Answer 19

Inflammation secondary to infection of renal parenchyma and soft tissues of the renal pelvis (Usually by UPEC)

Question 20

What are the 3 main symptoms of pyelonephritis?

Answer 20

1) Loin pain
2) Fever
3) Pyuria (Can be dehydrated and have severe headache)

Question 21

What are the main investigations you’d do with a pyelonephritic patient?

Answer 21

1) Urinalysis
2) MCS MSU
4) Bloods (WCC, CRP and ESR)

Question 22

What is the general treatment for pyelonephritis?

Answer 22

IV fluids and antibiotics (Gentamicin or co-amoxiclav)

- Drain obstructed kidney, catheterise if necessary and use analgesics

Question 23

What is the most likely cause of pyelonephritis in children?

Answer 23

Reflux

Structural/Functional abnormalities

Question 24

What is the epidemiology of stones in the urinary tract?

Answer 24

10-15% Lifetime risk
males>Females (2:1)
30-50y/o

Question 25

What are the main causes of stones in the UUT?

Answer 25

1) Genetic abnormalities
2) Dehydration
3) Infection
4) Hypercalciuria
5) Metastable urine (High amounts of products)

Question 26

What is the PP of stone formation in the UUT?

Answer 26

Stones form from crystals in supersaturated urine
-80% are calcium based
(65% are Calcium oxalate)

Question 27

What are the main symptoms of a UT stone?

Answer 27

1) Loin->Groin pain
2) Renal Colic (Blockage in UT causing recurring pain)
3) UTI symptoms e.g. urgency, dysuria, frequency
4) Recurrent UTI’s
5) Haematuria

Question 28

What are the ways to help prevent urinary stones?

Answer 28

1) Reduce salt amount in diet
2) Overhydration
3) Healthy protein intake
4) Reduce BMI and increase activity
5) Deacidification of urine

Question 29

What are the main investigations to see cause of renal colic?

Answer 29

1) Bloods (Urate, Calcium phosphate)
2) Urinalysis
3) MCS MSU
4) NCCT-KUB (Gold Standard)

Question 30

What is the main treatment for renal colic?

Answer 30

1) Analgesia e.g. NSAIDs
2) Anti-emetics
3) Check for sepsis

Question 31

How would treat someone with large ureteric stones?

Answer 31

1) Analgesia/anti-emetics
2) Observe for sepsis
3) PCNL

Question 32

Where in the nephron do urinary stones normally form/

Answer 32

Collecting Ducts

Question 33

What are the main treatment options for urinary stones?

Answer 33

1) Conservative
2) Medical e.g. nifedipine
3) Lithotripsy - Fragments of stone spontaneously pass
4) Surgical e.g. PCNL for larger stones or a nephrectomy

Question 34

Which anatomical parts are stones most likely to end up getting stuck in?

Answer 34

1) Ureteropelvic junction
2) Pelvic Junction
3) Vesoureteric junction

Question 35

What CCB can be used to treat renal stones?

Answer 35

Nifedipine