UTI and Urolithiases Flashcards
What is a UTI?
Inflammatory response of urothelium from bacterial invasion (Normally bacteriuria or pyuria)
What are 3 main UTI causative organisms?
1) Uropathogenic strains of E.Coli
2) CN Staph
3) Proteus mirabilis
4) Klebsiella Pneumoniae
5) Enterococci
What is the general epidemiological trend of UTI’s?
More common in women from short urethra and proximity to the anus
What is the PP of UTI’s?
Urethral meatus colonised by organisms and ascend via transurethral route
What facilitates bacteria ascent into the urinary tract via the urethra and how does this become a problem?
1) Catheter
2) Sex
- Means can get into the bloodstream and systemically enter the body
What are the main virulence factors of bacteria to aid them in causing UTI’s?
1) Pili/Fimbrae adhesion to the urothelium
2) Acid polysaccharide coat resistant to phagocytosis
3) Toxins
4) Enzyme production e.g. urease
Define Pyuria
Presence of WBC (Leucocytes) in the urine
What are the main host defensive mechanisms against a UTI?
1) Urinary IgA
2) Commensal flora
3) Low urine pH
4) GAG layer
5) Antegrade flushing of urine and Tamm-horsfall protein
What are the UTI’s of the LUT?
1) Cystitis
2) Prostatitis
3) Epididymitis
4) Urethritis
What is the UTI of the UUT?
Pyelonephritis
What are the main investigations for a suspected UTI individual?
1) Take good history
2) Urinalysis (Dipstick except for Catheter!)
3) Microscopy: Culture and sensitivity of mid-stream urine
4) Renal imaging (Recurrent/Complicated)
How do you distinguish between a complicated and uncomplicated UTI?
Uncomplicated: Non-pregnant young women
Complicated: Abnormal UT, man, pregnancy, children and Immunocompromised
What is the first line treatment for an uncomplicated UTI?
Nitrofurantoin/Trimethoprim for at least 3 days (Increased fluid intake and regular voiding)
How does managing a complicated UTI differ?
-MCS MSU essential with a longer antibiotics reflective of the sensitivity of the individual
What is the definition and main causes of a recurrent UTI?
- > 2 episodes in 6/3 in 12 months
Re-infection, Unresolved infection or bacterial persistence
How are recurrent UTI’s managed?
1) Increased fluid intake
2) Regular voiding
3) Void pre and post intercourse
4) Abx prophylaxis
5) Vaginal oestrogen replacement
What pathogen is most commonly associated with the cause of UTI’s?
E. Coli
What is one of the most common causes of a UTI?
Catheter (15-20% of inpatients have one)
What is pyelonephritis?
Inflammation secondary to infection of renal parenchyma and soft tissues of the renal pelvis (Usually by UPEC)
What are the 3 main symptoms of pyelonephritis?
1) Loin pain
2) Fever
3) Pyuria (Can be dehydrated and have severe headache)
What are the main investigations you’d do with a pyelonephritic patient?
1) Urinalysis
2) MCS MSU
4) Bloods (WCC, CRP and ESR)
What is the general treatment for pyelonephritis?
IV fluids and antibiotics (Gentamicin or co-amoxiclav)
- Drain obstructed kidney, catheterise if necessary and use analgesics
What is the most likely cause of pyelonephritis in children?
Reflux
Structural/Functional abnormalities
What is the epidemiology of stones in the urinary tract?
10-15% Lifetime risk
males>Females (2:1)
30-50y/o
What are the main causes of stones in the UUT?
1) Genetic abnormalities
2) Dehydration
3) Infection
4) Hypercalciuria
5) Metastable urine (High amounts of products)
What is the PP of stone formation in the UUT?
Stones form from crystals in supersaturated urine
-80% are calcium based
(65% are Calcium oxalate)
What are the main symptoms of a UT stone?
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
What are the ways to help prevent urinary stones?
1) Reduce salt amount in diet
2) Overhydration
3) Healthy protein intake
4) Reduce BMI and increase activity
5) Deacidification of urine
What are the main investigations to see cause of renal colic?
1) Bloods (Urate, Calcium phosphate)
2) Urinalysis
3) MCS MSU
4) NCCT-KUB (Gold Standard)
What is the main treatment for renal colic?
1) Analgesia e.g. NSAIDs
2) Anti-emetics
3) Check for sepsis
How would treat someone with large ureteric stones?
1) Analgesia/anti-emetics
2) Observe for sepsis
3) PCNL
Where in the nephron do urinary stones normally form/
Collecting Ducts
What are the main treatment options for urinary stones?
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
Which anatomical parts are stones most likely to end up getting stuck in?
1) Ureteropelvic junction
2) Pelvic Junction
3) Vesoureteric junction
What CCB can be used to treat renal stones?
Nifedipine
