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RENAL PATHOLOGY > UTI booklet > Flashcards

UTI booklet Flashcards

1
Q

What are the classical symptoms of UTI?

A 
Dysuria
Frequency of urination
Suprapubic tenderness
Urgency
Polyuria 
Haematuria
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2
Q

What is cystitis?

A

Inflammation of bladder

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3
Q

What is bacterinuria?

A

Presence of bacteria in urine (not associated with micturition)

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4
Q

What is pyuria?

A

Presence of significant quantities of pus (neutrophil polymorphs) in the urine

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5
Q

Pyuria suggests what?

A

Inflammatory response - supports UTI

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6
Q

What is sterile pyuria?

A

Significant pus cells with a negative culture

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7
Q

What is chronic pyelonephritis?

A

Renal scarring - potential loss of renal function

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8
Q

What non-infective factors can lead to chronic pyelonephritis?

A

Diabetes
Vesico-ureteric reflux
Urinary obstruction

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9
Q

How does UTI typically present in women?

A 
Dysuria
Frequency
Urgency 
Suprapubic pain
Polyuria 
Haematuria
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10
Q

The criteria suggests which female possible UTI patients should be given antibiotics?

A

3 or more symptoms OR severe symptoms

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11
Q

When should a middle-stream urine test be used on a patient?

A

Mild or 1, 2 symptoms

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12
Q

How can you assist the patient in providing a clean specimen?

A

Washing/swabbing with sterile saline

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13
Q

When should the urine be tested by dipstick?

A

When cloudy

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14
Q

What contents in urine suggest UTI?

A

Nitrites
Protein
Leucocytes

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15
Q

Why can UTIs cause nitrites in the urine?

A

Nitrites are a metabolic product of some bacteria

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16
Q

Why can UTIs cause proteins in the urine?

A

Proteins are a sign of inflammation or renal pathology

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17
Q

Why can UTIs cause leucocytes in the urine?

A

Marker of an inflammatory response

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18
Q

If the patient is positive only for leucocyte esterase, how do you proceed?

A

Urine culture

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19
Q

When should blood/protein in urine be investigated further?

A

When the dipstick is negative for leucocytes and nitrites

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20
Q

Why does the risk of UTI increase with age in men?

A

Increased likelihood of prostatic hypertrophy

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21
Q

Recurrent UTI in men is often a sign of what?

A

Prostatitis

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22
Q

Prostatitis is typically due to what in older men?

A

Coliform organisms

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23
Q

Prostatitis is typically due to what in younger men?

A

Chlamydia trachomatis

Neisseria gonorrhoeae

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24
Q

Bacterial infection of the upper tract is most common in which group?

A

Women of child bearing age

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25
Q

What is the typical presentation of Acute Pyelonephritis?

A

Loin pain
Fever
Urinary symptoms: Frequency, dysuria

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26
Q

What is a severe complication of severe acute pyelonephritis?

A

Bacteraemia

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27
Q

What are the signs of sepsis?

A

Rigors

Nausea and vomiting

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28
Q

How should suspected pyelonephritis be managed?

A

Urine culture
Immediate antibiotics - review when organisms known
Extended for 7 days

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29
Q

How should recurrent acute pyelonephritis be investigated?

A

Urinary tract investigation for abnormalities/calculi

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30
Q

What is the risk of bacteriuria in patients with indwelling catheters?

A

5% per day - cumulative

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31
Q

When should patients with indwelling catheters be investigated?

A

Only when they show SYMPTOMS/SIGNS of UTI

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32
Q

How does the incidence of asymptomatic bacteriuria vary with age?

A

Incidence increases with age

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33
Q

When should patients with asymptomatic bacteriuria be treated?

A

Pregnancy
Urological surgery
Surgery involving artificial prosthesis implantation

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34
Q

Asymptomatic bacteriuria is associated with what?

A

Pyelonephritis

Premature delivery

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35
Q

What would cause pyuria in the absence of a positive culture?

A

Undeclared presence of antibiotic in sample
Renal tuberculosis
Chlamydia

36
Q

What is recurrent sterile pyuria a sign of?

A

Renal tract stone
Interstitial Cystitis
Urological malignancy
Chronic prostatitis

37
Q

How do you test for renal tuberculosis?

A

3x morning urine
ZN stain
TB culture

38
Q

Untreated vesico-ureteral reflux can lead to what?

A

Renal scarring

39
Q

Most cases of chronic pyelonephritis in adult life are a result from what?

A

Damage done during childhood

40
Q

How do patients with chronic pyelonephritis present?

A

Vague abdominal discomfort
Hypertension
Sterile pyuria

41
Q

How does chronic pyelonephritis present radiologically?

A

Clubbing of calyces

Scarring of cortices

42
Q

If ureters appear dilated in a renal radiogram, how do you proceed?

A

Micturating Cystogram

43
Q

How is vesicoureteric reflux diagnosed?

A

Micturating cystogram

44
Q

Which factors predispose people to developing UTIs?

A 
Females - short urethra, sex, pregnancy, childbirth
Anatomical abnormalities
Renal cysts
Pre-existing parenchymal damage
Stones
Immunosuppresion
Instrumentation
Foreign body
45
Q

How does pregnancy increase a womans risk of UTI?

A

Progesterone dilates ureters

Physical pressure from foetus

46
Q

What is an uncomplicated UTI?

A

UTIs in healthy, sexually active women

47
Q

What are complicated UTIs?

A

UTIs in children, men, patients with abnormal renal tracts, immunosuppression, foreign bodies, retention

48
Q

What are the typical causes of uncomplicated UTIs?

A

E. coli
Skin commensals:
Staph. saprophyticus

49
Q

How are complicated UTIs different?

A

Require additional investigations
Upper renal tract assessment
Urinary flow studies
(find a cause)

50
Q

When should cultures be taken in suspected UTIs?

A 
Women with inconclusive dipstick test
Suspected UTI in men/children
Suspected pyelonephritis
Pregnant women 
After failed antibiotics
Recurrent UTI
51
Q

How are recurrent UTIs defined?

A

> 2 UTIs 6 months
OR
3 UTIs 1 year

52
Q

How is mid-stream urine taken?

A

Discard first 10-20mls
Ideally in morning
Boric acid containers

53
Q

How are catheter specimens taken?

A

Catheter sampling port

NOT from bag

54
Q

How is urine collected from children?

A

Clean catch urine sample

55
Q

How should urine be collected from children if clean catch is not possible?

A

Non-invasive:
Collection pads (high false -ve)
If fails:
Suprapubic aspiration

56
Q

How are urine culture results expressed?

A

Organisms/ml

57
Q

What is the most common organism responsible for UTI?

A

E. coli

58
Q

What are the less common species responsible for UTI?

A 
Proteus sp.
Enterococcus faecalis
Klebsiella sp.
Pseudomonas sp.
Staph. saprophyticus
59
Q

How do UTI pathogens differ in community vs hospital acquired pneumonia?

A

E. coli less common in hospital

‘Uncommon’ pathogens more common in hospital

60
Q

What causes E. coli to be good at causing UTI?

A

Presence of P fimbriae - adhere to uroepithelium

61
Q

Staph. saprophyticus is what type of bacterium?

A

Coagulase negative

62
Q

What causes Proteus spp. to be good at causing UTI?

A

Produces enzyme Urease
Urease causes urea -> ammonia
Makes urine alkali
Encourages Stone formation

63
Q

Staph. saprophyticus is a more common UTI pathogen in which groups?

A

Sexually active women

64
Q

Which pathogens are more common in hospital patients?

A

‘uncommon’

Proteus, Klebsiella, Pseudomonas

65
Q

‘uncommon’ pathogens in UTI are associated with what?

A

Indwelling catheters/instrumentation

66
Q

How do ‘uncommon’ pathogens differ from E.coli?

A

More antibiotic resistant

esp. Pseudomonas spp

67
Q

Stones in the urinary tract are associated with which species?

A

Proteus sp

Klebsiella

68
Q

Proteus and Klebsiella should always be managed how?

A

(UTI Rx)

Upper renal tract imaging to exclude stones

69
Q

When is the ‘10^5 rule’ used?

A

Asymptomatic patients

70
Q

What concentration of pus cells is defined as significant pyuria?

A

> 10 WBC/mm3

71
Q

What lab tests are performed on urine tests?

A

Culture

Microscopy

72
Q

What must be determined before antibiotic therapy is given for UTI?

A

Distinguish whether the patient has cystitis or acute pyelonephritis?

73
Q

How is suspected lower UTI in women treated? (simple cystitis)

A

Cheap/simple antibiotic
3 day course
Trimethoprim
Nitrofurantoin

74
Q

When is trimethoprim contraindicated?

A

Pregnancy

75
Q

Which pathogen is resistant to Nitrofurantoin?

A

Proteus spp

76
Q

How should patients who do not respond to a 3 day simple cystitis Rx be managed?

A

Take urine cultures

77
Q

How should suspected lower UTI in men be treated?

A

14 days Quinolone (covers prostatitis)

7 days Nitrofurantoin/Trimethoprim

78
Q

How should UTI in pregnancy be treated?

A 
7 days therapy 
Sensitivity testing
Pregnant women: 
 - Ciprofloxacin 
 - Cephalexin
79
Q

How should catheter related UTI be treated?

A

Symptomatic Pts only
Change catheter
Antibiotics

80
Q

How should asymptomatic bacteriuria be treated?

A

No treatment unless:
Pregnancy
Planned urinary tract surgery

81
Q

How should recurrent UTI be managed?

A

Careful history - hygiene, fluids after sex
Gynae examination
Long term antibiotic prophylaxis
One dose antibiotic after sex

82
Q

What is the long term antibiotic prophylaxis recommended for recurrent UTI?

A

1 tablet/night up to a year
Nitrofurantoin
Trimethoprim

83
Q

What is the management of acute pyelonephritis?

A

7 day therapy
Sensitivity testing
Review after urine cultures and sensitivity testing
Check resolution with sample after 1 week

84
Q

When should you suspect bacteraemia in acute pyelonephritis?

A

Vomiting

85
Q

When should acute pyelonephritis be managed?

A

Single episode in men

Repeat episodes in women

RENAL PATHOLOGY (16 decks)

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