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FA17 Nephrology > UTI & Pyelonephritis > Flashcards

UTI & Pyelonephritis Flashcards

1
Q

uncomplicated UTI

A

UTI

no structural or functional abnormalities

no comorbidities

not associated with GU tract instrumentation

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2
Q

patients with uncomplicated UTI

A

young

healthy

non-pregnant women

normal anatomic and functioning urinary tract

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3
Q

why are women more susceptible to UTI

A

shorter urethrae for uropathogenic bacteria to ascend

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4
Q

diagnostic criterion for UTI

A

bacterial colony count 10^5 CFU/mL

obtained via urine C and S

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5
Q

complicated UTI

A

UTI in patients with functional or structural abnormalities

infection in presence of comorbidities (renal dz, pregnant, DM)

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6
Q

risk factors for complicated UTI

anatomy

A

cystocele
rectocele
prostate hypertrophy
pregnancy (uterine enlargement)

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7
Q

risk factors for complicated UTI

A

nursing home/catheter

neonate

comorbid or neurologic diseases

atypical pathogen exposure

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8
Q

clinical features of complicated UTI

A

may vary or be absent

fever, pain, systemic inflammation may be absent

typically: weakness, malaise, AMS, abdominal pain

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9
Q

organisms of complicated UTI

A

more likely to be infected with resistant organisms

management of pts is same as pylo

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10
Q

MC pathogen for UTI

A

e.coli (>80%)

can adhere to wall and ascend via pili

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11
Q

increased risk for UTI

A

incomplete bladder emptying

post menopausal

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12
Q

incomplete bladder emptying and UTI

A

disrupt bladder’s ability to eradicate bacteria from mucosal surface

increased susceptibility to infection

esp. found in its with neurogenic bladders, prolapsed uterus, BPH

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13
Q

postmenopausal women and UTI

A

decreased estrogen

encourages transition from lactobacillus to e.coli colonization

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14
Q

asymptomatic bacteriuria

A

10^5 CFU in 2 successive cultures without symptoms

found mc in patients with catheters, also in females of nursing homes, males, pregnant women

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15
Q

who gets treatment of asymptomatic bacteriuria

A

recommended ONLY in pregnancy

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16
Q

acute cystitis

A

UTI isolated to bladder

acutely symptomatic w/ >10^5 CFU

otherwise healthy, w/o coexisting pyelo, non pregnant females, no obstruction

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17
Q

clinical features of cystitis

A 
frequency 
urgency 
suprabuic pain 
hesitancy 
visible hematuria

no fever

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18
Q

nature and severity of symptoms are determined by

A

etiology or organisms

portions of urinary tract involved

patients ability to mount immune and inflammatory response

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19
Q

history of vaginal discharge or irritation is associated with

A

vaginitis
cervicitis
pID

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20
Q

pyelonephritis

A

infection of upper urinary tract, involving renal parenchyma

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21
Q

presentation of pyelonephritis

A

subtle, difficulté to distinguish

FLANK PAIN 
voiding irritation
FEVER (systemic illness) 
tachycarida 
n/v
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22
Q

complications of pyelonephritis

A

missed diagnosis could lead to deterioration or urosepsis

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23
Q

pyelonephritis can progress into three patterns of renal infections:

A
  1. acute bacterial nephritis
  2. renal abscess
  3. emphysematous pyelo

order imaging if response to tx is inadequate

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24
Q

urosepsis

A

may or may not exhibit symptoms of UTI

fever or hypothermia
rising HR
elevated respiratory rate
leukocytosis

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25
Q

severe urosepsis symptoms

A 
HoTN 
organ dysfunciton 
hypoperfusion 
oliguria 
AMS
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26
Q

two methods of collecting a urine sample

A

clean catch

catheterization

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27
Q

diagnosis of UTI based on history

A

can be made with moderate probability if pt has dysuria, frequency and urgency

false positive rate is 43%

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28
Q

clean catch

A

midstream voiding

avoid collection of initial or last voided

29
Q

catheterization indicated

A

can’t void spontaneously
too ill
immobilized
extremely obese

only do in these patients bc can cause UTI with cath

30
Q

storage of urine

A

should be tested immediately or refrigerated to avoid colonization within the specimen

31
Q

urine dipstick

A

preformed on fresh uncentrifuged urine

quick and easy

32
Q

positive urine dipstick

A

nitrate or leukocyte esterase

supports diagnosis of UTI (negative test result doesn’t exclude it)

75% sensitive and 60% specific - negative result doesn’t exclude diagnosis bc it can’t detect acinetobacter, enterococcus, peudomonas, staph

33
Q

`leukocyte esterase

A

enzyme released by leukocytes

reflects pyuria

34
Q

nitrite

A

positivity nitrite indicates presence of enter-bacteria

35
Q

what can cause false positive in urine dipstick

A

substances that turn urine red

i.e. Pyridium or ingestion of beets

36
Q

urine WBC count values

A

pyuria

<5 suggests alternative diagnosis

> 5 in symptomatic patient indicates + test

37
Q

problems with UA

A

false positive can occur when vaginal or fecal contamination present

can’t detect chlamydia infection

contamination of sample must be considered if evidence of squamous cells on UA

38
Q

diagnostic accuracy is improved with

A

history + dipstick + UA

39
Q

urine culture not on who?

A

patient with typical symptoms of cystitis or uncomplicated UTI and positive findings on UA

pyuria on microscopic exam, postive leukocyte esterase or urine nitrite

majority of these respond to empiric therapy

40
Q

indications for urine culture

A 
complicated UTI 
pregnant women 
adult male 
relapse or reinfection 
septic pts
41
Q

blood culture

A

indication in patients with suspected clinical sepsis

don’t typically alter management

42
Q

imaging UTI

A

NOT typically done

done on male, elderly, diabetic, severely ill pts with pyelo if there is suspect of renal stone or non responsive to initial therapy

43
Q

kidney US in UTI

A

evaluate for obstruction and focal parenchymal abnormalities

44
Q

CT scan UTI

A

kidney stonesempysematous pyelonephritis

45
Q

plain film radiography

A

used to track kidney stones thru urinary tract

46
Q

uncomplicated UTI treatment

A

nitrofurantoin (Macrobid)
TMP-SMX (Bactrim)

5 days, no culture req.

47
Q

complicated UTI treatment, pyelonephritis

A

cipro, levaquin

urine culture recommended

7 day tx or 14 days for recurrent or pyelonephritis

48
Q

hospitalized UTI treatment

A

ceftriaxone/Rocephin IV

49
Q

complicated UTI treatment, pyelonephritis susceptible by C and S

A 
TMP SMX (Bactrim) 
Augmentin
50
Q

urethritis tx

A

ceftriaxone/rocephin IM
azithromycin (Zithromax) OR Doxy(vibramycin)

culture psotivie for Chlamydia or Gonorrhea

51
Q

outpatient follow up for whom?

A

healthy females tolerating fluids and meds

85% discharged

return to ED if: increased pain, fever, vomiting

52
Q

adjunctive therapies at discharge

A

increased fluid intake and frequent voiding

bladder anesthetic agents (Pyridium)

post coital voiding

cranberry juice

wipe front to back

53
Q

admission criteria UTI + adjunct tx

A

unable to retain fluids/meds
patients with signs of urosepsis
concomitant kidney stone
failed outpatient therapy

systemic analgesics and antiemetics PRN for pyelo patients

ALL PATIENTS GET IV MEDS

54
Q

chronic cath patients and asymptomatic UTI

A

almost universal

screening is not indicated

antibiotic tx of asymptomatic patients does not affect outcome - therefore rarely treat

may be protective

55
Q

when is screening recommended for asymptomatic UTI

A

pregnancy

prior urological procedures

56
Q

prevention of catheter associated UTI

A

avoidance of unnecessary cath

use of sterile technique

removal of cath ASAP

57
Q

why must we treat UTI in pregnant women

A

acute pyelo can precpiatet preterm labor, bcaterimia and septic shock

58
Q

screening for UTI in pregnancy

A

once a week for 12 weeks

week 16 do urine C and S

59
Q

treatment of asymptomatic UTI in pregnant pos

A

nitrofurantoin (microbic) 100 mg PO x 10 days

cephalexain (keflex) 500 mg PO bid x 10 days

60
Q

ABX not to use on pregnant patients

A

Bactrim
Fluroquinolones
Tetracycline

61
Q

tx of pyelonephritis in pregnant patient

A

hospitalize, hydrate, Rocephin/Ceftriaxone

continue until afebrile 48hrs and flank pain resolved

switch to oral therapy 10-14 days and discharge

62
Q

UTI in HIV/AIDS

A

patients are resistant to TMP-SMX so give fluoroquinolone upon initial treatment unless urine culture indicates something else

63
Q

pediatric UTI

A

most common serious bacterial infection

possible in all children

very common but children don’t show similar symptoms

64
Q

gross hematuria

A

1 mL of whole blood/L of urine

visible to naked eye

65
Q

microscopic hematuria

A

not visible

> 3 RBS/HPF

66
Q

pathophysiology of hematuria

A

any process that results in infection, inflammation or injury to GU tract can cause

painless after 50 yrs of age increased risk of renal, prostate, bladder CA

67
Q

uroepithelial cancer risk factors

A 
>50 y/o
male 
smoking 
family history of bladder CA 
occupational exposures in chemical, rubber, leather industry
68
Q

common causes of hematuria

A

UTI (MC)

kidney stone

neoplasm

trauma

glomerulonephritis

anticoagulation side effect

FA17 Nephrology (13 decks)

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