UTI + Pyelonephritis Flashcards
Infection of urethra, prostate, bladder, ureter, kidney, testes
Urethritis Prostatitis Cystitis Ureteritis = very rare Pyelonephritis Orchitis
What is an uncomplicated UTI
Sexually active female with normal renal structure
What is a complicated UTI
Abnormal tract e.g. catheter / obstruction / transplant
Co-morbid
Foreign body
Type of organism
What is the most common cause of UTI
E.coli
What are other causes
Usually gram -ve from vaginal / bowel
Pseudomonas
Klebsiella (enterococcus)
Proteus mirabilis
What is shown on USS with proteus
Staghorn calculi
What are gram +Ve causes
S. saphropgtticus
S.aureus
Usually due to haematogenous spread
What are common causes in hospital
Klebsiella
S.aureus
Pseudomonas
How is UTI transferred
Transurethral
Blood - schistosomiasis
Lymphatics
What are the symptoms of cystitis
Dysuria Frequency Urgency Polyuria Incontinence Smelly cloudy urine Loin / flank pain Haematuria Fever Confusion - common in elderly Vomiting - common in children Stranguary
What are symptoms of prostatitis
Pain - rectum / sctrotum / penis / bladder
Fever
Malaise
Tender prostate PR
Prostate Sx - terminal dribbling / hesitation etc
Cystits Sx
How do children present
Unexplained fever Diarrhoea N+V Crying Off food
What should you always do in children
Follow up for VUJ reflux as risk of chronic pyelonephritis
What are RF for UTI
Urine stasis Obstruction Pushing bacteria up urethra Predisposition to infection Female
What are RF for prostatitis
Biopsy
Catheter
Recent UTI
Bladder instruments
What causes urine stasis
Obstruction
Dehydration
Spinal injury = loss of sensation
Pregnancy as increased relaxation
What causes obstruction + hydronephrosis
Tumour Calculi Cyst Trauma BPH Uterine prolapse
What are causes in children
Congenital VUJ
Duplex kidney
CAKUT
What causes bacteria to be pushed up
Sex Catheter = very common cause Fistula Incontinence Constipation
What predispose you to an infection
DM Steroids Immunouppression CKD - immune Oestrogen insufficeicny Repeated cystitis Malnutrition
Why is female a RF
Short urethra Urethra close to rectum Lack of prostatic secetion Pregnancy Post menopause
What causes recurrent UTI in old and young male
Young= C+G Old = coliform
What should you check in recurrent UTI in elderly male
Check emptying bladder properly - post void USS
Check kidney - USS
Check bladder malignancy - cystourehtroscopy
What should you always check for in UTI
Distended bladder / enlarged prostate
Do not rely on classic Sx in cancer
How do you investigate UTI
Dipstick if <3 Sx
MSSU
Blood if systemically unwell patient - FBC, U+E, CRP
What level of MSSU suggests infection
10^5 but some bacteria pathological in low numbers
What does dipstick show
Nitrite = most specific
Protein
Leucocyte - if only leucocyte present, do not treat for UTI unless clinical evidence
Haematuria
What are further investigations
Refer urology Bladder USS Bladder flow study Isotope study Cystoscopy IVU / CT KUB
What Ax are used to treat UTI
Trimethoprim
Nitrofurantoin
Always increase fluid
If women with 3+ Sx, not pregnancy and no discharge
Treat
If mild or 2+ symptoms
Do dipstick first
What is advice if recurrent UTI
Fluid >2l
Void 2-3 hours
Void before bed and sex
Single dose Ax prophylaxis
When would you do MSSU or further investigations
Mild Sx ALL MEN ALL CHILDREN Recurrent >3 Failed Ax to find sensitivity Pregnant Suspected pyelonephritis Unusual bacteria
Why do you do MSSU in pregnancy
Dipstick not accurate
Want to screen for asymptomatic as risk of pyelonephritis and pre-term
Do you treat +ve dip in elderly
No
Need Sx or culture result
What are complications of UTI
Acute retention Recurrent UTI -> hydronephrosis Renal failure Chronic pyelonephritis Severe urosepsis Calculi formation = obstruction = more infection
Do you treat catheter infection
Only if symptoms
What is differential
PID
STI
What are the risks of nitrofurantoin
Fibrosis long term
Haemolytic anaemia if in pregnancy 3rd trimester
What causes sterile pyuria
Ax use = most common Renal TB C+G Calculi Malignancy Autoimmune - SLE Catheter Pregnancy Appendicitis Prostatitis PCKD
What should you ask if suspect renal TB
Fever
Malaise
Weight loss
Night sweats
What can renal TB lead to
Intersitital nephritis
Renal amyloidosis
What is sterile pyuria
Pus cells on microscopy
No organism cultured
How do you Dx renal TB present
-ve culture
Mycobacteria clture
AAFB
What causes acute pyelonephritis
Infection spreading up to kidney
- E.coli = most common
- Klebsiella
- Enterococcus
- Pseudomonas
What are the symptoms of pyelonephritis
Loin pain / tender + renal angle tenderness O/E Fever Rigors Vomiting Anorexia Haematuria Dehydration Cystits - frequency, dysuria, Systemically unwel
How do you Dx
Urine dip
MSSU
Blood culture
Renal USS
How do you treat
Broad spec - co-amox 7-10 days
Refer to hospital if signs of sepsis
IV gent
What are the risks of pyelonephritis
Sepsis
Renal abscess
Hameaturia if due to stone
What causes chronic pyelonephritis
Reflux in children
Duplex
DM
Repeated UTI
What happens in chronic
Scarring
Hypertension
Chronic infections
CKD
How do you Dx
Blood USS - scar Micturating cystogram - show reflux CT - show scar DMSA - scar
What can scarring lead too
Proteinuria
What do you do for urosepsis
SEPSIS 6
USS if not improving to look for abscess / stone
CT
How do you treat
Gentamicin - covers gram -ve E.coli
How do you treat pregnant women with UTI
7 days Ax
Send urine for culture and sensitive
Treat asymptomatic
Avoid nitrofurantoin near term as risk of haemolytic anaemia
Avoid trimethoprim in 1st trimester if taking other anti-folate drugs
How long do you treat simple UTI
3 days
How long if immunocompromised / abnormal kidney structure or function
5 days
How long if catheter / pregnant / men
7 days
What does UTI in pregnancy cause
Pyelonephritis
PPROM
Pre-term
What puts you at higher risk of pyelonephritis
Female
Pregnant
Structural abnormality
DM
