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Renal / Urology > UTI + Pyelonephritis > Flashcards

UTI + Pyelonephritis Flashcards

1
Q

Infection of urethra, prostate, bladder, ureter, kidney, testes

A 
Urethritis
Prostatitis
Cystitis
Ureteritis = very rare
Pyelonephritis
Orchitis
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2
Q

What is an uncomplicated UTI

A

Sexually active female with normal renal structure

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3
Q

What is a complicated UTI

A

Abnormal tract e.g. catheter / obstruction / transplant
Co-morbid
Foreign body
Type of organism

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4
Q

What is the most common cause of UTI

A

E.coli

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5
Q

What are other causes

A

Usually gram -ve from vaginal / bowel
Pseudomonas
Klebsiella (enterococcus)
Proteus mirabilis

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6
Q

What is shown on USS with proteus

A

Staghorn calculi

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7
Q

What are gram +Ve causes

A

S. saphropgtticus
S.aureus
Usually due to haematogenous spread

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8
Q

What are common causes in hospital

A

Klebsiella
S.aureus
Pseudomonas

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9
Q

How is UTI transferred

A

Transurethral
Blood - schistosomiasis
Lymphatics

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10
Q

What are the symptoms of cystitis

A 
Dysuria
Frequency 
Urgency
Polyuria
Incontinence 
Smelly cloudy urine 
Loin / flank pain
Haematuria
Fever
Confusion - common in elderly 
Vomiting - common in children 
Stranguary
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11
Q

What are symptoms of prostatitis

A

Pain - rectum / sctrotum / penis / bladder
Fever
Malaise
Tender prostate PR
Prostate Sx - terminal dribbling / hesitation etc
Cystits Sx

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12
Q

How do children present

A 
Unexplained fever
Diarrhoea
N+V
Crying 
Off food
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13
Q

What should you always do in children

A

Follow up for VUJ reflux as risk of chronic pyelonephritis

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14
Q

What are RF for UTI

A 
Urine stasis
Obstruction 
Pushing bacteria up urethra
Predisposition to infection
Female
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15
Q

What are RF for prostatitis

A

Biopsy
Catheter
Recent UTI
Bladder instruments

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16
Q

What causes urine stasis

A

Obstruction
Dehydration
Spinal injury = loss of sensation
Pregnancy as increased relaxation

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17
Q

What causes obstruction + hydronephrosis

A 
Tumour
Calculi
Cyst
Trauma
BPH
Uterine prolapse
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18
Q

What are causes in children

A

Congenital VUJ
Duplex kidney
CAKUT

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19
Q

What causes bacteria to be pushed up

A 
Sex
Catheter = very common cause 
Fistula
Incontinence
Constipation
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20
Q

What predispose you to an infection

A 
DM
Steroids
Immunouppression
CKD - immune
Oestrogen insufficeicny
Repeated cystitis
Malnutrition
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21
Q

Why is female a RF

A 
Short urethra
Urethra close to rectum
Lack of prostatic secetion
Pregnancy
Post menopause
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22
Q

What causes recurrent UTI in old and young male

A 
Young= C+G
Old = coliform
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23
Q

What should you check in recurrent UTI in elderly male

A

Check emptying bladder properly - post void USS
Check kidney - USS
Check bladder malignancy - cystourehtroscopy

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24
Q

What should you always check for in UTI

A

Distended bladder / enlarged prostate

Do not rely on classic Sx in cancer

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25
Q

How do you investigate UTI

A

Dipstick if <3 Sx
MSSU
Blood if systemically unwell patient - FBC, U+E, CRP

26
Q

What level of MSSU suggests infection

A

10^5 but some bacteria pathological in low numbers

27
Q

What does dipstick show

A

Nitrite = most specific
Protein
Leucocyte - if only leucocyte present, do not treat for UTI unless clinical evidence
Haematuria

28
Q

What are further investigations

A 
Refer urology
Bladder USS
Bladder flow study
Isotope study 
Cystoscopy 
IVU / CT KUB
29
Q

What Ax are used to treat UTI

A

Trimethoprim
Nitrofurantoin
Always increase fluid

30
Q

If women with 3+ Sx, not pregnancy and no discharge

A

Treat

31
Q

If mild or 2+ symptoms

A

Do dipstick first

32
Q

What is advice if recurrent UTI

A

Fluid >2l
Void 2-3 hours
Void before bed and sex
Single dose Ax prophylaxis

33
Q

When would you do MSSU or further investigations

A 
Mild Sx
ALL MEN
ALL CHILDREN
Recurrent >3 
Failed Ax to find sensitivity 
Pregnant 
Suspected pyelonephritis
Unusual bacteria
34
Q

Why do you do MSSU in pregnancy

A

Dipstick not accurate

Want to screen for asymptomatic as risk of pyelonephritis and pre-term

35
Q

Do you treat +ve dip in elderly

A

No

Need Sx or culture result

36
Q

What are complications of UTI

A 
Acute retention
Recurrent UTI -> hydronephrosis
Renal failure 
Chronic pyelonephritis
Severe urosepsis 
Calculi formation = obstruction = more infection
37
Q

Do you treat catheter infection

A

Only if symptoms

38
Q

What is differential

A

PID

STI

39
Q

What are the risks of nitrofurantoin

A

Fibrosis long term

Haemolytic anaemia if in pregnancy 3rd trimester

40
Q

What causes sterile pyuria

A 
Ax use = most common
Renal TB
C+G
Calculi 
Malignancy 
Autoimmune - SLE 
Catheter
Pregnancy 
Appendicitis
Prostatitis
PCKD
41
Q

What should you ask if suspect renal TB

A

Fever
Malaise
Weight loss
Night sweats

42
Q

What can renal TB lead to

A

Intersitital nephritis

Renal amyloidosis

43
Q

What is sterile pyuria

A

Pus cells on microscopy

No organism cultured

44
Q

How do you Dx renal TB present

A

-ve culture
Mycobacteria clture
AAFB

45
Q

What causes acute pyelonephritis

A

Infection spreading up to kidney

  • E.coli = most common
  • Klebsiella
  • Enterococcus
  • Pseudomonas
46
Q

What are the symptoms of pyelonephritis

A 
Loin pain / tender + renal angle tenderness O/E
Fever
Rigors
Vomiting
Anorexia 
Haematuria 
Dehydration
Cystits - frequency, dysuria, 
Systemically unwel
47
Q

How do you Dx

A

Urine dip
MSSU
Blood culture
Renal USS

48
Q

How do you treat

A

Broad spec - co-amox 7-10 days
Refer to hospital if signs of sepsis
IV gent

49
Q

What are the risks of pyelonephritis

A

Sepsis
Renal abscess
Hameaturia if due to stone

50
Q

What causes chronic pyelonephritis

A

Reflux in children
Duplex
DM
Repeated UTI

51
Q

What happens in chronic

A

Scarring
Hypertension
Chronic infections
CKD

52
Q

How do you Dx

A 
Blood 
USS - scar 
Micturating cystogram - show reflux
CT - show scar
DMSA - scar
53
Q

What can scarring lead too

A

Proteinuria

54
Q

What do you do for urosepsis

A

SEPSIS 6
USS if not improving to look for abscess / stone
CT

55
Q

How do you treat

A

Gentamicin - covers gram -ve E.coli

56
Q

How do you treat pregnant women with UTI

A

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

57
Q

How long do you treat simple UTI

A

3 days

58
Q

How long if immunocompromised / abnormal kidney structure or function

A

5 days

59
Q

How long if catheter / pregnant / men

A

7 days

60
Q

What does UTI in pregnancy cause

A

Pyelonephritis
PPROM
Pre-term

61
Q

What puts you at higher risk of pyelonephritis

A

Female
Pregnant
Structural abnormality
DM

Renal / Urology (16 decks)

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