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Renal > UTI's > Flashcards

UTI's Flashcards

1
Q

What is a UTI

A

Presence of microorganisms in the urinary tract causing inflammation such as cystitis, urethritis and prostatitis and upper causing pyelonephritis .

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2
Q

Why are UTI’S more common in women

A

Women have a shorter urethra thus bacteria has a shorter distance to travel to.

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3
Q

Methods of transmission

A

Faeces- when wiping
Sex
Incontinence
Poor hygiene
Urinary catheters

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4
Q

Most common microorganisms to cause a UTI

A

KEEPS

Klebsiella
E coli
Enterococci
Proteus
Staphylcoccus coagulase negative

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5
Q

key diagnostic factors of UTI

A

Dysuria (pain, stinging or burning when passing urine
New nocturia
Cloudy or foul smelling urine
risk factors

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6
Q

What is FUNDS

A

Frequency
Urgency
Nocturia
Dysuria

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7
Q

Other diagnostic factors for UTI

A

-Urgency
-Visible haematuria
- frequency
- suprapubic pain or tenderness

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8
Q

What symptoms would a patient have that would make you suspect pyelonephritis

A

Fever
Loin/back pain
Nausea/vomiting
Renal angle tenderness on examination
headache
Triad - loin pain, fever, pyuria

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9
Q

Presence of nitrates on urine dipstick would indicate

A

UTI- with gram -ve bacteria such as ecoli

E coli breaks down nitrates a normal waste product

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10
Q

Leukocytes in urine dipstick test would indicate

A

Infection or inflammation
presence of leukocyte esterase

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11
Q

What is microscopic haematuria

A

blood on dipstick but not seen looking at the sample

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12
Q

what is macrscopic haematuria

A

blood is visible in urine

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13
Q

Most common cause of UTI

A

E. Coli
gram neg-ve anerobic rod shaped bacteria

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14
Q

Duration of antibiotics

A

3 days - for simple UTI
5-10 days for immunosuppressed women, abnormal anatomy or impaired kidney function
7 days of antibiotics for men, pregnant women or catheter related UTI’S

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15
Q

UTI during pregnancy increases the risk of ..

A

pyelonephritis, premature rupture of membranes and pre-term labour.

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16
Q

antibiotic options for pregnancy ..?

A

Nitrofurantoin (avoid in the third trimester)
Amoxicillin (only after sensitivities are known)
Cefalexin

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17
Q

Nitrofuratoin needs to be avoided in the third trimester why ?

A

risk of neonatal haemolysis

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18
Q

describe sympathetic and parasympathetic neural control of the LUT

A

Parasympathetic - Detrusor contraction
Smooth muscle sphincter relaxation

Sympathetic- smooth muscle sphincter contraction
- inhibit detrusor contraction

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19
Q

What is pyelonephritis

A

Severe infectious inflammation of the parenchyma ( functional tissue )

ascend from the lower urinary tract

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20
Q

most common bacteria that causes pyelonephritis

A

E COLI

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21
Q

KEY DIAGNOSTIC FACTORS OF pyelonephritis

A

triad of loin pain, fever and pyuria

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22
Q

1st investigations to order for pyelonephritis

A

urinalysis
urine culture and sensitivity
fbc
ESR

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23
Q

GS investigation for pyelenephritis

A

Mid stream Urine and culture

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24
Q

Tx for pyelonephritis

A

IV Antibiotics- broad spectrum, cefalexin for 7-10 days, co-amoxiclav or gentimiacin
Trimethorpim or amoxicillin if sensitive
Analgesia- paracetamol
Fluid replacement
Drain obstructed kidney
Catheter

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25
Q

What is cystitis

A

inflammation of the urinary bladder, most common in sexually active women

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26
Q

Rx for cystitis

A
  • sexually active
  • DM
  • History of UTI
  • Pregnancy
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27
Q

Presentation of cystitis

A

Suprapubic tenderness and discomfort
Dysuria- discomfort , pain burning on urination
Frequency
Cloudy smelly urine
haematuria

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28
Q

Investigations for cystitis

A

1st line Urine dipstick- nitrates or WBC’S then uti
mid stream urine sample -GS

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29
Q

Management of cystitis

A

Antibiotics- 3 days trimethoprim BUT AVOID IF PREGNANT

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30
Q

What is prostatitis

A

Inflammation and swelling of the prostate due to E coli

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31
Q

Presentation of Prostatitis

A
  • VERY tender prostate
    FEVER, CHILLS, MALAISE
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32
Q

Management of prostatitis

A

ciprofloxacin or levofloxacin for 14 days

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33
Q

What is urethritis

A

Urethritis is inflammation of the urethra commonly caused by neisseria gonorrhoeae and chlamydia trachomatis

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34
Q

presentation of urethritis

A

Dysuria
Urethral discharge
pruritus at the end of the urethra
skin lesion

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35
Q

two main categories of urethritis

A

Gonococcal if neisseria is isolated
non gonococcal if neisseria is not isolated

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36
Q

key diagnostic factors of urethritis

A

presence of risk factors
urethral discharge
urethral irritation or itching
dysuria

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37
Q

risk factors of urethritis

A

age 15 to 24 years
female sex
Gay men
low socio-economic status

38
Q

1st line investigation for urethritis

A

Urine dipstick
GS = Mid stream MC+S

39
Q

gs for urethritis

A

mid stream urine sample

39
Q

Management of urethritis

A

NG - IM ceftriaxone and azithromyocin

40
Q

what is epidydo- orchitis

A

inflammation of the epididymis causing scrotal pain and swelling that develops over the course of a few days and lasts <6 weeks. It is usually unilateral.

The pain is relieved by elevating testes
Cremaster reflex intact

41
Q

Investigations for Epididymo-orchitis

A

1st line = urine dipstick + leukocytes/blood/nitrates
GS - Mid stream MC+S
NAAT - detect STI type for treatment if necessary

42
Q

key diagnostic factors of epidymo orchitis

A

age >19 years
unilateral scrotal pain
Gradual onset swelling
symptoms <6 weeks’ duration

43
Q

Rx for epidymo orchitis

A
  • unprotected sexual intercourse
  • bladder outflow obstruction
  • immunosuppression
44
Q

Difference between complicated and uncomplicated UTI

A

An uncomplicated UTI is an infection in the lower urinary tract, the bladder and urethra.

A complicated UTI is when the infection extends beyond the bladder to the kidneys and is more serious

Also deemed complicated in pregnancy

45
Q

Lower tract infections

A

UTI
Cystitis

46
Q

Upper tract infections

A

Pyelonephritis

47
Q

Classifications of UTIs

A

Asymptomatic bacteriuria

Uncomplicated

Complicated

48
Q

What is Bacteriuria

A

The presence of bacteria in the urine
-Symptomatic
-Asymptomatic

49
Q

What is pyuria?

A

Presence of leucocytes in the urine
Associated with infection
Sterile pyuria
– 10 or more white blood cells per cubic mm

50
Q

Causes of Pyuria

A

infections (chamydia, gonorrhoea, HSV, trichomonas)
Pyelonephritis
Papillary necrosis
Diabetes
Renal TB
Renal stones
Cancer

51
Q

Who does uncomplicated affect?

A

Non pregnant women

52
Q

Who does complicated effect?

A

Pregnant
Men
Catheterised
Children
Recurrent/persistent infection
Immuncompromised
Noscomial infection
Structural abnormality
Urosepsis
Associated urinary tract disease

53
Q

Which pathogen is associated with renal stones that causes UTI?

A

Proteus

54
Q

Which pathogen is assosciated with Hospital/catheter assosciated UTIs?

A

Klebsiella

55
Q

Which pathogen affects young women the most for UTIs?

A

Staph.saprophyticus

56
Q

What is the average bladder capacity?

A

500ml
Significant reduction in capacity accompanies acute inflammation and leads to increased frequency.

57
Q

Symptoms of UTI

A

UTI: Pain in peeing, needing to pee
LUT: Fever, haematuria

58
Q

Urinalysis for UTI

A

Blood
Protein
pH
Ketones
Nitrates
Leucocytes
Glucose

59
Q

What do we need for urine samples?

A

MSU
CSU
Bag urine
Early morning urine
SPA aspirate
Clean catch

60
Q

Why do we use early morning urine?

A

TB 3 x early morning urine. Highest concentration of bacilli so more likely to see

61
Q

What do we see on the microscopy for UTIs?

A

White blood cells

Red blood cells

Casts

Bacteria

Epithelial cells

62
Q

What are casts?

A
  • Cylindrical protein mouldings formed in the renal tubules
  • give clues to renal pathology
  • Can be indicative of infection
  • Damage to kidney epithelium (glomerulonephritis)
63
Q

What do RBC casts indicate?

A
  • glomerulonephritis
  • renal ischaemia and infarction
64
Q

Acute tubular necrosis is associated with what types of casts

A
  • granular
  • epithelial
65
Q

Asymptomatic bacteriuria treatment

A

If >65 then do not treat
Other groups that get asymptomatic bateriuria – pregnant patients, diabetics, transplant patients – all should be treated

66
Q

What is first-line treatment for uncomplicated
UTIs?

A

Nitrofurantoin:

67
Q

Side effects of antibiotics

A

Not given in thrid trimester –risk of neonatal jaundice/Neonatal haemolysis
Can’t be used in G6PD deficiency
Nausea and vomiting
headaches
dizziness
liver problems
neuropathy
acute and chronic pulmonary reactions
Antimicrobial resistance

68
Q

How does Fosfomyocin (New antibiotic) work

A

Prevents formation of N-acetyl muramic acid – component of bacterial cell wall

69
Q

Pivmecillinam (new antibiotic)

A

Interferes with bacterial cell wall. Bactericidal.

70
Q

How to prevent infections of catheter samples

A

Do not dipstick

Change or remove catheter
when starting treatment

Send a fresh sample (not from bag)

71
Q

Catheter associated UTI - pathogenesis

A

Insertion may carry organisms into the bladder

At risk of infection up to 24 hours post removal

Hospitable environment in the catheter

Formation of biofilms
(protected from flow of urine, host
defences and antibiotics)

Incomplete voiding

72
Q

What can short term catheters cause?

A

Monomicrobial infections

73
Q

Long term catheter issues

A

Polymicrobial infections

Complications:
UTI/Pyelonephritis
Stones
Obstruction
Chronic inflammation

74
Q

How to prevent catheterisation of UTI?

A

Intermittent catheterisation
Suprapubic catheterisation

75
Q

How to prevent bacteriuria

A

Keep catheter closed
Remove as soon as possible

76
Q

How to prevent complications

A

Don’t treat if asymptomatic
Catheter replacement

77
Q

How does the prevalence of UTI increase in pregnant women?

A

Age
Parity
Sexual activity
Diabetes
Previous UTI

78
Q

How to investigate UTI in pregnancy

A

Culture rather than dipstick

Positive cultures should be confirmed with a second sample

Asymptomatic bacteriuria should be treated(unlike elderly) -20-40% untreated bacteriuria develop acute symptomatic pyelonephritis

Test of cure should be sent 1 week after treatment

79
Q

Ascending route of infection for pyelonephritis

A

Urethra colonised with bacteria. Massage of the urethra during intercourse can force bacteria into the female bladder

80
Q

Haematogenous route of infection of pyeloephritis

A

S.aureus/Candida

Lymphatic spread is very rare

81
Q

Complications of pyelonephritis

A

Renal abscess
Slow/no response to Antibiotics
Imaging
More common in diabetics

Emphysematous pyelonephritis
Rare, gas accumulation in the tissues
Life threatening
May need nephrectomy

82
Q

Mrs A Vrige (23 years old) has been complaining of dysuria, urgency and frequency passing urine. Similar urinary symptoms over the last few months were treated with 3 days of Cephalexin by another GP. She is in a stable relationship with her husband and takes the oral contraceptive pill.
Using the BIA urinalysis algorithm to help you, you decide to treat empirically for UTI

Which antibiotic do you use while awaiting results?
A. Ciprofloxacin

B. Trimethoprim

C. Nitrofurantoin

D. Tazocin

E. No antibiotic needed

A

D. Tazocin

83
Q

Mr C Docalot is a 65 year old man with benign prostatic hyperplasia for which he has been prescribed tamsulosin for several years. He presents with 3 days of increased urinary frequency and lower back pain. On examination he is unwell and agitated: T 390C and BP 90/50 and there is right renal angle tenderness.

What key samples should be taken:

MSU and Blood culture
Sputum and MSU
CSU
Blood culture
All of the above

A

A - MSU and blood culture

84
Q

Mr C Docalot is a 65 year old man with benign prostatic hyperplasia for which he has been prescribed tamsulosin for several years. He presents with 3 days of increased urinary frequency and lower back pain. On examination he is unwell and agitated: T 390C and BP 90/50 and there is right renal angle tenderness.

What would you treat with first line and for how long?
A. Trimethoprim 7 days
B. Nitrofurantoin 14 days
C. Co-amoxiclav 14 days
D. Co-amoxiclav 7 days
E. Ciprofloxacin 7 days

A

C

85
Q

Mr E.Home is an 84 year-old man who has become confused and agitated. He has been sent to the frailty unit and you assess him. Other than the confusion, the only significant finding from history and examination is that he has a long-term urinary catheter.

The nurse uses a dipstick to assess the urine. This will give her an indication if an infection is present or not:

A. True

B. False

A

B. false

86
Q

Mr E.Home is an 84 year-old man who has become confused and agitated. He has been sent to the frailty unit and you assess him. Other than the confusion, the only significant finding from history and examination is that he has a long-term urinary catheter.

The nurse completes the form and sends the urine sample to the Microbiology lab who inoculate some culture plates and dispose of the sample. Should Microscopy be performed on the sample?

A. Yes

B. No

A

B. No

87
Q

Mrs B.gravid is a 37 year old, 28 weeks pregnant women in the antenatal clinic who has brought a urine sample with her. She is otherwise well.
Urinalysis shows leukocytes and protein. This indicates:

A. Nothing - this is expected in pregnancy
B. Pre-eclampsia
C. UTI
D. Possibility of pre-eclampsia and UTI
E. Obstetric cholestasis

A

D

88
Q

Mrs B.gravid is a 37 year old, 28 weeks pregnant women in the antenatal clinic who has brought a urine sample with her. She is otherwise well.

The microscopy shows epithelial cells but no pus cells, this suggests:
A. Definite infection
B. Pyelonephritis
C. Pre-eclampsia
D. Sample contamination
E. None of the above

A

D

89
Q

Mrs B.gravid is a 37 year old, 28 weeks pregnant women in the antenatal clinic who has brought a urine sample with her. She is otherwise well.
Based on this sample, the patient should be treated as a UTI.

A. True

B. False

A

B. False

90
Q

The risk of pyelonephritis in untreated asymptomatic bacteriuria in pregnancy is:
A. 5-10%
B. 20-40%
C. 50-60%
D. 60%
E. 70-75%

A

B

91
Q

What antibiotic should be avioided in pregnant women

A

Trimethoprim

Renal (15 decks)

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