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Renal > UTI - Self LEarn > Flashcards

UTI - Self LEarn Flashcards

1
Q

Define Pyuria and sterile pyuria

A

Pus cells present in the urine

Sterile pyuria = pus cells but -ve on urine cultures

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2
Q

What can cause chronic pyelonephritis?

A

Recurrent UTIs but also:

  • DM
  • Vesico-uretic reflux
  • Urinary Obstruction
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3
Q

Whats the difference between a complicated and uncomplicated UTI?

A

Uncomplicated = Young sexually active women with a clear correlation to sexual activity

Complicated = Any other so kids, men, abnormal tracts, immunosuppression, tumours, chronic retention or BOO

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4
Q

When do you we treat women with UTIs?

A

IF they have 3 or more symptoms
Then you start on empirical Abx

If all 3 dipstick components (nitrites/protein/leucocytes) are +ve -> Empirical Ab

If they only have 2 symptoms do an MSSU

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5
Q

What mostly causes UTIs in men?

A

Recurrent UTIs tend to be a sign of prostatitis in older men or STIs in younger men (chlamydia/gonorrhoea)

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6
Q

Whats risks are associated with UTI in pregnancy?

A

Pyelonephritis & Premature delivery

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7
Q

How do you approach pregnant women re UTIs?

A

Screen with an MSSU culture at first antenatal appointment.

Treat even if asymptomatic

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8
Q

How does pyelonephritis present vs lower UTI?

A

Lower UTIs:

  • Suprapubic Pain
  • Dysuria
  • Frequency
  • Urgency
  • Polyuria
  • Haematuria

Pyelonephritis:

  • Loin Pain
  • Fever
  • ~systemic unwellness
  • Severe cases have bacteraemia (rigors, N&V etc)
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9
Q

How do you manage pyelonephritis?

A

Urine culture
Empircal Abx
Blood cultures if systemically unwell

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10
Q

How would a UTI appear in children? and how would you investigate?

A

Often very unspecific. Any young child whos sick or has unexplained fever might be a UTI.

So any child like that gets an MSSU and follow up to ensure they don’t have vesico-ureteric reflux

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11
Q

What are the main community and hospital acquired UTI bacteria?

A

Mostly E.Coli

  • Proteus sp.
  • Klebsiella sp.
  • Pseudomonas sp.
  • Staph saprocyticus: associated with the skin
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12
Q

What extra investigation would you do for a patient with a proteus or Klebsiella UTI?

A

Non-contrast CT for stones.

They’re produce a lot of stones

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13
Q

What are the important parts of the dipstick test for a UTI?

A

Nitrites (produced by bacteria)
Protein (inflammation or renal pathology)
Leucocytes
If all 3 are present its an indication for empirical Abx

Also blood

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14
Q

What are the indications for a MSSU?

A

1) Women in which the dipstick is inconclusive
2) Men
3) Acute pyelonephritis
4) Pregnant (screening & Symptomatic)
5) Failed Abx or persistant symptoms
6) Recurrent UTIs
7) Children

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15
Q

How do you take a MSSU?

A

1) Discard the first 10-20ml of stream
2) Early morning urines are more likely to be +ve
3) Boric Acid container prevents overgrowth

If its a catheter specimen take it from the sampling port not the bag

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16
Q

How do you take a urine sample from a child?

A 
Most kids can't give a decent MSSU.
So a clean catch urine sample is preferable.
IF that fails:
- Urine collection Pad
- Catheter Sample
- Suprapubic Aspiration
17
Q

How do we detect pyuria?

A

With microscopy

Significant pyuria = >10WBC/mm^3

18
Q

How do we tell if its contamination or infection on a urine culture?

A

10^4 organisms/ml indicates infection > contamination
(10^5 in asymptomatic bacteriuria)

MIxed organisms usually means contamination

19
Q

What factors predispose to a UTI?

A
  • Female- Small size of urethra
  • Coitus or childbirth
  • Pregnancy
  • Anatomical abnormalities
  • Renal Cysts
  • Pre-existing parenchymal damage (e.g. recurrent pyelonephritis)
  • Stones
  • Immunosuppression e.g. diabetes
  • Urinary Tract instruments e.g. cystoscopy
  • Foreign Body e.g. catheter or stent
20
Q

Why does pregnancy predispose you to UTIs?

A

Your urine is static due to physical pressure from the foetus and because progesterone dilates ureters

21
Q

Its almost inevitable that patients with indwelling catheters get bacteriuria, how do you approach Catheter-related infections?

A

Dont do culture or treatment if they’re not symptomatic.

If they are do a urine culture and empirical Abx, the catheter should be changed immediately prior to treatment.

22
Q

Asymptomatic Bacteriuria is quite common in adult women and men with BPH, in which cases would we culture and treat and when would we leave it be?

A

We’d only do a urine culture and treat such patients if they’re:

  • Pregnant
  • Undergoing urological surgery
  • Undergoing surgery involving prosthesis
23
Q

What can cause sterile pyuria?

A
  • Abx in blood preventing bacterial growth
  • Renal Tuberculosis
  • Genito-urinary infections
  • If its recurrent its might be stones, malignancy, chronic prostatitis or interstitial cystitis.
24
Q

How do we rule out renal TB in sterile pyuria?

A

Collect 3 early morning MSSUs for ZN stains & TB cultures.

25
Q

Uncomplicated UTIs can be started on empirical therapy after dipstick testing.
How do you investigate a complicated UTI?

A 
MSSU
Also:
- US or CT-KUB
- Cystoscopy
- Post-void bladder scan
- Urinary Flow study
26
Q

What treatments can be used for a UTI?

A

Fluids
Alkalinizing agents (over the counter)
Antibiotics

27
Q

Describe the Abx course you use for uncomplicated UTIs?

A

3 Day course of trimethoprim OR nitrofurantoin OR Co-trimoxazole

28
Q

What abx must be avoided in pregnancy?

A

Trimethoprim -Teratogenic

29
Q

Describe the Abx course for Lower UTIs in men?

A

With Prostatitis:
- a 14 day course of ciprofloxacin (a quinalone)

Without Prostatitis:
- 7 Days nitrofurantoin or Trimethoprim

30
Q

Describe the Abx course for Acute Pyelonephritis?

A

7 Days of Ciprofloxacin
Patients admitted to hospital who are bacteraemic may require parental therapy- especially if vomiting
Also check the urine sample again 1-2wks post cessation of therapy to ensure resolution

31
Q

How can you use prophylaxis in recurrent UTIs?

A

Up to 1 yr of Trimethoprim or Nitrofurantoin can be used to break the cycle.

For uncomplicated recurrent UTIs, women can use single doses of nitrofurantoin after sex

32
Q

What kind of immunosuppression predisposes to UTI?

A

1) Prolonged Steroids
2) Transplant Rejection Meds
3) Diabetes

33
Q

What is chronic pyelonephritis

A

Pathological condition with renal scarring and loss of renal function. An infection may be present at the time but the whole disease is not a result of an ongoing investigation

34
Q

Symptoms of UTI

A
  • Dysuria : pain on passing urine
  • Frequency: small amounts – often
  • Urgency – feeling of needing to pass urine
  • Suprapubic pain
  • Polyuria – increased volume of urine
  • Hematuria
35
Q

How to interpret urine cultures

A
  • Number of organisms is proportional to number of colonies which grow on the agar plate
  • Asymptomatic: 105
  • Symptomatic should be as low as 102 but most labs in the UK will not detect below 104
  • Presence of pus cells is usually diagnostic
  • Mixed cultures is usually diagnostic

Renal (28 decks)

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