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Renal > UTIs > Flashcards

UTIs Flashcards

1
Q

What is leukocyte esterase test?

A

a marker for increased neutrophils using the urine dipstick.

PMN >10 is a + test

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2
Q

What is the nitrite test?

A

It is a marker for most bacteria that cause UTI on the urine dipstick.
Most UTI bacteria cleave nitrates to nitrites

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3
Q

What are the two types of infections that fall under the blanket term “UTI”?

A
  1. Cystitis- infection of the bladder
  2. Pyelonephritis- infection of the kidney

UTI do NOT includes infections of urethra, prostate gland, testes or epididymis.

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4
Q

Describe how the epidemiology of UTI changes with age.

A

Infants boys due to contamination of the urethra with rectal flora (poor wiping technique)

Adults: Women > men due to proximity of urinary tract to vaginal tract, rectum, and the short urethra.

Elderly: Women > men, but there is an increase in older men due to prostate problems

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5
Q

Describe the recurrence rates of UTIs.

A

Women - recurrence of 25%

Men- recurrence 50% (less likely to get them, but if they do, they will continue to come back)

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6
Q

Describe the pathogenesis of UTI.

A

Bacteria in stool –> colonization of urethra, introitus–> bladder colonization—> REFLUX/OBSTRUCTION—> ascending infection

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7
Q

What are the 3 main natural defense mechanisms the body has against UTIs?

A
  1. lactobacillus of the perineal flora keep vagina pH t allow colonization
  2. pH, osmolarity and urea in the urine inhibit bacteria (if the urine is free flowing)
  3. Tamm-Horsfall proteins from renal tubular cells bind and capture mannose epitopes of bacteria with type 1 fimbrae
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8
Q

What are the risk factors for children to get UTI?

A
  1. anatomical abnormality

2. vesicouteral reflux (VSR) which sends urine from bladder back up through the ureter and to kidneys

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9
Q

What are the three anatomical reasons why women are more likely to get UTI than men?

A
  1. short distance anus –> urethra
  2. short distance vagina–> urethra
  3. short urethral tract–> less distance for the bacteria to go to get to the bladder
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10
Q

What is the most common risk factor for UTI in young women? Why?

A

sexual intercourse is the most common risk factor (honeymoon cystitis) because

  1. it leads to transient urethral edema and obstruction of urine flow
  2. spermicide and antimicrobials affect normal vaginal flora
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11
Q

What are the 5 most most common risk factors for UTI in older women?

A
  1. hormonally associated change in the mucousa (estrogen is protective) after menopause
  2. incontinence
  3. antibiotic use
  4. history of prior UTI
  5. sex
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12
Q

Why does pregnancy increase the risk of developing a UTI?

A
  1. physical/hormonal changes
  2. loss of ureteral and bladder muscle tone leading to functional obstruction of urine flow
  3. Uterine bulk can compress the right ureter leading to hydroureter and hydronephrosis
  4. VUR
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13
Q

What are the risk factors for men developing UTI?

A
  1. BPH with age can decrease or obstruct urinary outflow
  2. incontinence (diabetic nephropathy, vascular disease)
  3. institutional settings
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14
Q

What are the typical infecting organisms for UTI caused by catheter (CAUTI)?

A

enteric flora, skin flora, environmental organisms

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15
Q

What are the virulence factors associated with UPEC (uropathogenic E. coli)?

A
  1. Flagella
  2. adhesins
  3. Toxins
  4. siderophores
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16
Q

What are the 2 types of adhesins UPEC possess?
Which is more likely to cause cystitis?
Which is more likely to cause pyelonephritis?

A

Adhesins are pili or fimbrae that allow adhesion to epithelial cells of the colon, vagina, and uroepithelium.

  1. P fimbrae- invade kidney (p = pyelonephritis)
  2. Type I fimbrae- mannose sensitive and adhere to mannose receptor sites on Tamm Horsfall proteins. These are more likely to cause lower tract infections
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17
Q

What are the 3 main toxins associated with UPEC?

A
  1. Hemolysin- cytotoxic injury to PMNs and uroepithelial cells [children with UTI, adult upper UTI]
  2. Cytotoxic necrotizing factor 1 (CNF1) - cytoskeletal rearrangement of cells and apoptosis of bladder cells
  3. Secreted autotransporter proteins (Tsh, Sat, Pic) with serine protease activity
18
Q

What is the function of siderophores of UPEC?

A

acquire iron for the bacteria

19
Q

What is an uncomplicated UTI?
Is it more commonly cystitis or pyelonephritis?
What are the offending organisms?

A

It affects women without anatomical abnormalities or catheters.
It can be cystic or pyelonephrotic.
The offending organism is usually monomicrobial and is:
1. E coli
2. klebsiella
3. proteus
4. Staph saprophyticus -CONS is occassional

20
Q

What makes a UTI “complicated”?

A
  1. male patients
  2. females with other risk factors (pregnant, instrumentation, obstruction)

It can be mono or polymicrobial depending on the underlying issue

21
Q

What is the most common infecting organ for a child UTI?

neonates, anatomic abnormalities

A

Enteric flora.

Neonates- GB strep (from mother)

Anatomic abnormalities, primary immunodeficiency

  1. proteus mirabilis
  2. staphylococcus aureus
  3. CONS
22
Q

A patient comes to see you and has fever chills, malaise, sepsis, flank pain, dysuria.

Lab tests show leukocytosis, pyuria, bactiuria, +/- bacteremia. There are occasional WBC casts.

What is the likely diagnosis and location?

A

Pyelonephritis- upper tract (kidneys, ureter)

23
Q

A patient presents with dysuria, frequency and suprapubic pain.

Lab findings show pyuria and bacteriuria.

What is the likely diagnosis and location?

A

Cystitis in the bladder

24
Q

A patient comes for a routine physical. They dont have any symptoms, but lab results show bacteriuria and pyuria.

What is the likely cause and location?

A

Asymptomatic bacteriuria in the lower urinary tract

25
Q

The signs and symptoms of UTI are general descriptions and cannot be relied on for diagnosis.
What should be included on the differential if a patient has UTI-like symptoms?

A
  1. vaginitis
  2. urethritis (esp if chlamydia is suspected)
  3. structural urethra abnormalities
  4. PID
  5. nephrolithiasis
  6. appendicitis
  7. prostatitis
26
Q

What all is assessed by the urine dispstick?

A

SG, pH, leukocyte esterase, blood, nitrite, bilirubin, urobilinogen, negative proteins, glucose

27
Q

What findings in the urinalysis cannot be found on the dipstick but require microscopic examination?

A

RBCs, WBCs, casts, crystals

28
Q

What 5 lab findings are most suspicious for a UTI?

A
    • leukocyte esterase
  2. Nitrite
  3. WBCs
  4. casts
  5. +/- hematuria
29
Q

Why is nitrite indicative of a bacterial infection?

What is a limitation of the nitrite test?

A

We get nitrates in our diet. Bacteria in the urine are able to convert the nitrate to nitrite

Limitation: urine needs to be incubated for a sufficient amount of time in the bladder for the test to be + (4 hours) so you will get false - if:
1. not enough nitrate in diet
2. pee not in bladder for 4 hours
3 .E. faecalis- does not nitrate–> nitrite

30
Q

Sterile pyuria (PMN with no bacterial infection) can be seen in what 7 scenarios?

A
  1. urine contamination
  2. chronic interstitial nephritis
  3. kidney stones
  4. uroepithelial tumors
  5. interstitial cystitis
  6. renal tuberculosis
    7 chlamydia
31
Q

What 3 plates are urine cultures streaked on?

A
  1. BA- non-selective
  2. MacConkey’s - selects gram neg, differentiates lactose fermenters from non-fermenters
  3. CNA- selects for gram +
32
Q

How should a urine sample be collected?

What CFU is reflective of infection?

A

Patients should clean the urethral meatus, discarded the first few ml of urine and then collected the remainder in a sterile cup.
(mid-stream urine specimen)

CFU > 10 ^5 is infection

Symptomatic women with pyuria will have colony count between 10^5 and 10^2

33
Q

If a patient with a catheter is symptomatic, what CFU determines a UTI?

A

10^5 or more regardless of urinanalysis

10^3 with evidence of pyuria

34
Q

If a child is suspected of UTI, how should sample for culture be collected?
What determines + culture?

A
  1. catheterization
  2. suprapubic aspiration

10^4 CFu plus symptoms = UTI

35
Q

What imaging tests are indicated for cystitis?

A

none

36
Q

What imaging tests are indicated for pyelonephritis?

A

Ultrasound and CT can help show renal or perinephric abscesses, urolithiasis, anatomic complications.

37
Q

In children, what imaging test is most frequently done if symptomatic for a UTI?

A
  1. renal and bladder sonography

2. voiding cystourethrogram based on ultrasound results if suspected VUR

38
Q

What is used to calculate antimicrobial susceptibility patterns?

A

Antibiograms

Treat with empiric therapy based on the susceptibility results

39
Q

What group of people is treatment of asymptomatic bacteriuria absolutely indicated in?

A
  1. Preggos. Screen at first visit

2. patients to undergo urologic procedures with invasion of the mucousa

40
Q

What 4 factors determine the duration of the antibiotic given?

A
  1. the drug
  2. the type of infection
  3. patient characteristics
  4. clinical response
41
Q

If treating pyelonephritis, an antibiotic should be chosen that has ____________ distribution rather than ____________________. DO NOT use ____________ or ______________ alone.

A

systemic distribution rather than concentrating in the urine.
Do NOT use nitroferintoin or ampicillin alone. (use ampicillin with gentamycin)

Renal (11 decks)

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