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Kidneys > UTIs > Flashcards

UTIs Flashcards

1
Q

What percentage of kids have UTIs?

A

~5% of girls and 1% of boys have a UTI before 5 y.o.

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2
Q

What are the stats for women and UTIs?

A

~50% of women report at least one UTI by 50 years

Sexually active women have one UTI every 2 years

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3
Q

What is acute cystitis?

A

Inflammation of the urinary bladder

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4
Q

What is Pyelonephritis?

A

Inflammation of the urinary bladder and kidneys

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5
Q

What is sterile pyuria?

A

Pus in the urine with a negative culture

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6
Q

What are the sterile areas of the urinary tract?

A

The kidneys, ureter and bladder

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7
Q

Does the urethra have bacteria in it?

A

Yes - it has a microbiota

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8
Q

What is the source of most UTIs?

A

The microbiota (E. Coli is predominant and it the predominant cause of UTI)

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9
Q 
What percentage of community acquired UTIs are caused by:
E. coli
Proteus species 
Staph. saprophyticus
Other
A

80
5
10
5

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10
Q 
What percentage of hospital acquired UTIs are caused by:
E. coli
Proteus species 
Staph. saprophyticus
Other
A

40
10
2
48

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11
Q

What are the other bacteria which cause UTIs?

A

Other GNRs: Klebsiella, Enterobacter, Serratia, Pseudomonas.

G+ bacteria: Enterococcus, other Staphylococcus.

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12
Q

With regard to CMV why is the urinary tract important?

A

The patient may have asymptomatic shedding (i.e. they may transmit the virus through urine)

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13
Q

How do bacteria access the urinary tract?

A

Most infections are ascending (i.e. from commensals in the distal urethra)
They can make their way up into the bladder and then occasionally to the kidneys

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14
Q

What bacteremias can cause UTIs?

A

Requires systemic infections
• Staph. aureus (renal abscess)
• Salmonella Typhi
• TB

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15
Q

What type of epithelium is present in the urinary tract?

A

Transitional epithelium

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16
Q

What is the benefit of having transitional epithelium in the urinary tract?

A

It resists bacterial colonisation

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17
Q

Do bacteria grow in urine?

A

Many do not like this medium

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18
Q

What are the elements of innate immunity of the UT?

A

Transitional epithelium
Many bacteria do not grow in urine
Constant flushing of urine and regular bladder emptying plays a key role in resistance to infection

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19
Q

What are the effects of constant flushing of urine from the bladder?

A

Bacteria cannot reach sufficient numbers to activate virulence mechanisms.
Those who cannot empty their bladder completely are much more susceptible

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20
Q

What are females more commonly affected by UTIs?

A

Shorter urethra

Infection comes from the perineum and female urethra essentially opens in the perineum

Sexual intercourse massages bacteria up the female urethra

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21
Q

What may protect against UTIs in infant boys?

A

Circumcision

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22
Q

What is thought about the colonisation of the distal urea with regard to UTIs?

A

Suggested that the higher the level of colonisation the more susceptible to infection

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23
Q

What are some abnormal host factors which contribute to UTIs?

A

Incomplete bladder emptying

Catheterization

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24
Q

What are some causes of incomplete bladder emptying?

A 
Structural abnormality (congenital, tumour, pregnancy, stone, enlarged prostate). 
(May be first evidence in a child - always investigate boys girls are allowed a couple)

Functional abnormality (neurological conditions, vesico-ureteric reflux - urine pushed up the ureters)

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25
Q

What allows bacteria to adhere to the bladder?

A

Type 1 pili
(Almost all E. Coli can produce these)

PAP pili - these allow for good adhesion to the transitional epithelium

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26
Q

What the role of flagella in UTI causing bacteria?

A

It allows for motility - perhaps to reach the kidneys

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27
Q

Bacteria which are more likely to produce UTIs do what with the epithelium?

A

Can invade transitional epithelium and form intracellular communities

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28
Q

What is a biofilm?

A

A community of microbes within a matrix

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29
Q

What are biofilms usually made out of?

A

Polysaccharides

30
Q

What are siderophores?

A

These are compounds with very high affinity for iron

31
Q

Which bacteria is noted for producing urease?

A

Proteus sp

32
Q

What does urease do?

A

It changes the pH of urine and promotes the formation of struvite stones

33
Q

Where are PAP effective?

A

In the kidneys

34
Q

Where are flagella effective?

A

In the ureter

35
Q

Where are type 1 pili effective?

A

In the bladder

36
Q

Are filaments produced by E.Coli a virulence factor?

A

Yes - some evidence

37
Q

How is UTI diagnosed?

A
  • History and physical examination
  • Imaging
  • Collect appropriate samples
  • Interpret lab report
38
Q

What comes up in the history of someone with a UTI?

A

Pain
Frequency
Urgency
(it is hard to distinguish between upper and lower UTI - fever is an indication)

39
Q

When is a person with a UTI imaged?

A

Usually only done in people who we do not expect to get a UTI

40
Q

What samples are collected to test for UTIs?

A

Urine in most cases

Blood - if pyelonephritisis suspected

41
Q

What is the most common urine sample?

A

A midstream urine sample (only collect middle bit of urine, not end or start)

42
Q

What are some other types of urine samples?

A
  • Catheter/nephrostomy sample
  • Bag sample (in babies - not very helpful)
  • Suprapubic aspirate (paediatrics - needle directly into bladder)
43
Q

Where is urine for analysis collected from the catheter?

A

From the catheter itself

44
Q

What examinations are done of urine samples?

A
  • Microscopy
  • Count
  • Quantitative culture for bacteria
  • Susceptibility testing
45
Q

What are the pathologists looking for in microscopy?

A 
WBC, 
RBC, 
epithelial cells, 
casts, 
crystals, 
microorganisms incl. parasitic forms
46
Q

What parasite infects the bladder?

A

Flatworm - fluke

47
Q

What is the level of WBC in the urine for it to be considered an infection?

A

> 10^5/ml

Could also be due to stones or tumours or other inflammatory processes

48
Q

What is the normal squamous epithelial presence in a urine sample?

A

0 - any present = not well collected sample

49
Q

What is one colony forming unit?

A

One bacterium before culturing

50
Q

What is the infectious level of colony forming unit/ml?

A

> 10^5 CFU/ml is strongly suggestive of infection (especially if only one species isolated)

51
Q

What is the CFU threshold for urine taken from the catheter?

A

> 10^2 CFU/ml

52
Q

What is the CFU threshold for urine taken via suprapubic aspirate?

A

0 - should be sterile

53
Q

How quickly should urine samples be transported to the lab?

A

Less than 1 hour

Or can be kept at less than 4 degrees for a period of up to 18 hours

54
Q

What is sterile pyuria?

A

No growth with WBC consistently >10^5/ml

55
Q

What are the causes of sterile pyuria?

A
  • non-infectious conditions
  • partial treatment
  • difficult to grow bacteria, e.g., TB
56
Q

What is a treatment for uncomplicated cystitis?

A

Alkalanise urine (check pH first)

57
Q

Why is alkalanising the urine helpful?

A

It may stop burning

The burning on micturition is due to the acid which the bacteria are producing

58
Q

Why does the pH need to be checked before the alkalanising the urine?

A

Proteus species produces ammonia during its growth and thus the urine will already be alakaline. Making it more so may precipitate the formation of struvite stones

59
Q

What is the recomended treatment for uncomplicated cystitis?

A

Trimethoprim OR cephalexin OR co-amoxyclav OR nitrofurantoin

60
Q

How long is the recommended treatment dosage for uncomplicated cystitis?

A

5 days [women & children] or 7 days [men]

61
Q

If a child less then 2 y.o. has a UTI what needs to happen?

A

Need to check for UT abnormality

A girl may allow one but a boy = none

62
Q

What drugs are used to treat pyelonephritis?

A

co-amoxyclav OR cephalexin OR trimethoprim

63
Q

How long do we treat for in Pyelonephritis?

A

10-14 days

64
Q

How is sepsis treated?

A

If severe sepsis, use ampi/amoxycillin + gentamicin

65
Q

When is asymptomatic bacteriuria treated?

A

In pregnancy (it is associated with prem delivery and other obstetrics complications)

66
Q

What is used to treat women with asymptomatic bacteriuria in pregnancy?

A

cephalexin OR co-amoxyclav OR other

67
Q

What is considered to be a recurrent UTI in women?

A

> 2 UTIs in 6 months

most are reinfections i.e. not relapse

68
Q

What causes recurrent UTIs?

A

Genetic predisposition

Behaviour: intercourse, spermicide, incontinence, etc

69
Q

How can reccurent UTIs be managed?

A 
Change behaviour; ↑ fluid intake; postcoital voiding
Antimicrobial prophylaxis (different regimes)/early intervention
70
Q

What is the normal level of WBC in the urine?

A
71
Q

What is the normal level of RBC in the urine?

A
72
Q

What is the normal colony forming unit/ml?

A

Kidneys (15 decks)

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