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Y4: Nephrology > UTIs > Flashcards

UTIs Flashcards

1
Q

Definition of bacteriuria?

A
  • Bacteria in the urine
  • Not a disesase
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2
Q

Definition of a UTI?

A
  • Acute urethritis and cystitis caused by a micro-organism
  • Diagnosis based on symptoms and signs
  • Mostly females affected
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3
Q

Definition of a lower UTI?

A
  • Involves:
    • Bladder (cystitis)
    • Prostate (prostatitis)
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4
Q

Definition of an upper UTI?

A
  • Pyelonephritis
    • Infection of kidney/renal pelvis
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5
Q

Definition of Abacterial cystitis/urethral syndrome?

A

Diagnosis of exclusion in patients with dysuria and frequency, without being able to prove an infection

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6
Q

Describe the pathophysiology of UTIs?

A
  • Urine is good medium for bacterial growth
  • Women: shorter urethra, no bactericidal prostatic secretions
  • Sexual intercourse can cause minor urethral trauma and transfer bacteria
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7
Q

Describe the classifications of a UTI?

A
  • Uncomplicated
    • Normal renal tract structure and function
  • Complicated
    • Structural/functional abnormality of the GUT
    • eg obstruction, catheter, stones, neurogenic bladder
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8
Q

What are the risk factors for a UTI?

A
  • Foreign bodies
  • Lost of host defences
  • Neurological problems
  • Anatomical abnormalities
  • Bladder outflow obstruction
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9
Q

What are the symptoms of Cystitis?

A
  • Frequency
  • Dysuria, Urgency
  • Suprapubic pain
  • Polyuria, Haematuria
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10
Q

What are the symptoms of Acute pyelonephritis?

A
  • Fever, rigors, vomiting
  • Pain: loin, costovertebral
  • Associated cystitis symptoms
  • Septic shock
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11
Q

What are the symptoms of Prostatitis?

A
  • Pain:
    • perineum, rectum, scrotum, penis, bladder, lower back
  • Fever, malaise, nausea
  • Urinary symptoms
  • Swollen/tender prostate on PR
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12
Q

Clinical signs of all urinary tract infections?

A
  • Fever, abdominal/loin tenderness
  • Distended bladder, enlarged prostate
  • If vaginal discharge, consider pelvis inflammatory disease
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13
Q

Describe the tests for a UTI?

A
  • ​Dipstick (not for use in pregnant women)
  • MSU culture
  • FBC, U&Es, CRP,
  • Imaging (for kidney/bladder involvement)
    • USS, cytoscopy, CT
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14
Q

What are the organisms which can cause UTI?

A
  • Usually anaerobes and gram negative
    • E. coli (most common)
    • Staphylococcus saprophyticus (skin commensal)
    • Proteus mirabilis
    • Klebsiella pneumonia
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15
Q

Describe E. coli?

A

Gram negative anaerobic coliform rod

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16
Q

Describe Proteus mirabilis?

A
  • Gram negative anaerobic rod
  • Gut commensal
  • Stone formation due to urease production
    • Breaks down urea to form ammonia
    • Struvite stones then form in the presence of magnesiumm, calcium and phosphate
17
Q

Describe Klebsiella pneumoniae?

A
  • Gram negative encapsulated rod
  • Colonizes skin, nasopharynx, GIT, hospitalized patients
  • Association with antibiotic exposure, catheterization, immunosuppression
18
Q

Causes of sterile pyuria?

(increased white cells but sterile on standard culture)

What should be ruled out as a cause?

A

TB should be ruled out

19
Q

What is important to remember about the management of a UTI?

A

Antibitoics should not be used for the treatment of an asymptomatic bacteriuria in non-pregnant women, men and adults with catheters

20
Q

Describe the treatment of non-pregnant women with a UTI?

A
  • 1o: Trimethoprim (3 days)
    • 2o Nitrofurantoin
    • Trimethoprim/nitrofurantoin should not be used if GFR<30
  • If first line fails then culture and treat according to sensitivity
21
Q

Describe the treatment of a UTI in a pregnant woman?

A
  • Seek expert help
  • Refer to local guidelines
    • Avoid
      • 1st trimester: Ciprofloxacin, trimethoprim
      • 3rd trimester: Nitrofurantoin
22
Q

What is UTI in pregnancy associated with?

A
  • Preterm delivery
  • Intrauterine growth restriction
23
Q

Describe the treatment of a UTI in men?

A
  • Lower UTI:
    • 7 days of trimethoprim/nitrofurantoin(eGFR>30)
  • Prostatitis:
    • 4 weeks of Fluoroquinolone (ciprofloxacin)
  • Upper/recurrent UTI:
    • Refer for urological investigation
24
Q

Treatment for a UTI in someone who is catheterized?

A
  • Send MSU only if symptomatic
  • Symptoms: fever, pain, vomiting, confusion, sepsis
  • Change catheter before starting anitbiotic
25
Q

Describe Urinary tract TB?

A
  • Cause of sterile pyuria
  • Ask about malaise, night sweats, pain, visible haematuria
  • Can cause interstitial nephritis and renal amyloidosis
26
Q

Diagnosis of urinary tract TB?

A
  • Microscopy with acid-fast techniques
  • Mycobacterial culture of an early morning MSU
27
Q

Treatment for Urinary tract TB?

A
  • Rifampicin + isoniazid: 6 months
  • Pyrazinamide + ethambutol: 2 months
28
Q

Differentials for UTI?

A
  • Urethritis from STI
  • Urethritis associated with reactive arthritis
  • Post-menopausal atropic vaginitis
29
Q

Differentials for pyelonephritis?

A
  • Acute appendicitis
  • Diverticulitis
  • Ectopic pregnancy
  • Ruptured ovarian cyst
30
Q

Prophylactic measures to be adopted by women with recurrent UTIs?

A
  • Fluid intake of at least 2L/day
  • Regular complete emptying of the bladder
  • Emptying of bladder before and after sexual intercourse
  • Cranberry juice may be effective
31
Q

When does Asymptomatic bacteriuria require treatment?

A
  • Infants
  • Pregnant women
  • Urinary tract abnormalities
32
Q

Triad of Acute pyelonephritis?

A
  • Fever
  • Loin pain
  • Tenderness over kidneys
33
Q

Predisposing factors for Acute pyelonephritis?

A
  • Cysts
  • Renal scarring
34
Q

Describe the treatment of Acute pyelonphritis?

A
  • 1: Ciprofloxacin
    • 2: Gentamicin
  • IV fluids
  • Renal tract US
    • Exclude obstruction and perinephric collection
  • If obstruction:
    • Drainage by percutaneous nephrostomy
    • Ureteric stent insertion

Y4: Nephrology (8 decks)

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