UTIs / pyelonephritis Flashcards

1
Q

What is cystitis?

A

Inflammation of the bladder

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2
Q

What is pyelonephritis?

A

Inflammation of the kidneys

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3
Q

Why are UTIs more common in females?

A

Due to the shorter urethra

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4
Q

What are risk factors for UTIs?

A
Female
Sexual activity
Incontinence
Poor hygiene
Urinary catheters
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5
Q

How do lower UTIs present?

A
Dysuria - painful stinging / burning when urinating
Suprapubic pain or discomfort
Frequency
Urgency
Haematuria
Nocturia
Cloudy / foul smelling urine

In older / frail patients - confusion

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6
Q

How is a lower UTI diagnosed?

A

Often done based on presentation in females

Mid stream urine sample

  • dipstick - positive for leukocytes, nitrites + RBCs
  • microscopy, culture and sensitivity in some patients (e.g. recurrent, pregnant)
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7
Q

What are the two antibiotics used for simple UTIs?

A

Trimethoprim (high resistance to this)
Nitrofurantoin (avoid if GFR <45)

Normal course is 3 days in women

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8
Q

How are UTIs managed during pregnancy?

A

Urine for microscopy, culture and sensitivity
7 days of antibiotics
- nitrofurantoin (avoid in 3rd trimester)
- amoxicillin (depending on sensitivity of organism)

**avoid trimethoprim in pregnancy

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9
Q

Why should trimethoprim be avoided in pregnancy?

A

Can lead to congenital malformations - neural tube defects

Works as a folate antagonist. Folate is essential for normal development of fetus.

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10
Q

In which people are UTIs and pyelonephritis most common?

A

Women ages 15-29

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11
Q

What are some risk factors for pyelonephritis?

A
Female
Urological structural abnormalities
Vesico-ureteric reflux (normally in children)
Catheters
Obstruction / retention
Immunosupression
Sexual intercourse
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12
Q

What organisms commonly cause UTIs?

A

Escherichia coli - most common

Klebsiella pneumoniae
Enterococcus
Staphylococcus aures
Pseudomonas

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13
Q

How does pyelonephritis present?

A

Triad of

  • fever
  • unilateral loin pain
  • nausea + vomiting

Alongside lower UTI symptoms - frequency, urgency, dysuria, haematuria
May also have features of sepsis

On examination - renal angle tenderness

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14
Q

What are some differentials for pyelonephritis?

A
Renal calculi
Acute cholecystitis
Ectopic pregnancy
PID
Lower lobe pneumonia
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15
Q

How is pyelonephritis investigated?

A

Urine analysis - dipstick - also do bHCG in women of child bearing age
Urine culture + microscopy
Bloods - FBCs , CRP , U + Es
Imaging - renal ultrasound scan or CT

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16
Q

How is pyelonephritis managed?

A

Antibiotics - broad spec until culture results - for 7-10 days (in community)
IV fluids
Analgesia

Consider admission - if septic start the SEPSIS 6

Treat any obstruction / complications (e.g. pyonephrosis or abscesses)

17
Q

What is pyonephrosis?

A

Pus collects in the kidney due to infection

18
Q

What are some complications of pyelonephritis?

A
Sepsis
Renal scarring --> CKD
Pyonephrosis
Perinephritic abscess
Preterm labour in pregnancy
Chronic pyelonephritis - leads to scarring -->CKD