UTIs / pyelonephritis Flashcards
What is cystitis?
Inflammation of the bladder
What is pyelonephritis?
Inflammation of the kidneys
Why are UTIs more common in females?
Due to the shorter urethra
What are risk factors for UTIs?
Female Sexual activity Incontinence Poor hygiene Urinary catheters
How do lower UTIs present?
Dysuria - painful stinging / burning when urinating Suprapubic pain or discomfort Frequency Urgency Haematuria Nocturia Cloudy / foul smelling urine
In older / frail patients - confusion
How is a lower UTI diagnosed?
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)
What are the two antibiotics used for simple UTIs?
Trimethoprim (high resistance to this)
Nitrofurantoin (avoid if GFR <45)
Normal course is 3 days in women
How are UTIs managed during pregnancy?
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
Why should trimethoprim be avoided in pregnancy?
Can lead to congenital malformations - neural tube defects
Works as a folate antagonist. Folate is essential for normal development of fetus.
In which people are UTIs and pyelonephritis most common?
Women ages 15-29
What are some risk factors for pyelonephritis?
Female Urological structural abnormalities Vesico-ureteric reflux (normally in children) Catheters Obstruction / retention Immunosupression Sexual intercourse
What organisms commonly cause UTIs?
Escherichia coli - most common
Klebsiella pneumoniae
Enterococcus
Staphylococcus aures
Pseudomonas
How does pyelonephritis present?
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
What are some differentials for pyelonephritis?
Renal calculi Acute cholecystitis Ectopic pregnancy PID Lower lobe pneumonia
How is pyelonephritis investigated?
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