11- UTI and Diuretics

Question 1

What are diuretics

Answer 1

Act on kidney to increase production of urine and eliminate water from body

Question 2

What do diuretics do

Answer 2

Reduce plasma volume and CO
Reduce BP
Reduce edema and ascites
Act on tx on luminal membrane or renal tubular cells

Question 3

Where do carbonic anhydrase inhibitors work

Answer 3

Inhibit carbonic anhydrase in PCT

Question 4

Where do osmotic diuretics work

Answer 4

Whole tubule

Question 5

Where do loop diuretics work

Answer 5

Loop of Henle

Question 6

Where do K sparing diuretics work

Answer 6

DCT/CD

Question 7

Where do thiazide and thiazide like diuretics work

Answer 7

DCT

Question 8

How do CA inhibitors work

Answer 8

So HCO3 not produced in cell
So Na/HCO3 cotransporter can’t work
So high Na in cell
So less reabsorbed

Question 9

How do osmotic Ds work

Answer 9

Freely filtered
But no transporters so not reabsorbed
Stay in lumen and pull in water
Na spared
Expand ECF initially, decrease blood viscosity, inhibit renin release, increase renal blood flow

Question 10

How do Loop Ds work

Answer 10

Work on Na/K/2Cl
So less reabsorbed
Stay in lumen so water stays too

Potent
Emergency situations

Question 11

How do K sparing Ds work

Answer 11

With diuretics there is lots of Na in lumen
So when gets to CD the ENAC works and reabsorbs Na and ROMK kicks out K due to Na/K turning
With K sparing = ENAC/ROMK not upregulated

Question 12

How do Thiazide Ds work

Answer 12

Block Na/Cl Co
So less Na
Can induce high Ca as less Na in cell so favours Na/Ca antiporter so more Ca absorbed

Question 13

Why does low K cause alkalosis

Answer 13

Cell swaps intracellular K for H so less H in blood = higher Ph

Question 14

What are the defences of the UT against colonisation

Answer 14

Emptying of bladder
Immunological factors
Mucosal barriers
Urine acidity

Question 15

Why do you get false negatives with collection bag

Answer 15

Peritoneal contamination

Question 16

How long can you take to get samples to culture

Answer 16

4 Hours or refrigerate or boric acid

Question 17

When does a dipstick indicate UTI

Answer 17

Leucocyte esterase
Nitrates
Blood
Higher pH 
Protein- WBC

Question 18

When is a dipstick useful

Answer 18

Under 65

Children to help rule out

Question 19

When is a dipstick not useful

Answer 19

Over 65

Catheter

Question 20

When is a dipstick not necessary

Answer 20

2-3 of dysuria, new nocturia, cloudy urine

Question 21

When is a dipstick not necessary

Answer 21

2-3 of dysuria, new nocturia, cloudy urine

Question 22

What is the role of culture

Answer 22

Investigate complicated infections
Epidemiology
Antibiotic susceptibility data

Question 23

When do you do image urinary tract

Answer 23

Children with UTI
Septic patients to see renal involvement
Males: urethral valves
Females and children: vesico-ureteric reflux

Question 24

When would you get sterile pyuria (WBC but not growth)

Answer 24

Prior abx
Urethritis- STI
Vaginal infections- postmenopausal vaginitis
TB
Appendicitis

Question 25

Asymptomatic bacteriuria

Answer 25

High prevalence in elderly | Screen and treat in pregnancy

Question 26

Risk of asymptomatic bacteriuria in pregnancy

Answer 26

Premature birth | Pyelonephritis

Question 27

Treat UTI

Answer 27

Increased fluid Analgesia Treat underlying disorders

Question 28

How to treat uncomplicated UTIs

Answer 28

3 day nitrofurantoin | Catheter - treat only if unwell

Question 29

How to treat complicated

Answer 29

5-7 days nitrofurantoin, pivmecillinam, trimethoprim | Cefelexin in pregnancy

Question 30

How to treat pyelonephritis/ septicaemia

Answer 30

7-10 days Need systemic activity IV Co-amoxiclav, Gen, cipro (7 days)

Question 31

When to give prophylaxis

Answer 31

More than 3 episodes in a year Good hygiene and behavioural measures taken No treatable underlying condition Abx chosen according to recent culture and susceptibility results Breakthrough infections documents

Question 32

Side effects of osmotic Ds

Answer 32

Headache, nausea, vomitting due to high Na Extracellular volume expansion = oedema, HF Do not use in chronic HF Dehydration and high Na

Question 33

Side effect of Loop D

Answer 33

Low electrolytes | Metabolic alkalosis

Question 34

Side effect of Thiazide Ds

Answer 34

Hypercalcaemia low intracellular Na so more Na/Ca antiporter

Question 35

When not to use K sparing Ds

Answer 35

Hyperkalemia | Liver disease

Question 36

When to use K sparing Ds

Answer 36

Secondary hyperaldosteronism CHF, hepatic cirrhosis, nephrotic syndrome Hypertension in combination with others

Question 37

When to use K sparing Ds

Answer 37

Secondary hyperaldosteronism CHF, hepatic cirrhosis, nephrotic syndrome Hypertension in combination with others

Question 38

When to use osmotic Ds

Answer 38

Acute renal failure Acute drug poisoning Before surgery to reduce intracranial pressure

Question 39

When to use loop Ds

Answer 39

Severe oedema Hypercalcemia Acute pulmonary oedema Acute hyperkalaemia

Question 40

When to use thiazide Ds

Answer 40

Essential hypertension Mild heart failure Osteoporosis

Question 41

What is main complaint of UTI

Answer 41

Dysuria

Question 42

What is a gram pos cocci that is coagulase neg

Answer 42

Staphylococcus epidermidis

Question 43

What is Staphylococcus saprophyticus

Answer 43

Found in normal flora of female genital tract and perineum Coagulase positive coccus If nitrites negative

Question 44

What is the first immunoglobulin to respond

Answer 44

IgM

Question 45

What D normally added to loop to create potency

Answer 45

Thiazide when low GFR

Question 46

What is a side effect of spironalactone

Answer 46

Gynecomastia as work on other steroid receptors

Question 47

What drug reduces mortality by 30% in those with HF and LV dysfuntion

Answer 47

Spironolactone