Renal: UTIs Flashcards
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What is the difference in organs implicated between lower UTI and upper UTIs? [3]
Lower: cystitis; prostatitis
Upper: pyelonephritis (kidney / renal pelvis)
What is abacterial cystitis / urethral syndrome? [1]
A diagnosis of exclusion with dysuria and frequency, without demonstrable infection
What is the difference between complicated and uncomplicated UTI? [2]
Complicated UTI: structural/functional abnormality of genitourinary tract (e.g. stone / catheter / neurogenic bladder)
Uncomplicated UTI: normal renal structure and function
State 4 categoriesand examples of risk factors for UTIs
Increase in bacterial innoculation:
* sexual activity
* urinary incontinence
* faecal incontinence
Increased binding of uropathogenic bacteria:
- spermicide use
- decreased oestrogen
- menopause
Decreased urine flow
Increased bacterial growth:
- DM
- I/S
- Stones
- Obstruction
- Pregnancy
Lower urinary tract infections present with which symptoms? [6]
Dysuria (pain, stinging or burning when passing urine)
Suprapubic pain or discomfort
Frequency
Urgency
Incontinence
Haematuria
Cloudy or foul-smelling urine
Confusion is commonly the only symptom in older and frail patients
Pyelonephritis has a similar presentation to lower urinary tract infections plus the additional triad of symptoms [3]
Fever
Loin or back pain (bilateral or unilateral)
Nausea or vomiting
Renal angle tenderness on examination
If vaginal discharge is present, what is your most likely differential? [1]
PID
Which pathogen is the most common cause of UTI? [1]
Name two other causes
E. coli
Staph. saprophyticus
Klebsiella pneumoniae
How do you manage UTIs in non-pregnant women? [2]
If 3+ symptoms of cystitis and no vaginal discharge:
- 3 day course of trimethoprim or nitrofurantoin
- If fails, take a MSU and send for culture
How do you manage UTIs in pregnant women? [1]
Which drugs should be avoided [3] and in which semesters? [3]
Get expert help: associated with pre-term babies
Avoid:
* trimethoprim & ciprofloxacin in trimester 1
* nitrofurantoin in 3rd trimester
How do you manage UTIs in men:
- If lower UTI [2]
- If suspected prostatic involvement [1]
If lower UTI:
* 7 day course of trimethoprim or nitrofurantoin
If suspected prostatic involvement:
- Ciprofloxacin
- Cefalexin (the typical choice)
The typical duration of antibiotics is:
[] days of antibiotics for simple lower urinary tract infections in women
[] days of antibiotics for immunosuppressed women, abnormal anatomy or impaired kidney function
[] days of antibiotics for men, pregnant women or catheter-related UTIs
The typical duration of antibiotics is:
3 days of antibiotics for simple lower urinary tract infections in women
5-10 days of antibiotics for immunosuppressed women, abnormal anatomy or impaired kidney function
7 days of antibiotics for men, pregnant women or catheter-related UTIs
What risk does giving nitrofurantoin in 3rd trimester risk? [1]
Nitrofurantoin should be avoided in the third trimester as there is a risk of neonatal haemolysis (destruction of the neonatal red blood cells).
What risk does giving trimethoprim in 1st trimester risk? [1]
Trimethoprim should be avoided in the first trimester as it works as a folate antagonist.
Folate is essential in early pregnancy for the normal development of the fetus. Trimethoprim in early pregnancy can cause congenital malformations, particularly neural tube defects (e.g., spina bifida). It is not known to be harmful later in pregnancy but is generally avoided unless necessary.
Two things to keep in mind with patients that have significant symptoms or do not respond well to treatment are? [2]
Two things to keep in mind with patients that have significant symptoms or do not respond well to treatment are:
Renal abscess
Kidney stone obstructing the ureter, causing pyelonephritis
