Infections and Kidney Disease Flashcards
What abnormalities in the urinary tract may be present?
Preg
Transplant kidney
Renal tract stones
Obstruction
Abnormal renal tract architecture
Indwelling catheter/ureteric stents
Discuss UTIs in children
Structural issues more likely
Posterior urethral valves
Duplex ureters
Repeated pyelonephritis in childhood can cause renal scarring (aka chronic pyelonephritis)
What is vesicoureteric reflux?
Backward flow of urine from the bladder into the kidneys
Primary = defect in valve from birth
Secondary = obstruction in bladder
How does TB effect the urinary tract?
Come from the blood stream
Starts in kidneys – caseation, eventually cause calcification of kidneys
If untreated = can spread to ureters and bladder
Can result in end-stage renal disease
Ureteric stricture = fibrosis
Thin walled bladder = reflux = ESRD
How does schistosomiasis effect the renal system?
Blood fluke, that can lie dormant for many years
Calcification of bladder, fibrosis/stenosis of VUJ, bladder cancer
What are the infectious causes of GN?
Post-infectious glomerulonephritis
Endocarditis
Hepatitis B
Hepatitis C
HIV
Devel countries = TB, syphilis, malaria
What is post-infectious GN?
Inflam of nephrons due to infect elsewhere in the body
Group A streptococcus
Very rare in UK
1-4 weeks throat infect
Generally children (5 – 12) and > 60 year olds
What is endocarditis associated GN
Pts with endocarditis ending up with GN
Streptococcus viridans or Staphylococcus aureus
AKI
What are the risk factors that increase the risk of infection in CKD?
Co-morbidity = DM
Decreased immune response
Decreased vaccine responsiveness
Malnutrition
Nephrotic syndrome
Lots of hospital visits = increased exposure
Increasing age
If you have kidney disease what immune cells are defunct?
Neutrophils
NK
Dendritic/macrophages
Adaptive immunity = T and B cell’s
Why are haemodialysis pts at risk of infection?
Introduction of bacteria via dialysis lines
Bacteraemia common
Metastatic infections
What are peritoneal dialysis pts at risk of?
Peritonitis common
Cellulitis
Tunnel site infection
Chest infection
GI infections
UTI
Why are transplant patients at risk of infection?
Greatest immunosuppression in the first 3 months
Source = nosocomial, community-acquired, reactivated, donor-derived
UTI commonest infection
Immunosuppression can mask sign of infection = reduced inflam, temp may be normal, may not have raised WBCs, Ab response delayed
Outline the methods used to prevent infection in transplant
Prophylactic anti-microbials given during initial period after transplant
Co-trimoxazole (Pneumocystis pneumoniae)
Valganciclovir (CMV)
What of donors screened for?
Evidence of CNS infection
Evidence of sepsis
HSV – herpes simplex virus
VZV
EBV – epstine barr vius
HIV
Hepatitis B, Hepatitis C
TB
