9 - Infection and chronic kidney disease Flashcards
(14 cards)
Why is repeated pyelonephritis a problem?
Causes renal scarring
How does TB affect the urinary tract?
Starts in the kidneys, can cause calicification and caseous necrosis (granuloma). Spreads to ureter haematogenously, causing sterile pyuria or haematuria. Thickening of the bladder due to fibrosis, causing reflux and ESRD
What organism causes schistosomiasis?
Shistosoma Haematobium
How does schistosomiasis affect the urinary tract?
Causes chronic cystitis, calcification of bladder, fibrosis and stenosis of vesico ureteric junction and bladder cancer
What systemic infections cause glomerular nephritis
Endocarditis, Hep B and C, HIV, TB, syphilis, malaria and post infectious glomerulonephritis (after streptococcal infection)
What organisms cause endocarditis that affects the kidneys?
Streptococcus viridans
Staphylococcus aureus
What symptoms will present with endocarditis associated kidney disease?
AKI
Non visible haematuria
Fever
Arthralgia (joint pain)
What alternative mechanisms can cause endocarditis to cause kidney disease?
AKI from antibiotics
Renal infarction from septic emboli
Why is interferon gamma release assay for screening TB used in patients with ESRD?
Because many patients with ESRD have anergy (dont react to TB skin test) and immunosuppressants interfere with the tuberculin skin test too
How does the infection risk of patients on haemodialysis differ?
Many are anuric, so unlikely to get UTIs
Likely to get bacteraemia, so metastatic diseases common (eg osteomyelitis - bone infection, heart valve disease), chest and GI infections
What kinds of infection are patients on peritoneal dialysis likely to develop?
Peritonitis
Cellulitis
UTIs
Chest and GI infections
How are transplant patients likely to develop infections?
Nosocomial (hospital acquired)
Community acquired
Donor derived
Reactivation of previous infection - TB, Hep B and C, BK polyomavirus (harmless except in renal failure)
How do immunosuppressants alter signs of infection?
Reduced inflammatory response
Normal temperature
Normal WBC
Antibody response relayed
What treatment is given prophylacticly to immunosuppressed patients?
Co-trimoxazole (for pneumocystis pneumonia)
Valganciclovir (CMV cytomegalovirus)
Isoniazid (TB)
Vaccines for influenza, hep B, pneumococcal (streptococcus pneumonia), meningococcal (neisseria meningitidis)- not live vaccines
