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Flashcards in Renal infections Deck (20)
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1

Cystitis vs urethritis

Cystitis
- inflammation of the bladder
- **can be infection or generalized inflammation causes
- also presents with frequency and urgency as well as possible suprapubic pain

Urethritis
- inflammation of the urethra
- **strongly consider with younger males with dysuria
- often STI caused (chlamydia/gonorrhea)


**both present with dysuria**

2

What symptoms are needed to make a diagnosis of a UTI?

Pyuria (presence of white blood cell)

Bacteriuria (presence of bacteria in urine)

Symptoms of infections (fever, sniffles, headache)
- is atypical in elderly or spinal cord injury

3

Dipstick analysis for UTI

Leukocyte esterase
- breakdown of active WBCs

Nitrites
- present when bacteria reduce dietary nitrates
- ***enterobacteriaceae is the most affecting agent showing these

Blood trace on dipstick

**microscopy looks for WBC/RBC hpf
- pyuria = 10 or > wbc/hfp

***need the triad of blood, nitrates and leukocyte esterase on dipstick***

4

What types of UTIs are seen in immunocompromised patients, but almost never in normal immune systems?

Gonorrhea, trichomonas, chlamydia

5

What two species of bacteria that produce UTIs dont show leukocyte esterase on dipstick?

Enterobacteriacae
- will show nitrates but no leukocyte esterase

Staphylococcus saprophyticus
- wont show either nitrates or leukocyte esterase

6

What is the classic number of CFUs/mL in order to 100% diagnosis someone with a UTI?

10^5 CFUs/mL

*this is starting to drop down to 10^3, but the classic teaching is 10^5*

7

Why are male patients almost always complicated UTIs?

Because they hardly ever get them due to longer urethra

8

What types of patients require cultures?

Pretty much everyone who doesnt present with a simple uncomplicated UTI and is symptomatic
- children, men and pregnant women are automatically complicated UTIs

9

How does one make the diagnosis of asymptomatic bacteria?

Is a normal appearing person that lacks typical signs and symptoms of UTI’s
- especially no fever or vomiting

However urinary dipstick shows signs of infection and culture will come back positive with >10^5 with some organism

***lack of treatment does NOT lead to injury to the patient, as compared to pyelonephritis***
- therefore, we DONT treat patients with this as long as they are asymptomatic and are not pregnant!!

**if patient is pregnant or the patient is undergoing urologic procedures and can likely bleed, must still treat since it can affect the child**

10

What are long term complications of untreated UTI

Renal scarring and GFR dysfunction

HTN (sometimes malignant)

Septic shock

11

Why is it important to ask patients who present with UTI symptoms if they have recently been using antibiotics?

If they say yes, it likely is a resistant organisms you are dealing with

12

Classic presentation of a UTI

A female who presents with:
-Dysuria
-Frequency
-Urgency of urination without vaginal symptoms

**even higher chance if they state they have history of UTI/STD in the past**

***if the patient has all the above, especially the no-vaginal symptoms, then acute lower UTI = 90%***

13

First line therapies for uncomplicated UTI and cystitis

Nitrofurantoin (NO in pregnancy)

TMP-SMX (OK in pregnancy outside of the 3rd trimester)

Fosfomycin

Cephalosporins (3rd gen ceftriaxone/cefotaxime or 4th gen cefepime)

**second line = fluroquinolones**

***you don’t need imagining/cultures to diagnosis this and start treatment if the they have the classic triad of symptoms***

14

What is 1st line in VRE?

Carbapenems needed to be added
- ertapenem

15

What is added to cover MRSA infections

Vancomycin

16

When should you expect urinary tract infection obstruction with a UTI

If a patient is on appropriate antibiotics and they are not getting better (in fact often get worse)

17

When do you need to consider prostitis with a UTI?

Males who present with febrile UTIs
- requires 4-6 weeks of SMX-TMP or fluroquinolones

18

What is required to diagnosis sepsis?

SIRS criteria (need 2 of the 4) + infection = sepsis
SIRS criteria:
- temperature > 38.0 C
- heart rate > 90 bpm
- Respiratory rate > 20 breaths
- WBC > 12,000

Treatment = start IV fluids. If it doesn’t solve hypotension, then start vasopressors (usually NE 1st)

19

Multiple organ dysfunction syndrome

Progressive organ dysfunction in acutely ill patients
- can be caused by infectious or non-infectious diseases

**will show multiple organ systems failing which are seen bellow with the respective lab abnormalities
- hematologic = low platelet count/INR
- liver = bilirubin high
- brain = low GCS and AMS
- renal = low creatinine and urine output
- cardiovascular = low blood pressure and height heart rate
- respiratory = oxygen requirements
- cellular metabolism = high lactate

20

What is the #1 compounding risk factor in males that present with febrile UTIs?

Prostatitis
- almost always shows this (90%)
- needs 4-6 weeks of treatment