renal infections and tumours: Flashcards
Urinary tract infection (UTI):
Inflammation of
urinary tract - Usually caused by bacteria from gut flora
Classified according to location Cystitis– bladder inflammation Pyelonephritis – inflammation of upper urinary tract Urethritis – inflammation of the urethra
Urinary tract:
Normally – most bacteria washed out of
the urethra during micturition
• Bladder contraction prevents reflux of urine to the ureters and
kidneys.
Bacteriocidal Environment • Low pH • High osmolarity of urea • Secretions from uroepithelium • Presence of a protein called Tamm-Horsfall protein (uromodulin)
urinary tract infection
- predisposing factors:
- Age / host defense – Pregnancy – Calculi – Medical procedures (e.g catheter) – Diabetes – Chemotherapy – Tumors – Antibiotics
Urinary tract infection:
Presents as a clinical constellation of symptoms
• Pyelonephritis is common in younger
women
•Unilateral symptoms are suggestive of
pyelonephritis rather than ureteric extension of cystitis which is more likely to be bilateral
• Often occurs in otherwise well
women
UTI’s: CYSTITIS
Cystitis is inflammation of bladder
• Infection with coliform
bacteria
– E. coli 80%
– Klebsiella, Proteus, Staph (10%), Pseudomonas
• (Can also be caused by fungal infection ,parasitic invasion –Schistosomiasis–Africa, South America)
• Women (30%) > Men (1%); Why?
•≈10% of women will have a UTI per year
• ≈60% of women will have a UTI in a
lifetime
ACUTE CYSTITIS – CLINICAL FEATURE:
- signs of bladder irritability and cloudy urine:
signs of bladder irritability: • Urgency • Frequency • Dysuria (painful urination) • Lower abdominal pain
cloudy urine: • Pyuria (pus in urine) • Hematuria • Bacteriuria (70%) • Chills, fever, nausea, vomiting
- 10% asymptomatic
ACUTE CYSTITIS – CLINICAL FEATURE:
serious symptoms:
more serious symptoms:
- Cloudy urine
- Hematuria
- Foul smelling urine
- Flank pain
ACUTE CYSTITIS – CLINICAL FEATURE
- asymptomatic and older patients:
Asymptomatic
• Healthy people may have evidence of bacteria in the urine but have no infection
•‘Asymptomatic bacteriuria’ – no treatment required exceptin pregnant women.
Older patients
•May not experience these
symptoms
• Often experience non–localised abdominal discomfort
•ALSO AT RISK OF CONFUSION, COGNITIVE IMPAIRMENTAND RAPID PROGRESSION TO SEPSIS
•Older adults with UTI and another concurrent illness are at greater risk of
mortality
UTI - management:
- History, presenting signs, urinalysis,
urine culture, full blood count
•Identifying presence of bacteriuria & Px
of appropriate AB
• Managing any underlying risk factors
e.g. obstruction
• Very common for recurrence (25% within a week)
• Follow up urine cultures are recommended to avoid repeat attacks
• BUN, creatinine, electrolyte values obtained to rule out change in renal function
UTI - management:
Older patients (esp. from nursing homes) are often resistant to some antimicrobials • Interventions also include – Antibiotics – Adequate fluid intake – Urinary alkaliniser • Intravenous rehydration may be needed in severe cases • Hot packs to relieve discomfort
UTI’s: Acute Pyelonephritis
Bacterial infection of the upper urinary tract – renal pelvis
• Usually caused by E. coli (80%) after an underlying, predisposing condition
• Usually occurs because of spread from ureter (cystitis) but may occur from blood borne infection
• Will affect renal pelvis, calyces & medulla
– it is rare for glomerular involvement
• If infection is extensive, can permanently damage tubules
• Can result in permanent renal
damage
UTI’s: Acute Pyelonephritis
- patho:
- clinical manifestations:
Pathology
• Enlargement, scalered areas of
abscess, increased neutrophils in the
tubules
- Clinical Manifestations
Generally produces fever, chills, flank p
proteinuria, pyuria (PMN’s
in the urine) white cell casts hematuria, generalized malaise
Different symptoms from cystitis by clinical manifestation alone is difficult
UTI’s: Acute Pyelonephritis:
Prehospital management
Prehospital management
• pain relief
• transport
• Consider fluids (consult for ALS)
– Septic & hypotensive
– Long transport
Definitive
– Antibiotic therapy
UTI’s - Treatment:
Prehospital
– Symptomatically
– Analgesia
Definitive treatment – Blood and urine tests required – Analgesics (anaesthetics, opiates) – Fluid replacement – Anti- emetics
UTI’s: CHRONIC PYELONEPHRITIS
• By definition, any chronic renal inflammation
• By name-honoured misnomer, severe scarring from one or more kidney
infections
• Pyelonephritis always produces some renal scarring around the calyces and renal pelvis and among the tubules
• Once scarring occurs, one
is more likely to get a bacterial infection (blood borne)
