Renal - Urinary Tract Infections

Question 1

What is a urinary tract infection?

Answer 1

Persistent colonization of any point of the urinary tract (except for the distal portion) by microorganisms

Question 2

What usually is the origin of UTIs?

Answer 2

Migration (ascending) enteric bacteria from the lower urinary tract

Question 3

What makes up the upper urinary tract?

Answer 3

Kidneys and ureters

Question 4

What makes up the lower urinary tract?

Answer 4

The bladder and urethra

Question 5

What part of the urinary tract is not sterile?

Answer 5

The distal urethra/prepuce

Question 6

What is the normal flora of the male dog urinary tract?

Answer 6

Mixed population (Gram +/-, aerobic/anaerobic)

Question 7

What is the normal flora of the male cat urinary tract?

Answer 7

Mixed population (gram +/-), mostly aerobic, some anerobic - Pasterurellaceae, E. coli, and Staph/strep

Question 8

What is the normal flora of the female dog urinary tract?

Answer 8

Mixed population (Gram +/-, aerobic/anaerobic)

Question 9

What is the normal flora of the female cat urinary tract?

Answer 9

Almost exclusively aerobic

Question 10

What is bacterial cystitis?

Answer 10

bacterial infection of the bladder

Question 11

What is bacterial pyelonephritis?

Answer 11

Bacterial infection of the renal pelvis and kidney

Question 12

What is small volumes of urine known as?

Answer 12

pollakiuria

Question 13

What sex are UTIs most common in?

Answer 13

females

Question 14

Are dogs or cats more likely to get UTIs?

Answer 14

Dogs - up to 14% of dogs will have a UTI in their lifetime

Question 15

Less than _____ of cats with lower urinary tract signs have UTIs.

Answer 15

Less than 10%

Question 16

What percentage of cats below the age of 10 with urinary tract signs have UTIs?

Answer 16

less than 2 %

Question 17

What percentage of cats above the age of 10 with urinary tract signs have UTIs?

Answer 17

10-20 % of cats

Question 18

What are the lower urinary tract signs?

Answer 18

Pollakiuria, dysuria, and hematuria

Question 19

Lower urinary tract signs are associated with what urinary disease process?

Answer 19

cystitis

Question 20

Pyelonephritis is associated with ________ signs +/- lower urinary tract signs.

Answer 20

systemic signs

Question 21

What systemic signs are associated with pyelonephritis?

Answer 21

fever, depression, vomiting, renal pain, and PU/PD

Question 22

True or False: Subclinical bacteriuria is associated with no symptoms.

Answer 22

TRUE

Question 23

How are subclinical bacteriuria infections found?

Answer 23

Bacteria are identified on routine urine cultures with no lower urinary tract signs

Question 24

Subclinical bacteriuria is higher in patients with comorbidities. What comorbidities is it associated with?

Answer 24

Diabetes mellitus, obesity, chronic kidney disease, acute intervertebral disk disease, and chronic immunosuppression

Question 25

What are the most common orgamisms associated with subclinical bacteriuria?

Answer 25

E. coli and Enterococcus faecalis

Question 26

What CBC/Serum chemistry signs are associated with pyelonephritis?

Answer 26

neutrophilic leukocytosis, azotemia, and hyperphosphatemia

Question 27

What will you see on urinalysis in patients with urinary tract infections?

Answer 27

Increased pH with urease producing bacteria, pyuria WBC presence, hematuria, proteinuria, bacteriuria, and granular/cellular casts (pyelonephritis)

Question 28

What is the gold standard diagnosis for urinary tract infections?

Answer 28

urine culture

Question 29

What sample should be used for urine culture?

Answer 29

sterile urine sample - cystocentesis

Question 30

Does urine culture confirm the location of a urinary tract infection?

Answer 30

no

Question 31

How do you determine the location of a urinary tract infection?

Answer 31

Abdiminal radiographs, ultrasound, and prostatic wash

Question 32

What are the mechanisms of defense of the urinary tract?

Answer 32

Anatomy, urine chemical/physical characteristics, normal urine flow and voiding, local (mucosal) defenses, and systemic immunity

Question 33

What anatomical mechanisms defend the urinary tract?

Answer 33

Proper anatomy prevents retrograde flow of urine/bacteria, ureteral peristalsis, ureterovesicular valve, high urethral pressure, and well exposed vulva

Question 34

What antatomical disorders can cause impaired host defenses against UTIs?

Answer 34

Recessed (hooded) vulva, vestubulovaginal septal remnant, ectopic ureters, hydroureter, incomplete urethral sphincter mechanism, and indwelling catheter

Question 35

What urine characteristics provide defense from UTIs?

Answer 35

Hyperosmolality, lack of bacterial substrate, organic acids, and urea

Question 36

At what pH is the urine a good defense mechanism?

Answer 36

<5 so it is likely not a physiologic mechanism of defense

Question 37

What pathologic conditions can effect urine as a defense mechanism?

Answer 37

Loss of hyperosmolality and presence of bacterial substrate

Question 38

What can cause loss of hyperosmolality?

Answer 38

Chronic kidney disease, hyperadrenocorticism, and hyperthyroidism

Question 39

What can cause the presence of bacterial substrate in urine?

Answer 39

Diabetes mellitus

Question 40

What are the components of urine flow that can aid in defense?

Answer 40

adequate volume of flow, frequent voiding, and complete voiding

Question 41

What pathological conditions can effect normal flow of urine?

Answer 41

Spinal cord injury (most common), urethral/ureteral obstruction by a tumor or stone, detrusor muscle atony

Question 42

What are the mucosal defenses of the urinary tract?

Answer 42

Glucoaminoglycans, cellular exfoliation, and resident flora

Question 43

What type of molecules are glucosaminoglycans?

Answer 43

hydrophilic molecules

Question 44

What do glucosaminoglycans do?

Answer 44

They protect the epithelium from urine and bacteria attaching to them

Question 45

How can glucosaminoglycans become damaged?

Answer 45

tumors and stones

Question 46

What do resident flora of the distal urinary tract do?

Answer 46

They block migration

Question 47

What antibodies are present in the urine?

Answer 47

IgG and IgA

Question 48

Increased prevalence of UTIs are seen in patients receiving _______ and ________ as well as patients with ___________ __________ that affect systemic immunity.

Answer 48

Glucocorticoids, immunosuppressives, and endocrine diseases

Question 49

True or False: 70-90% of UTIs involve only one type of bacteria.

Answer 49

TRUE

Question 50

Are most urinary tract infections gram positive or gram negative?

Answer 50

Gram negative

Question 51

What virulence factors aid in bacterial pathogenesis?

Answer 51

Hemolysin, urease, and P fimbria

Question 52

What does hemolysin do?

Answer 52

It lyses RBCs, WBC, and epithelial cells and then releases iron for bacteria

Question 53

What does urease do?

Answer 53

It degrades urea into CO2 and NH3 which increases pH and causes epithelial damage and aids bacterial attachment

Question 54

What is urease produced by?

Answer 54

Proteus, Staphylococcus, and Klebsiella

Question 55

What does urease promote the formation of?

Answer 55

struvites

Question 56

What do P fimbria allow for?

Answer 56

adhesion to the epithelium and some allow intracellular uptake of E. coli

Question 57

What factors must you consider when choosing appropriate antimicrobial therapy?

Answer 57

What are the most common bacteria? Which antibodies are concentrated in urine? Where is the nidus of infection? Does the patient have comorbidities?

Question 58

What antibodics are good for emperical therapy of UTIs?

Answer 58

1st generation cephalosporins and tetracyclines

Question 59

What are the antibiotics that have the best activity against urinary tract infections?

Answer 59

Penicillin, TMS, later generation cephalosporins, fluoroquinolones, and amnioglycosides

Question 60

What antibiotics are secreted in high concentrations in the urine?

Answer 60

Sulfonamides, beta-lactams, fluoroquinolones, and aminoglycosides

Question 61

What should you assume that is going on simultaneously in 90% of intact males that have bladder infections?

Answer 61

prostatitis

Question 62

What antibiotics are best for prostatitis (general)?

Answer 62

Antibiotics that are weak bases and/or lipophilic

Question 63

What antibiotics are best for prostatitis (specific)?

Answer 63

fluoroquinolones, trimethoprim, and clindamycin/macrolides

Question 64

Typically, how long is prostatitis treatment?

Answer 64

6 weeks long

Question 65

What should you always do in cases of pyelonephritis?

Answer 65

culture/sensitivity

Question 66

What antibiotics are best for pyelonephritis?

Answer 66

Fluoroquinolones and Nitrfurantoin (not if bacteremia)

Question 67

How long should treatment be for pyelonephritis?

Answer 67

at least 6 weeks

Question 68

What is a sporadic UTI?

Answer 68

Sporadic bacterial infection of the bladder in an otherwise healthy individual with a normal urinary tract anatomy and function

Question 69

What classifies as a recurrent UTI?

Answer 69

When there are more than 3 UTIs in a year

Question 70

What is a recurrent UTI?

Answer 70

Infection that occurs in the presence of an anatomic or finctional abnormality or comorbidity that [redisposes the patient to persistent or recurrent infections

Question 71

What is the recommended length of treatment for a sporadic UTI?

Answer 71

3-5 days

Question 72

What is the recommended length of treatment for a recurrent UTI?

Answer 72

minumum of 3-5 days and can be up to 2 weeks

Question 73

When should reevaluation occur for recurrent UTIs?

Answer 73

Culture urine 5-7 days into treatment and 7 days after treatment

Question 74

What abnormalities and comorbidities are associated with UTIs?

Answer 74

Prostatitis, pyelonephritis, uroliths, urinary tract neoplasia, anatomic/functional abnormalities, endocrine diseases, and immunocompromise