How would a UTI present?
- Dysuria (pain on micturation)
- Smelly cloudy urine
- Flank Pain
- Strangury (Wanting to void but can’t)
- Confusion (elderly)
What microorganisms cause UTI?
Mostly bowel organisms
- E. Coli
- Proteus Spp.
- Klebsiella Spp.
- Pseudomonas Aeruginosa
What do we call infalmmation of the urethra, bladder, ureter or kidney?
Acute Pyeonephritis (chronic if recurrent or prolonged)
What are the main tests for UTI?
Mid Stream specimen of Urine - MSSU for urine culture & Microscopy
Suprapubic aspiration (mainly for people who cant give an MSSU e.g. young kids or elderly)
How do you tell if bacteria in a urine culture are pathogenic or contaminating commensals?
They grow in log scales in the culture. 10^5 is almost certainly infectious even if asymptomatic.
What are the complications of a UTI?
- Sepsis and septic shock
- Chronic pyelonephritis
- Calculi –> Obstruction –> Hydronephrosis –> Hypertension & chronic renal failure
What are the categories of UTI aetiology?
1) Stasis of Urine (either obstruction or loss of full bladder feeling)
2) Pushing bacteria up urethra (sex in women or urological procedures)
3) Generalised predisposition to infections (e.g. diabetes)
What can cause you to lose the feeling of a full bladder?
A spinal cord or brain injury
Whats the main cause of obstruction in children?
Its a loss of the angle of entry of ureter to bladder
What are the main causes of obstruction in adults?
- Benign Prostatic Hyperplasia (men)
- Uterine Prolapse (Women)
- Tumours & Calculi (both)
What are the consequences of an obstruction?
back up of urine causing hydroureter and hydronephrosis and eventually chronic renal failure.
Slowed flow –> Infection & sediment formation (calculi)
Why are women more at risk of UTIs?
- Short urethra
- No prostatic bacteriostatic secretion
- Close urethral orifice to rectum
- Sexual activity (vagina just behind urethra so pushes bacteria up)
- Pregnancy pressures the ureter & bladder
Why does diabetse predispose you to UTIs?
1) Glc in urine
2) Poorly functioning WBCs
How would a UTI present in a small child?
- Crying & not eating
How would pyelonephritis appear?
~dehydration Fever Loin/flank pain ~systemic unwellness/bacteraemia Cloudy Urine
Risk factors for a UTI?
- Immunosuppression (Long term CCS, DM or transplant meds)
- Anatomical Abnormalities e.g. horseshoe kidney or duplex collecting system
- Foreign Body e.g. catheter or stent
- Static urine due to Poor bladder emptying e.g. retention
- Pre-existing parenchymal disease
- Fistula between bladder/bowel
- Oestrogen Deficiency
How do you test for a UTI?
Dipstick Urinalysis looking for nitrites/protein/leucocytes and blood.
MSSU - Culture & Microscopy
What other tests would we do in kids with UTIs?
A micturating Cystogram to check for vesico-ureteric reflux
How do we treat most UTIs?
3-5 days of amoxicilin, trimethoprim or nitrofurantoin
How would we advise women with recurrent UTIs?
Drink plenty of fluids
Urinate frequently, particularly bbed and before/after sex.
How do we handle UTIs due to indwelling catheters.
Only treat if the patients symptomatic.
If you do treat you have to change the catheter before starting treatment
What radiological signs (CT) may indicate pyelonephritis?
- Clubbing of Calyces
- Emphysematous (gaseous) pyelonephritis. Lots of gas pockets within the kidney due to gas-forming bacteria.