UTIs/nephrotic/nephritic syndrome

Question 1

what is a complicated and uncomplicated UTI

Answer 1

complicated = men, pregnancy, immunocompromised 
uncomplicated = non pregnant women

Question 2

Presentation of UTI

Answer 2

dysuria 
frequency and urgency 
Haematuria 
smelly urine 
Suprapubic pain and tenderness 
back and flank pain 
elderly confusion 
Fever (indicates pyelonephritis)

Question 3

causative agent of UTI

and their effects

Answer 3

E Coli, commonest 50%
kelbestia - more likely to occur during hospital stay
proteus- stones
S. Aureus - risk of infective endocarditis
Pseudomonas chlamydia - immunocompromised

Question 4

Investigations for a UTI

Answer 4

Urinalysis
dipstick - proteinuria, nitrites, pyuria (wbc)
MSU MC and S increased wcc and bacteria (MIDSTREAM)

Question 5

dipstick for a UTI

Answer 5

proteinuria, nitrites, leukocytes

haematuria, pyuria (WBCs in urine)

Question 6

what is a lower and upper UTI

Answer 6

Lower= cystitis (Bladder), urethritis (urethra) or prostatitis 
Upper= pyelonephritis, ureteritis

Question 7

what is pyelonephritis

Answer 7

Infection of the renal pelvis by UTI

Question 8

presentation of pyelonephritis

Answer 8

Same as lower UTI ( dysuria, haematuria, Frequency, suprapubic pain and tenderness)

TRIAD = LOIN PAIN
FEVER
RENAL TENDERNESS
plus N+V, rigors

Question 9

Treatment of UTI: cystic UTI complicated or uncomplicated

Answer 9

Oral TRIMETHOPRIM
or IV gentamicin if in patient care
or amoxicillin

Question 10

Treatment of UTI: pyelonephritis

Answer 10

ciprofloxacin

Question 11

what is defined as recurrent UTI

Answer 11

more than 2 in 6 months

more than 3 in a year (same bacteria)

Question 12

what is a uti usually associated with

Answer 12

bacteriuria and pyuria (WBC in urine)

bacteriuria = pure growth of more than 10^5 organisms per ml collected from fresh CLEAN CATCH urine sample

Question 13

whats a uti in bladder called (Upper or Lower)

Answer 13

cystitis

lower

Question 14

what uti in prstate called (Upper or Lower)

Answer 14

prostatitis

lower

Question 15

whats a uti in uterthra called (Upper or Lower)

Answer 15

urethitis

lower

Question 16

UTI in uereter caller

Answer 16

ureteritis

upper

Question 17

UTI in renal pelvis

Answer 17

pyelonephritis

upper

Question 18

what are RF of pyelonephritis

Answer 18

increased compicated
- age -= infants, elderly
anatomical abnormaloty - PKD horsehoe kindey
forgein body (stone or catheter)
immunocomp (DM, transplant, chemo HIV/aids)
pregenant

Question 19

Mx of pyelonephritis

Answer 19

ciprofloxacin ABX IV
fluids
drain obstructed kidney
analgesia

Question 20

what does nephritic sydnrome show on microscopy of urine

and dipstick

Answer 20

RED CELLS CASTS

dipstick = haemturia

Question 21

diference between nephrItic and nephrOtic syndrome basic

Answer 21

nephrItic = heamaturia and proteinuria
nephrOtic = proteinuria ONLY. NO BLOOD

Question 22

triad of presentation for nephrItic syndrome vs nephrOtic

Answer 22

nephrItic = heamaturia, oliguria and HTN
nephrOtic = proteinuria, hypoalbuminemia and
oedema

Question 23

what causes nephritic syndrome

Answer 23

Commonest cause is IgA nephropathy (primary cause)
Secondary causes=
SLE,
Goodpasture’s (ANti GBM disease, cresecnt shaped pulm haemorrhage glomeruli)
POST STREP URTI INFECTION

Question 24

what is malfunctioning in nephrotic sydnrome

Answer 24

struct chagnes and functional abnormalilities of the pPODOCYTES
= foot processes fuse = MINIMAL CHANGE DIEASE (children)
=or podocyte LOSS == inadeq filtration barrier = PROTEINURIA

Question 25

what is minimal change disease

Answer 25

primary cause of nephrotic syndrome in children podocyte foot processes fuse togeter = no longer filtration barrier = protien loss

Question 26

why is there albumin loss in nephrotic sydnrome

Answer 26

foot processs damaged - no longer neg charge so dont repel albumin albumin lsot to glomerular filtrate = lowers oncotic p in blood= low osmotic p = water moves OUT into tissues = OEDEMA (hence triad = hypoalbuminaeima, proteinaeimia, oedema)

Question 27

causes of nephrotic syndorme

Answer 27

primary = minimal change membranous nephropathy - thick GBM ``` secondary = hep C or B DIABETIC NEPHROPATHY SLE Malignacny Drugs (NSAIDs) ```

Question 28

complications of nephrotic syndrome

Answer 28

``` thromboembolism as liver in overdrive to replace protieins lost (?) i.e increased clotting factors == (LMW Heparin, warfarin) DVT renal v thrombosis INfections - give vaccine - pneumococcal hyperlipidaemia - statins ```

Question 29

Treatment of Nephrotic syndrome

Answer 29

``` primary - min change disease = steroids Oedema= Loop diuretic furosemide Proteinuria: ACEi or ARB Prevent atheromas by statins and anticoagulation Treat underlying cause ```

Question 30

what see on dipstick of nephrotic syndrome

Answer 30

high proteins | NO BLOOD

Question 31

what see in blood of nephrotic syndrome

Answer 31

LOW albumin (can now pass through barrier as faulty)

Question 32

management of nephritic sydnrome

Answer 32

Antihypertensives = salt restriction - loop dieruetics (furosemide), CCBs (amlodipine) Treat cause

Question 33

what infection is main cause of nephrItic synsrome

Answer 33

streptococcus URTI infection