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Summary Essential Notes: Renal Medicine: Urinary Tract Infections
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PathologyUrinary tract infections Urinary system has many defences:
Micturition
Urine osmolarity, pH + organic acids are antibacterial
Definition infection of the urinary tract w/ typical signs + Secreted factors Tamm-Horsfall protein binds bacteria
symptoms: either upper/lower; F > M non-specifically, produced by cells of the thick ascending
Aetiology LoH
In females, urinary tract is anatomically normal IgA specific bacteria
In males/children, there is an anatomical abnormality Lactoferrin hoovers up free Fe
Commonly due to bacteria in the pts own bowels – common Mucosal defences micropolysaccharides coat mucosal
route of transmission is: up the urethra, through blood, surfaces of the bladder
lymphatics/fistula
UTI can infect any part of the urinary tract: Signs + symptoms
LUTI fever/chills, flank pain, haematuria
Bladder = cystitis
UUTI dysuria, frequency, urgency, suprapubic pain
Prostate = prostatitis = most common in males Pyelonephritis fever, rigors, loin pain, tenderness, vomiting,
Renal pelvis = pyelonephritis oliguria if ARF
UTIs more common in diabetics Cystitis frequency + urgency, polyuria, haematuria, dysuria,
RF suprapubic tenderness, foul-smelling urine
Female Prostatitis flu-like, lower backache
Sexual intercourse
Catheterisation Ix
Pregnancy Urine dipstick: positive leucocytes + nitrates
Menopause Urine culture (MSU) Bacteria >105 organisms in urine Dx
Diabetes Bacteria > 102 + pyuria Dx
USS/cystoscopy if UTI in children, men/recurrent
Genitourinary malformation
Immunosuppression Mx
UT obstruction e.g. stones Lower urinary tract infections
Non-pregnant = Trimethoprim/Nitrofurantoin for 3 days
Causative organisms Pregnant = symptomatic bacteria Abx for 7 days
1. E. coli (>70% in community, >40% in hospital) Asymptomatic bacteruria = Rx w/ Abx during pregnancy + culture
2. Staph. saptophyticus =2nd leading cause in sexually before + after Rx
active females Pyelonephritis = Cefotaxime Ig IV BD 10 days
3. Klebsiella= 3rd leading cause Acute pyelonephritis = hospital admission blood spectrum
cephalosporin/quinolone for 10-14 days
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