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Lecture: Infection and Immunity
Date: Thursday 4th April
Time: 11am – 12pm
Urinary Tract Infections: Function to Infection
Today we are going to provide an overview of the kidneys, how to diagnose an infection and
the perspective of microorganisms involved (their features, properties etc). The last section
will discuss treatment, and antibiotics.
Symptoms of a kidney infection:
- Cloudy urine
- Pain in groin or lower back or side or abdomen
- Nausea
- Vomiting
- Pattern of urination
- Burning or painful urination
- High fever and chills
Risk factors:
- Compromised immune system.
- Damage to urinary tract
- Females have higher frequency and risk.
- Pregnancy
What does the urinary tract do?
The Urinary Tract, also known as the renal system, consists of the kidneys, urethras to the
bladder and ureters. The kidneys remove liquid waste from the blood in the form of urine.
Narrow tubes called ureters carry urine from the kidneys to the bladder. Urine is stored in
the bladder and emptied through the urethra. Ureter blood vessels enter and exit the kidney
through the renal hilum. When you pass urine, it leaves the bladder through the urethra.
The urethra opens in front of the vagina in women and penis in men.
Kidneys are bean shaped and just below the rib cage, measuring 10 – 12cm in width and
150g in weight. Normal function is described by the GFR which is the volume of plasma
cleared of an ideal substance at the time.
Function:
- Removing waste
- Regulating salt concentration.
- Regulate fluids in the body.
- Regulate blood pressure.
- Maintains acid base balance.
1
, - Produce hormone and hormone like compounds (i.e. vitamin D, erythropoietin and
prostaglandins)
UTI
The average adult passes about a quarter and a half of urine each day, depending on fluids
and foods consumed, the volume formed at night is half than in the daytime. Normal urine is
sterile, it contains fluids, salts and waste products but should be free of bacteria, viruses,
and fungi. This topic is still undetermined and up for discussion.
The microbiota of urinary tract to UTI
Researchers believe the microbiome plays a role in UTIs. The microbiome of women
(diagram 1), displays 25 samples of women with and without urgency urine incontinence. It
shows you have a diverse endogenous microflora but there is a move when we go from
control to infection. Anaerobic organisms can be problematic but thought not in bacterial
vaginosis to be sole cause of infection. This image represents a cross section of bacteria.
Another study looks at UUI (2016), showing displacement alteration of numbers within the
fibre (See slide 10). If we look at the UTI microbiome, from control to case, there is an
increase in proteobacteria, Enterobacteriaceae and comamonadaceae. As well as a decrease
in Bacteroidetes and prevotellaceae.
Nomenclature of bacterial diseases of Urinary Tract
1) UTI
2) Bacteriuria
3) Covert bacteriuria – presence during sampling
4) Upper tract bacteriuria
5) Bacterial cystitis
6) Abacterial cystitis
7) Acute bacterial pyelonephritis – a movement from initial opening of the urethra to
the kidneys. Kidney infection due to bacteria.
Prevalence of UTIs– 20% of women aged 20-65 will suffer one annually and 50% develop
a UTI during their lives. Prevalence varies depending on age and sex. The risk for girls
after 6 months is greater than boys. There is a 10-fold increase in incidence for older girls
compared to boys and this continues through adult life until 55.
Urinary Tract Infections
UTIs are the presence of microorganisms within the urinary tract but can be difficult to
distinguish between.
1) Contamination – pathogen colonises the urethra and towards bladder.
2
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