Give examples of UTIs.
- Pyelonephritis
- Renal abscess
- Cystitis
- Urethritis
- Prostatitis
- Epididymo-orchitis
What is the incidence of UTI?
- Common
- Accounts for around 6% of GP consultations
Who is usually affected by UTI?
- F:M 3:1
- Affects 30% of women at some time
What is UTI an important cause of in children?
CRF
What is the incidence of pyelonephritis in women?
3 per 1,000 women per year
What is the incidence of symptomatic UTI in men?
5 per 10,000 men per year
How prevalent is UTI as an HAI?
Accounts for around 38% of HAI (the largest contributor)
General factors which make an individual
more susceptible to UTI (or other infection)
include:
- Immunosuppression
- Steroids
- Malnutrition
- Diabetes
What factors may predispose someone to UTI?
- Female sex (short urethra)
- Sexual intercourse and poor voiding habits
- Congenital abnormalities e.g. duplex kidney
- Stasis of urine e.g. due to poor bladder emptying
- Foreign bodies eg catheters, stones
- Oestrogen deficiency in postmenopausal women
- Fistula between bladder & bowel
Why can wiping from front to back after a bowel movement cause UTI?
It may force germs into the urethra
What organisms usually cause UTI?
Bowel Organisms
- E. coli
- Proteus
- Klebsiella
- Entercoccus
How can bowel bacteria be transferred to cause UTI?
- Transurethral route
- Bloodstream
- Lymphatics
How may bacteria be transferred from the urethra to the bladder?
- Intercourse
- Catheterisation
What events usually occur to result in UTI caused AKI?
- Colonisation
- Uroepithelium penetration
- Ascension
- Pyelonephritis
- AKI
How can UTI be classified?
- Single episode (90%) vs recurrent
- Complicated vs uncomplicated
What are the clinical features (signs and symptoms) of UTI in children?
- Diarrhoea
- Excessive crying
- Fever
- Nausea and vomiting
- Not eating
What are the clinical features (signs and symptoms) of UTI in adults?
- Flank pain
- Dysuria (“like passing broken glass”)
- Cloudy offensive urine
- Urgency
- Chills
- Strangury (desperate to pee but only small/nothing comes out)
- Confusion (very old people)
What are the clinical features of acute pyelonephritis?
- Pyrexia
- Poor localisation
- Loin tenderness (renal angle)
- Signs of dehydration
- Turbid urine
How should UTI be investigated?
- MSSU
- Urinalysis in ward
- Microbiology in lab (microscopy and gram staining)
What are you looking for in the urinalysis carried out on the ward?
- Blood
- Leucocytes
- Protein
- Nitrites
When should culture and sensitivity be carried out on urine samples?
Bacteruria >10^5 CFU/ml
What should be carried out on children, males or recurrent UTI patients?
- US or IVU may be helpful
- Isotope studies to rule out reflux and scarring
What are the principles of UTI management?
- Identify the infecting organism & institute appropriate treatment
- Identify predisposing factors and treat if possible
What is the treatment for UTI?
- Fluids
- Antibiotics
- IV antibiotics (for severe infections)
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Introduction38
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Embryology48
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Glomerular Filtration42
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Reabsorption and Filtration61
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Loop of Henle46
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Regulation of Osmolality60
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ECF Volume Regulation75
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Pathology of UTI61
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Glomerular Disease51
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Acid Base Balance131
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Physiology of Micturition82
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Presentation of Diseases97
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Clinical Glomerular Disease69
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Acute Kidney Injury56
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Chronic Kidney Disease119
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Transplantation58
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Dialysis34
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Benign Prostate Disease63
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Urinary Tract Obstruction27
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Clinical Pharmacology66
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Tumours of the Urinary System6
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Imaging32
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Nephro-Urolithiasis40
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The Kidney in Systemic Disease61
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Organ Donation18
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UTI39
