What are some clinical signs of cystitis? What type of symptoms are usually absent?
Present: dysuria, urgency, frequency, suprapubic pain
Absent: systemic signs - fever, chills, etc.
In cystitis, describe lab findings on:
- Urinalysis
- Dipstick
- Culture
- Cloudy urine with > 10 WBCS/hpf
- Positive leukocyte esterase & nitrites
- > 100,000 CFU
What are the top 5 most common microorganisms causing cystitis?
- E coli
- Staph saprophyticus
- Klebsiella pneumoniae
- Proteus mirabilis
- Enterococcus faecalis
What is sterile pyuria?
Pyuria ( > 10 WBCs/hpf + leukocyte esterase positive) but negative urine culture
What are some causes of sterile pyuria?
- Urethritis due to Chlamydia or Neisseria gonorhoeae
- Stones
- Cancer
- TB
What do people with pyelonephritis present with?
Systemic signs: fever, etc + flank pain
Lab findings: WBC casts, leukocytosis
+ Symptoms of cystitis
What are the three most common pathogens causing pyelonephritis?
- E coli (90%)
- Klebsiella
- Enterococcus faecalis
What are the consequences of multiple incidences of acute pyelonephritis?
Interstitial fibrosis & atrophy of tubules
What effects does chronic pyelonephritis have on the kidney?
- Scarring in cortex (scarring specifically in upper and lower poles characteristic of VUR)
- Blunted calyces
- Waxy casts in urine
What is seen in the kidney tubules of an individual with chronic pyelonephritis? What does this resemble?
Contains eosinophilic proteinaceous material –> resembles thyroid follicles
Name two risk factors for the development of kidney stones.
- Increased concentration of solute in urinary filtrate
2. Low urine volume
What do individuals with a kidney stone present with?
- Colicky pain
- Hematuria
- Unilateral flank tenderness
What does one do about a kidney stone?
Wait. Usually passes within hours. If it doesn’t, surgery!
What is the most common type of kidney stone?
Calcium oxalate and/or calcium phosphate
How do you treat someone with recurrent calcium stones?
HCTZ –> Ca sparing diuretic (increased Ca absorption via enhanced Na Ca exchanger)
Or citrate
Calcium oxalate crystals are associated with what?`
- Ethylene glycol
- Vitamin C abuse
- Crohn disease
What is the most common cause of ammonium magnesium phosphate stones?
Infection with urease-positive organisms (Proteus, Klebsiella)
What type of stones do ammonium magnesium phosphate stones form?
Staghorn calculi in renal calyces –> increase risk of UTIs
How are ammonium magnesium phosphate stones treated?
Surgical removal & eradication of pathogen to prevent recurrence
What is the only type of stone that is radiolucent?
Uric acid stones
What are risk factors for developing uric acid stones?
- Hot, arid climates
- Low urine volume
- Acidic pH
What type of stones are commonly seen in gout patients?
Uric acid stones
How do you treat someone with uric acid stones?
- Hydration
- Alkalinization of urine –> potassium bicarbonate
- Allopurinol in gout patients
Which type of stone is commonly seen in children?
Cysteine stones
