Urinary Tract Infections, Pyelonephritis - Medicine - RDT

Topic: Urinary Tract Infection, Acute Pyelonephritis, Chronic Pyelonephritis, Cystitis
Faculty: General Medicine
Course: BSc RDT- 2nd year

1. URINARY TRACT INFECTIONS Dr. Salman Ansari Kanachur Institute of Medical Sciences

2. Urinary Tract Infections Definition : Infection of any part of the urinary tract Presence of more than 10 5 organisms/ml in midstream sample of urine(MSU)

3. Contents

4. Classification Lower UTI C ystitis (bladder) Prostatitis urethritis Upper UTI kidney(pyelonephritis) Perinephric abscess

5. “Asymptomatic bacteriuria” Presence of bacteria(>10 5 /ml on 2 occasions in females and 1 occasion in males) without any symptoms It is common in pregnancy There are no symptoms Does not usually require treatment

6. Causes of UTI Causative organism : Majority(85%) of UTIs are due to gram-negative bacilli Most common : E. coli, Proteus, Klebsiella, Enterobacter, Pseudomonas Less common” Streptococcus faecalis, viruses

7. Pathogenesis Route of infection : Bacteria reaches urinary tract via: bloodstream, lymphatics or directly Most common: ascending route, via urethra - called “ transurethral route ” Ascending infection : infection ascends from lower urinary tract into the renal parenchyma

8. Risk factors UTIs are more common in females , due to the following: Shorter urethra(4 cm) Absence of prostatic fluid, which has antibacterial effect Hormonal changes in females Trauma to urethra during sexual intercourse makes it easier for bacteria to enter the bladder Gram-negative organisms living around the anal region colonise the periurethral region

9. Clinical features of UTI Fever with chills and rigor Problems with micturition, such as: Increased frequency Painful micturition - “dysuria” Burning micturition Urgency

10. Desire to pass more urine after bladder has been emptied - “strangury” Suprapubic pain Hematuria Cloudy urine with unpleasant odour

11. Investigations Urine examination: Dipstick tests : positive nitrite test and leukocyte esterase test Microscopic examination : WBCs, WBC casts and RBCs seen Urine culture : using MSU specimen

12. Special investigations : Cystoscopy Renal USG Intravenous urography DMSA renal scan

13. Treatment of UTI Antibiotic therapy Antibiotic depends on result of urine C&S Cotrimoxazole(trimethoprim and sulfamethoxazole) 1 double strength tablet two times daily Ampicillin 250 mg three times daily Amoxicillin 250 mg three times daily In uncomplicated cases: taken for 2-5 days In complicated cases: taken for 7-10 days

14. Hospitalised patients: Ceftriaxone 1 g iv once daily Or piperacillin-tazobactam 3.375 g iv every 6 hours Fluid intake should be high - 2 litres per day to maintain high rate of urine flow Regular complete emptying of bladder at 2- to 3-hour intervals

15. Alkalinisation of urine Analgesics, antispasmodics e.g: hyoscyamine Perineal hygiene, empty the bladder before bedtime

16. Honeymoon cystitis or Honeymoon disease Cystitis as a result of frequent or prolonged sexual activity, typically expected in the honeymoon period of marriage

17. Causes of dysuria : UTI STD Gonorrhea Bladder or urethral stones

18. ACUTE PYELONEPHRITIS

19. Definition Acute infection of the upper urinary tract, affecting the tubules, interstitium, and renal pelvis. Can be acute or chronic Bacterial infection commonly

20. Etiology Causative organisms: Gram-negative bacilli E.coli, Klebsiella , Enterobacter Route of infection: ascending infection from lower urinary tract Less common: hematogenous spread

21. Risk factors

22. Pathogenesis Bacteria from perineum spread to lower urinary tract due to poor hygiene and colonise it spread from lower tract to upper tract via catheterisation/trauma/reflux Multiply in upper urinary tract and cause infection( acute pyelonephritis ) Leads to Acute kidney injury(AKI)

23. Clinical features Fever Sudden onset of pain in abdomen Dysuria, frequency and urgency Cloudy urine Tenderness and guarding in the renal angle

24. Investigations Total leukocyte count(TLC) : increased Urine analysis : pus cells, WBC casts Bacterial C/S : to find out organism and which antibiotic it is sensitive to USG

25. Treatment Antibiotics - oral or intravenous i.v amoxicillin + aminoglycoside i.v piperacillin + tazobactam Supportive measures: fluids, analgesics

26. Complications

27. CHRONIC PYELONEPHRITIS

28. Chronic pyelonephritis Chronic inflammation of tubulointerstitial tissue leading to scarring of calyces, pelvis and renal parenchyma. important cause of end-stage renal disease

29. Types 2 types 1. Reflux nephropathy (chronic reflux-associated pyelonephritis) 2. Chronic obstructive pyelonephritis Develops due to recurrent infections superimposed on obstructive lesions, which lead to renal inflammation, parenchymal atrophy and scarring.

30. Morphology Kidney is shrunken and scarred

31. Clinical features Back-pain Fever pyuria bacteriuria

32. Diagnosis Culture is usually sterile CT scan - kidneys: shows irregular outline of kidneys, shrunken size Intravenous pyelography(IVP) for diagnosis

33. Irregular scar Small contracted kidney

34. Treatment Treat risk factors Control of infection - antibiotics for 7 days Complete emptying of bladder Double micturition of bladder: empty the bladder and after 10-15 minutes, try to empty the bladder a second time

35. Cystitis Inflammation of urinary bladder Can be acute or chronic repeated attacks of acute lead to chronic cystitis

36. Etiology Bacterial/fungal infections Most commonly E.coli, Enterobacter, Klebsiella, Pseudomonas Fungal: Schistosoma More common in females(shorter urethra) Drug-induced Radiation cystitis Chemical cystitis

37. Clinical features Triad of: F requency D ysuria Lower abdominal p ain “FDP” - Frequency, Dysuria, Pain

38. Diagnosis Urine analysis to check for UTI Cystoscopy may be needed Treatment : Antibiotics for infection

39. Questions: LE : SE : Mention causes, Mx and prevention of UTI Mx of lower UTI in males asymptomatic bacteriuria Types of UTI with symptoms SA : define cystitis and pyelonephritis organisms causing UTI

40. For notes, click here or scan: References: Archith Boloor, Ramadas Nayak - Exam Preparatory Manual Questions: [email protected] For PPT, scan: