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Questions and Answers
What temperature may indicate a possible kidney infection?
What temperature may indicate a possible kidney infection?
Which of the following conditions is characterized by recurrent or persistent UTIs and haematuria?
Which of the following conditions is characterized by recurrent or persistent UTIs and haematuria?
Which of the following is a first-line antibiotic treatment for cystitis in women?
Which of the following is a first-line antibiotic treatment for cystitis in women?
What symptom along with frequent symptoms such as increased thirst may indicate uncontrolled diabetes?
What symptom along with frequent symptoms such as increased thirst may indicate uncontrolled diabetes?
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Which of the following over-the-counter treatments is known to stop bacteria from adhering to the bladder walls?
Which of the following over-the-counter treatments is known to stop bacteria from adhering to the bladder walls?
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Which of the following is a common cause of bacteria reaching the bladder in women?
Which of the following is a common cause of bacteria reaching the bladder in women?
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What factor significantly increases the risk of developing cystitis in men?
What factor significantly increases the risk of developing cystitis in men?
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Which symptom is characteristic of cystitis but not typically associated with a kidney infection in adults?
Which symptom is characteristic of cystitis but not typically associated with a kidney infection in adults?
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How does diabetes contribute to the development of cystitis?
How does diabetes contribute to the development of cystitis?
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What change occurs in post-menopausal women that may increase the risk of cystitis?
What change occurs in post-menopausal women that may increase the risk of cystitis?
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What indicates that an infection could potentially have spread to the kidneys?
What indicates that an infection could potentially have spread to the kidneys?
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Which of the following is NOT a common treatment for a urinary tract infection?
Which of the following is NOT a common treatment for a urinary tract infection?
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What type of kidney stone is associated with an infection?
What type of kidney stone is associated with an infection?
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What is a common risk factor for developing recurrent kidney stones?
What is a common risk factor for developing recurrent kidney stones?
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What symptom could suggest a potential kidney infection when experiencing urinary issues?
What symptom could suggest a potential kidney infection when experiencing urinary issues?
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Which dietary factor is likely to contribute to the formation of calcium-oxalate stones?
Which dietary factor is likely to contribute to the formation of calcium-oxalate stones?
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Which of the following medications is known to increase the risk of recurrent kidney stones?
Which of the following medications is known to increase the risk of recurrent kidney stones?
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Cystine stones are typically caused by which underlying condition?
Cystine stones are typically caused by which underlying condition?
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Study Notes
Renal Health - Clinical Decision Making
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Lecture Overview:
- Urinary tract infections (UTIs) are a differential diagnosis, along with vaginal thrush, bacterial vaginosis (BV), and trichomoniasis.
- Specific UTIs include cystitis, pyelonephritis, and kidney stones.
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Causes of Kidney Pain:
- Kidney stones
- Urinary tract infection (UTI)
- Kidney injury/trauma
- Polycystic kidney disease
- Kidney cancer
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Urinary Tract Infections (UTIs):
- UTIs can affect any part of the urinary tract.
- Inflammation can involve the bladder (cystitis) and urethra (urethritis).
- Upper UTIs can affect the ureters or kidneys (pyelonephritis).
- This can result in kidney scarring, abscesses, kidney failure or sepsis.
- Symptoms of lower UTIs usually include dysuria, increased urination frequency, and urgency, strong/cloudy urine, blood in urine and persistent lower abdominal pain.
- Upper UTIs are usually accompanied by pain in the loin area (lower back pain) and fever.
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Cystitis:
- Cystitis is inflammation of the bladder, typically caused by bacteria from the gastrointestinal tract.
- E. coli is the most common cause.
- Other bacteria that can cause cystitis include Staphylococcus species, Proteus mirabilis, and enterococci.
- Candida albicans may cause cystitis in immunocompromised patients or those with a catheter.
- Bacteria can enter the bladder through poor hygiene practices such as wiping from back to front, after sexual intercourse or use of a diaphragm.
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Risk Factors for Cystitis:
- Not completely emptying the bladder.
- Blockages in the bladder
- Pregnancy pressure
- Enlarged prostate
- Menopause (reduced oestrogen levels can weaken the urethra lining, and changing vaginal microbiome)
- Diabetes (high levels of sugar in urine create a favorable environment for bacterial growth)
- Chemical irritants (e.g., soaps, perfumes)
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Cystitis Symptoms:
- Increased frequency and urgency of urination.
- Burning or stinging sensation during urination.
- Dark, cloudy, or strong-smelling urine.
- Blood in urine
- Lower abdominal pain
- Fever or loin pain may indicate a kidney infection (upper UTI).
- Symptoms in children might include fever (≥38°C), irritability, reduced appetite, and vomiting.
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Differential Diagnosis for Cystitis:
- Kidney infection: Kidney infection typically does not cause fever in adults. Pain in the lower back or side plus a fever may indicate a kidney infection.
- Drug-induced cystitis: Medications like cyclophosphamide and allopurinol can cause cystitis.
- Threadworms: Threadworm infections can cause peri-anal or peri-vaginal itching which can be accompanied by discomfort during urination
- Vaginitis/Vaginal infection: Dysuria associated with a vaginal discharge is suggestive of vaginitis.
- Bladder cancer: Recurrent or persistent UTIs, especially with haematuria, require further investigation for bladder cancer.
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Referral for Cystitis:
- First-time or persistent/frequent cystitis
- Cases of suspected cystitis in men or children
- Symptoms such as fever, vomiting, or vaginal discharge associated with cystitis
- Cases of blood in urine; Pregnant women
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Treatment for Cystitis (OTC):
- Potassium and sodium salts to make urine more alkaline. Eg, Canesten Oasis (sodium citrate), Cystopurin (potassium citrate).
- Cranberry juice to discourage bacterial adhesion to the bladder walls. (Little evidence it is good for treatment).
- Analgesics (e.g., paracetamol, ibuprofen)
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Prescription Treatment (Antibiotics):
- First-line treatment: Nitrofurantoin (100 mg twice daily for 3 days in women, 7 days in males, and pregnant women)/ Trimethoprim (200 mg twice daily for 3 days in women, 7 days in males).
- Second-line treatment: Nitrofurantoin (if not used for first line), or amoxicillin (Appropriate use is contingent on culture results to assure susceptibility to drug).
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General Advice:
- Hot water bottle for discomfort
- Over-the-counter pain relief (paracetamol/ibuprofen).
- Drink plenty of water
- Avoid sexual intercourse until feeling better
- Avoid tight clothes, caffeine and alcohol
- Avoid harsh cleaning products and perfumes.
- Wipe front-to-back for hygiene
- IMPORTANT: Seek professional medical advice if symptoms persist or worsen.
High-Level Service Overview
- Pharmacy First service involves seven conditions: Sinusitis (12+ yrs), Sore Throat (5+ yrs), Acute Otitis Media (1-17 yrs), Infected Insect Bite (1+ yrs), Impetigo (1+ yrs), Shingles (18+ yrs), and uncomplicated UTI (Women aged 16–64).
Pharmacy First Service - Key elements
- Clinical pathway consultations: New component of the service.
- Urgent supply of repeat medications and appliances: previously part of the CPCS
- Referrals for minor illness consultations: Previously part of the CPCS
Important information for the referral of low-acuity minor illnesses
- Pharmacists will recognize "red flags" (serious symptoms) and adjust their approach based on patient information.
- Prioritize self-care advice and the supply of over-the-counter (OTC) medicines.
- Refer patients as needed to GPs or other suitable healthcare providers for further assessment or treatment.
- Record all outcomes (appropriate for consultations that are conducted).
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Description
This quiz covers clinical decision-making regarding renal health, focusing on urinary tract infections (UTIs) and their various presentations, such as cystitis and pyelonephritis. You'll explore the causes of kidney pain, including kidney stones and infections, while understanding the implications of UTIs on renal function.
