Q11

urinalysisUrine Analysis Results                                                         Leukocytes: 3+                                                                                  Nitrite: 1+                                                                                             Protein: 2+                                                                                               Blood: 2+                                                                                             Ketones: Negative                                                                                       Bilirubin: Negative                                                                                       Glucose: Negative

Please describe the abnormalities

  • High poly and RBC counts with positive protein and blood (in the absence of epi-clean catch) indicates infection

Pass Criteria:

  • Bold to pass

What is the most likely diagnosis?

  • In the clinical context c/w pyelonephritis +/- stone

Pass Criteria:

  • Bold to pass

Q12

What organisms cause acute pyelonephritis?
Prompt: What are the most common?

  • G -ve bacilli (>85%)
  • Endogenous organisms
  • E. coli
  • Proteus
  • Klebsiella
  • Enterobacter
  • Strep faecalis (enterococcus)
  • Other: staph, fungi, viruses in immunocompromised and renal transplant patients

Pass Criteria:

  • G-ve & 3 organisms to pass

What steps are involved in ascending infection of the urinary tract?

5 Steps:

  1. Colonisation distal urethra
  2. Entry into bladder
  3. Urinary tract obstruction/stasis of urine
  4. Vesicoureteric reflux
  5. Intrarenal reflux

Pass Criteria:

  • Need to explain the concept clearly

What conditions predispose to acute pyelonephritis?

  • Urinary tract obstruction
  • Instrumentation
  • Vesico-ureteric reflux
  • Pregnancy
  • Female up to 50 yrs
  • Males > 50 yrs
  • Abnormalities – congenital/acquired
  • DM/Immunosuppression

Pass Criteria:

  • 4/9 to pass

Q13

Photo – myoglobinuria

Biochemistry:

Interpret the biochemistry results?

  • Renal failure likely acute kidney injury in clinical context
  • Elevated urea + Cr
  • Markedly elevated CK – rhabdomyolysis
  • Normal K+

Pass Criteria:

  • Bold

Why is the urine dark?

  • Rhabdomyolysis
  • Breakdown of skeletal muscle –> myoglobinuria

Pass Criteria:

  • Bold