Urinary Ttract

Infections
Urinary tract infection:

 A urinary tract infection (UTI) is a bacterial infection

that affects part of the urinary tract.
 Classification
 1)- Upper UTI (pyelonephritis)
- Lower UTI (Cystitis, Urethritis)
 2) – Simple (No abnormalities, No spread,
Recovered)
- Complicated (abnormalities, spread, not
Recovered
 Prevalence:

 Most important cause of kidney diseases is urinary

tract infection and it's considered as the 2nd most
important form of infection.
 More than 90 % of kidney diseased patients have
UTI
 Occurs in adults more than in children and more
commonly in female than in male because -
females have short urethra and Males have
prostatic fluid that resist bacteria
 Recurrences are more common
Prognosis:
 According to site of infection:
In case of lower UTI >>>> it is easily cured as it is simple infection .
In case of upper UTI it may be cured or not cured >>>>> death
(elderly and immunosuppressive patients ) or result in chronic
disease (renal failure).
Etiology:
 The main causal agent of both types is Escherichia coli, however
other bacteria, viruses or fungus may rarely be the cause.
 UTIs acquired during a stay in hospital may include infection by
staphylococci, streptococci or Pseudomonas or Proteus species.
 UTIs are also commonly associated with long-term urinary
catheters
Risk factors:
 Poor hygiene, sexual intercourse and family history
Other risk factors include :
 Obstructive urinary tract (stones, BPH, bilharziasis )

 Pregnancy

 Catheterization

 Immunosuppressive patients

 post-menopausal women

 spinal cord injury

Signs and symptoms:
In case of Lower urinary tract infection , the most common symptoms
are
 Dysuria (painful or burning sensation with urination)
 Urgency (inability to hold or an urge to urinate )
 Histancy ( having to urinate frequently )
 Cloudy urine with bad smell …………..in absence of fever and sever
pain………….>These symptoms may vary from mild to severe and
lasts an average of six days.
In case of upper urinary tract infection, or pyelonephritis, may
experience:
 flank pain, fever, nausea and vomiting in addition to the classic
symptoms of a lower urinary tract infection . Rarely the urine may
appear bloody or contain visible pyuria (pus in the urine).
Diagnosis
 Clinical picture
 Lab analysis:

- Urin analysis (bacteria E-coli, Pus, WBCs )

- Imaging test : ultrasound cystoscopy, X-ray, CT or MRI

Treatment:
Goals of treatment:
 • eradicate the infection
 • prevent spread
 • prevent complications such as septicaemia

and secondary infection

Pharmacological treatment:
Oral Antibiotics such as:
 Quinolones (not to be taken below 18 years old)

 Sulfamethoxazole/trimethoprim (A three-day
treatment with trimethoprim)
 Cephalosporines (2nd generation)
 Nitrofurantoin ( requires 5–7 days)
 Amoxicillines+ampicilline
 Symptomatic treatment include analgesics,
antipyretics and antispasmodics
In pregnancy:

 Urinary tract infections are more during

pregnancy because high progesterone levels
elevate the risk of decreased muscle tone of the
ureters and bladder >>>>> urine flows back up
the ureters and towards the kidneys.
 Thus if urine testing shows signs of an
infection—even in the absence of
symptoms—treatment is recommended.
Cephalexin or nitrofurantoin are typically used .
 A kidney infection during pregnancy may result
in premature birth or pre-eclampsia.
 Non pharmacological treatment

 Acidification of the urine by Vit C

 Taking excessive fluid intake
 Stop smoking , tea and coffee beverages.
 Other kidney diseases

Glomerulonephritis
 It is a bilateral inflammatory disease that affect the
glomerulus of the kidney.
Causes:
 Resulted from Ag-Ab interaction >>>> formation of Ag-
Ab complex that rest on the basement membrane of
the glomeruli >>>>causing erosion In the membrane >
>>>>> >>>>>>> proteinuria and haematuria
 The most common caused antigen is streptococci

 Mostly in childhood
 Signs and Symptoms:

1-3 weeks before… tonsilitis, otitis or fever

Protein uria
Periorbital oedema
Complications:
Hypertention
Cerebral strock
Renal failure
Treatment:
Antibiotics for streptococci ……….. long acting
penicilline (procaine penicilline)
Symptomatic ttt if complication occur as diuretics,
salt/water restriction and renal dialysis if renal failure
occur
Non infectious kidney disease

 Nephrotic syndrome
Autoimmune disease treated by corticosteroids
 Polycystic disease
congenital disease mostly occur in children
kidney stones (Urolithiasis )

Examples as : Calcium oxalate ,calcium phosphate,

struvite stones and urate stones
Causes: Kidney stones occur when any element increase
more than max. solubility.
Calcium stones:
 Occur due to Xss intake of Calcium and due to diseases
that cause hypercalcemia as caushing syndrom,
vitamin D toxicity and hyperparathyroidism.
Urate stones:
 Occur due to Xss intake of xanthines (urates) and
diseases that increase uric acid .
Oxalates :
Struvite stones
 Symptoms:

 Colic pain, and cramps that occur suddenly and

increase with movement. May accompanied with
vomitting.
 Haematuria due to obstruction

Precausions:
 Excessive fluid intake

 Warming the area of the pain

Treatment:
 Alkalinization of the urine to dissolve urate stones.

 Acidification of the urine to dissolve phosphate stones.

 Lithotripsy

 Surgical removal.
Lithotripsy
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