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![TREATMENT
1st Choice 2nd Choice
Pyelonephritis Co-amoxiclav 500/125 mg 3X daily X 14 days
Ciprofloxacin 500 mg 2X daily X 7 days
**Admission is required if no response within 24
hours**
Gentamycin dosage according to renal
function & serum level X 14 days
Cefuroxime 150 – 1500 mg 3X daily X 14
days
Cystitis Trimethoprim 200 mg 2X daily X 3 days Amoxicillin 250 mg 3X daily X 3 days
Nitrofurantoin 50 mg 4X daily X 3 days [7
– 10 days in men]
Cefalexin 250 mg 4X daily X 3 days
Ciprofloxacin 100 mg 2X daily X 3 days
Epididymo-
orchitis
Ciprofloxacin 500 mg 2X daily X 14 days
**Refer genito-urinary TRO Neisseria gonorrhoea infection**
Acute prostatitis Trimethoprim 200 mg 2X daily X 28 days Ciprofloxacin 500 mg 2X daily X 28 days
Prophylactic Trimethoprim 100 mg at night continuosly Nitrofurantoin 50 mg at night continuously
Co-amoxiclav 250/125 mg at night
continuously](https://image.slidesharecdn.com/20-170609211615/75/Urinary-tract-infections-UTI-Renal-vascular-diseases-19-2048.jpg)
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Urinary tract infections (UTI) & Renal vascular diseases
Urinary tract infections are common, especially in women, and occur when bacteria enter the urinary tract. The most common types are cystitis (bladder infection) and urethritis (urethra infection), usually caused by E. coli. Symptoms include painful urination and urinary frequency. Recurrent infections and infections that spread to the kidneys can cause serious complications if left untreated. Diagnosis involves a urine dipstick test and culture. Treatment depends on the location and involves antibiotics. Renal vascular diseases affect blood flow to the kidneys and can cause high blood pressure or kidney damage/failure. Risk factors include age, atherosclerosis, and smoking. Causes include atherosclerosis and conditions like renal artery stenosis.
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Urinary tract infections (UTI) & Renal vascular diseases
- 1. URINARY TRACT INFECTION & RENALVASCULAR DISEASES NURUL HIDAYU | NASHRIQ AIMAN | AUDI ADIBAH
- 3. Except for thedistal urethra, the urinary tract is normally sterile due to host defences against bacterial colonization.
- 4.
- 5. DEFINITION • A urinarytract infection (UTI) is an infection in any part of your urinary system — kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra. • Women are at greater risk of developing a UTI than men are. Infection limited to your bladder can be painful and annoying. However, serious consequences can occur if a UTI spreads to your kidneys.
- 6. CLASSIFICATION UPPER UTI LOWERUTI Pyelonephritis: Renal pelvis Urethritis: Urethra Cystitis: Urinary bladder Prostatitis: Prostate RECURRENT URINARY TRACT INFECTIONS Acute pyelonephritis results from bacterial invasion of the renal parenchyma, which are usually reach the kidney by ascending from the lower urinary tract or via the bloodstream. It is a potentially organ- and/or life-threatening infection that often leads to renal scarring.
- 7. The most commonUTIs occur mainly in women and affect the bladder and urethra. • Infection of the bladder (cystitis). —Usually caused by Escherichia coli (commonly found in GIT). —However, sometimes other bacteria are responsible. —Sexual intercourse may lead to cystitis. —All women are at risk of cystitis because of their anatomy - specifically, the short distance from the urethra to the anus and the urethral opening to the bladder. • Infection of the urethra (urethritis). —This type of UTI can occur when GI bacteria spread from the anus to the urethra. —Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.
- 8. RISK FACTORS SPECIFIC TOWOMEN OTHERS Female anatomy. A woman has a shorter urethra than a man does, which shortens the distance that bacteria must travel to reach the bladder. Sexual activity. Sexually active women tend to have more UTIs than do women who aren't sexually active. Having a new sexual partner also increases your risk. Certain types of birth control. Women who use diaphragms for birth control may be at higher risk, as well as women who use spermicidal agents. Menopause. After menopause, a decline in circulating estrogen causes changes in the urinary tract that make you more vulnerable to infection. Urinary tract abnormalities. Congenital anomalies that don't allow urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTIs. Blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of UTIs. A suppressed immune system. Diabetes and other diseases that impair the immune system — the body's defense against germs — can increase the risk of UTIs. Catheter use. Increased risk of UTIs. This may include people who are hospitalized, people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed. A recent urinary procedure. Urinary surgery or any exam of urinary tract involving medical instruments can both increase your risk of developing a UTI.
- 9. How do uget a urinary tract infection? • Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defences sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract. • The most common UTIs occur mainly in women and affect the bladder and urethra.
- 11. Aetiology (Causative Organisms) Community •E. coli • Proteus spp. • Pseudomonas spp. • Strep. spp. • Staph. epidermidis Nosocomial • E. coli • Klebsiella spp. • Strep. spp.
- 12. Symptom Corresponding signMechanism Dysuria Due to acute inflammation of the bladder, resulting in discomfort upon contraction during voiding. Frequency and urgency Reduced bladder capacity due to inflammatory edema causing decreased compliance and pain due to bladder distension. Hematuria Irritated, edematous urinary tract bleeding with voiding. Suprapubic tenderness Due to palpation and compression of an inflamed, edematous bladder. Chills and sweats Fever Inflammatory cascade resulting in a febrile response. Flank pain (may radiate to groin, often dull and constant) Costovertebral angle (CVA) tenderness Sudden renal edema, resulting in increased pressure an Clinical Features
- 13. Types of urinarytract infection Each type of UTI may result in more-specific signs and symptoms, depending on which part of your urinary tract is infected. Part of urinary tract affected Signs and symptoms Kidneys (acute pyelonephritis) Upper back and side (flank) pain High fever Shaking and chills Nausea Vomiting Bladder (cystitis) Pelvic pressure Lower abdomen discomfort Frequent, painful urination Blood in urine Urethra (urethritis) Burning with urination Discharge
- 15. COMPLICATIONS Recurrent infections, especiallyin women who experience three or more UTIs. Permanent kidney damage from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI. Urethral narrowing (stricture) in men from recurrent urethritis, previously seen with gonococcal urethritis. Sepsis, a potentially life-threatening complication of an infection, especially if the infection works its way up your urinary tract to your kidneys.
- 16. INVESTIGATION • Full BloodCount • Culture & Sensitivity • Blood culture • Urethral Swab • Urine culture ( Culture using a midstream urine (MSU) specimen to reduce the risk of contamination) • Collection of urine specimen – clean catch urine • Urine dipstick (can identify patients with infection and the need for treatment without culture.) — Nitrite — Leucocyte esterase — Glucose • Microscopy / cytometry of urine — WBC — Organisms (>105 organisms/mL MSE) • Ultrasound • CT scan • w/ fever or complicated infection —FBC U&E / Creatinine —Blood culture • w/ persistent hematuria / suspect bladder lesion cystoscopy • Upper / Recurrent UTI —Imaging ultrasound / CT —Pelvic (F) / Rectal (M) examination
- 17. URINE DIPSTICK RESULT NITRITE+VE +VE -VE -VE LEUCOCYTE ESTERASE +VE -VE +VE -VE Start antibiotic treatment for urinary tract infection Start antibiotic treatment if fresh sample was tested Send urine sample for culture Send urine sample for microscopy and culture Only start antibiotic treatment for urinary tract infection if there is good clinical evidence of such infection Result may indicate infection elsewhere Treat depending on results of culture Do not start treatment for urinary tract infection Explore other causes of illness INVESTIGATION
- 19. TREATMENT 1st Choice 2ndChoice Pyelonephritis Co-amoxiclav 500/125 mg 3X daily X 14 days Ciprofloxacin 500 mg 2X daily X 7 days **Admission is required if no response within 24 hours** Gentamycin dosage according to renal function & serum level X 14 days Cefuroxime 150 – 1500 mg 3X daily X 14 days Cystitis Trimethoprim 200 mg 2X daily X 3 days Amoxicillin 250 mg 3X daily X 3 days Nitrofurantoin 50 mg 4X daily X 3 days [7 – 10 days in men] Cefalexin 250 mg 4X daily X 3 days Ciprofloxacin 100 mg 2X daily X 3 days Epididymo- orchitis Ciprofloxacin 500 mg 2X daily X 14 days **Refer genito-urinary TRO Neisseria gonorrhoea infection** Acute prostatitis Trimethoprim 200 mg 2X daily X 28 days Ciprofloxacin 500 mg 2X daily X 28 days Prophylactic Trimethoprim 100 mg at night continuosly Nitrofurantoin 50 mg at night continuously Co-amoxiclav 250/125 mg at night continuously
- 20. PREVENTION • Fluid intake>2L per day • Regular complete emptying of bladder • Good personal hygiene • Emptying bladder before & after sexual intercourse • Cranberry / lingo berry juice / tablets • Antibiotic prophylaxis
- 21. Renal Vascular Diseases Renal vasculardisease affects the blood flow into and out of the kidneys. It may cause kidney damage, kidney failure, and high blood pressure. WHO AT RISK? Older age >50 y/o Female Atherosclerosis High blood pressure Smoking High cholesterol Diabetes Family hx of peripheral arterial disease Family hx of renal artery disease WHAT CAUSE IT? Atherosclerosis Injury Infection Inflammatory or other underlying disease Surgery Tumour Aneurysm Pregnancy Birth defect Medication
- 22.
- 23. BLOOD SUPPLY OFKIDNEY
- 24. Rare disease whichpresents clinically with hypertension Causes —Artherosclerosis —Fibromuscular dysplasia —Vasculitis —Thromboembolism —Aneurysm of renal artery
- 25. • Pathophysiology : —Reductionin renal perfusion (If narrowing more than 70%) activating the RAA system present commonly with post- stenotic dilatation. —Artherosclerosis within aorta which affects other branches like iliac vessels & further complicated by small vessel diseases. Severe stenosis Renal ischemia Atrophy & shrinkage Renal failure
- 27. : In fibromusculardysplasia where the cause is unknown, there will be narrowing of artery most commonly present with hypertension in younger patients, affects women. : Irregular narrowing in distal renal artery and sometimes extends into intrarenal branches. : Collateral vessels develop if there is gradual progression of stenosis, infarction can be prevented Hypertension Asymmetrical kidney Renal failure with bilateral kidney disease Acute pulmonary edema Peripheral vascular disease of lower limbs Impaired renal function due to use of drugs (ARB, ACE inhibitors) CLINICAL FEATURES
- 28. Renal functiontest Ultrasound CT angiography MR angiography INVESTIGATION Antihypertensive drugs Statins and low dose aspirins in artherosclerotic patient Angioplasty where in no atheromatous fibromuscular dysplasia shows high chances of success by improving blood pressure and protects renal function* *Young patients *Uncontrolled HPT with antihypertensive drugs *History of ‘flash’ pulmonary edema / accelerated phase of hypertension *Impaired renal function # Risks include renal artery occlusion, renal infarction, atheroemboli MANAGEMENT
- 29.
- 30. Figure: Algorithm forevaluating patients in whom renal artery stenosis is suspected. (From Safian RD, Textor SC. Medical progress: Renal-artery stenosis. N Engl J Med. 2001;344:431-442.)
- 31.
- 32. • Sudden occlusionof renal arteries • Mainly caused by local atherosclersis or by thromboemboli • Multiple infarction with renal parenchyma • Loin pain and hematuria • CRP and LDH often elevated • Ct scan • Management : anticoagulation and stenting
- 33. DISEASES OF SMALLINTRARENAL VESSELS
- 34. Hemolytic Uremic Syndrome(HUS) • Damage to endothelial cells • Swelling of endothelial cells, platelet adherence and intravascular thrombosis • Most common causes is infection with verotoxin producing E. coli • Contaminated food and water • Atypical HUS (non infective cause)
- 35. Thrombotic Thrombocytopenic Purpura(TTP) • Autoimmune disorder caused by antibodies against ADAMTS-13 • Causes microvascular occlusion by platelet thrombi (brain / kidney) • Emergency plasma exchange • Corticosteroid, aspirin, rituximab
- 36. Systemic sclerosis • Intimalcell proliferation and luminal narrowing of intrarenal arteries • Vasospasm and renin activity • Severe hypertension and oliguric RF • ACEI AND RRT
- 38. Cholesterol emboli • Renalimpairment • Hematuria • Proteinuria • Eosinophilia with inflammatory features • Ischemic toes and livedo reticularis • No specific treatments