2. Urinary Tract Infections
ďŚIs an infection of the urinary tract caused by the
presence of pathogenic microorganism in the
urinary tract with or without signs & symptoms
ďŚThe most common sites of infections
ď¤Urethra â Urethritis
ď¤Bladder â Cystitis Lower UTI
ď¤Prostate â Prostatitis
ď¤Ureter â Ureteritis
ď¤Renal pelvisâ Pyelonephritis Upper UTI
ď¤Kidney-Interstitial nephritis
ď¤Renal abscess
By: Belete N 2
3. Urinary Tract InfectionsâŚ
ďąRisk factors
ďŚIatrogenic/Drugs
ď¤Indwelling catheter
ď¤Antibiotic use and spermicides
ďŚBehavioral
ď¤Voiding dysfunction
ď¤Frequent or recent sexual intercourse
ďŚAnatomic/physiologic
ď¤Vesico-urethral reflux
ď¤Female sex and Pregnancy
By: Belete N 3
4. Urinary Tract InfectionsâŚ
ďŚGenetic
ď¤Susceptible uroepithelial cells(secrete less
IgA)
ď¤Vaginal mucus properties
ďąEtiology
ď¤Ascending infections (that enter via urinary
meatus)
ď¤Obstructive abnormalities (strictures,
prostatic tumors or hyperplasia)
ď¤Upper urinary tract disease may occasionally
cause recurrent bladder infections
By: Belete N 4
5. Urinary Tract InfectionsâŚ
ďąPathophysiology
ďŚThe bacteria causing UTIs usually originate from
bowel flora of the host acquired via three
possible routes
ď¤Ascending
ď¤Hematogenous or
ď¤Lymphatic pathways
ďŚThree factors determine the development of
UTIs
ď¤The size of the inoculum
ď¤Virulence of the microorganism, and
ď¤Competency of the natural host defense
By: Belete N 5
6. Urinary Tract InfectionsâŚ
ďŚAn important virulence factor of bacteria is their ability
to adhere to urinary epithelial cells by fimbriae
ďŚOther virulence factors include hemolysin, a cytotoxic
protein produced by bacteria
ď¤Lyses a wide range of cells including
erythrocytes, polymorphonuclear leukocytes, and
monocytes ; and aerobactin
â Facilitates the binding and uptake of iron by
Escherichia coli
By: Belete N 6
7. Urinary Tract InfectionsâŚ
ďŚThe most common cause of uncomplicated UTIs is E.
coli
ď¤Accounting for more than 85% of community
acquired infections
ďąSign and symptoms
ď¤Dysuria, frequency, urgency, and nocturia
ď¤Suprapubic pain and discomfort
ď¤Hematuria and back pain
ď¤Syndromes of urosepsis- If complicated
ďąDiagnosis
1. Urine dipstick-may react positively for blood WBC
2. Urine microscopy- shows RBC and many WBC-
HPF By: Belete N 7
8. Urinary Tract InfectionsâŚ
ďąOther Classification
ďŚUncomplicated UTI
ď¤UTI that occurs in individuals who lack
structural or functional abnormalities in the UT
that interfere with the normal flow of urine
â Mostly in healthy females of childbearing
age
ďŚComplicated UTI
ď¤UTI that occurs in individuals with structural
or functional abnormalities i.e. congenital
distortion of the UT, a stone, a catheter,
prostatic hypertrophy, obstruction, or
neurological deficit
â UTI in men are usually complicated-why?
By: Belete N 8
9. Urinary Tract InfectionsâŚ
ďŚRecurrent UTI
ď¤Refers to multiple symptomatic UTIs with
asymptomatic periods in between
ď¤It is considered significant when there is two
or more symptomatic episodes per year or it
interferes with patientâs quality of life
ď¤It is usually a reinfection than a relapse
By: Belete N 9
10. Urinary Tract InfectionsâŚ
ďąManagement
ďŚThe management of a patient with a UTI includes
ď¤Initial evaluation
ď¤Selection of an antibacterial agent and
duration of therapy, and
ď¤Follow-up evaluation
ďŚSelection of antimicrobial agent for the treatment
of UTI is based on
ď¤The severity of the presenting signs and
symptoms
ď¤The site of infection
ď¤Whether the infection is complicated or
uncomplicated
By: Belete N 10
11. Urinary Tract InfectionsâŚ
ďŚThe general Management principle includes
1. Relieve discomfort and provide rest
(catheterization if needed)
2. Antibiotic
3. Follow up culture to prove treatment
effectiveness
4. Increase fluid intake- water is best
5. Avoid irritants - Coffee, tea, alcohol, cola
drinks
6. Promote urinary output- Q 2 to 3 hrs
By: Belete N 11
12. Urinary Tract InfectionsâŚ
ďąAntibiotic therapy according to ESTG
ďŚAcute, uncomplicated UTI in women
ď¤First line:
â Ciprofloxacin, 500mg P.O., BID, for 3 days
or
â Norfloxacin, 400mg P.O.,BID, for 3 days.
ď¤Alternatives:
â Nitrofurantoin 50mg P.O., QID for 7 days or
â Cotrimoxazole 160/800mg P.O, BID for 3
By: Belete N 12
13. Pyelonephritis
ďŚPyelonephritis is an inflammation of the renal pelvis,
calyces, and medulla
ďŚThe infection usually arises in the lower urinary tract
with organisms ascending into the renal pelvis
ďŚBegins in the interstitium & rapidly extending to
involve the tubules, glomeruli & blood vessels
ďąClassifications
ďąAcute pyelonephritis
ďąChronic pyelonephritis
By: Belete N 13
14. PyelonephritisâŚ
ďąAcute pyelonephritis
ďŚIt is sudden onset & self-limited bacterial disease
of the kidneys.
ďąEtiology
ďŚBacteria: E-coli (80%), Proteus, Pseudomonas,
S. aures, Strep. faecalis (entrococcus)
ďŚProcedures: Catheterization, Cystoscopy,
Urologic surgery
ďŚSystemic infections (such as tuberculosis)
ďŚOther causes: Urinary obstruction, Neurogenic
bladder (Vesicourethral reflux)
By: Belete N 14
15. PyelonephritisâŚ
ďŚAcute pyelonephritis is an active bacterial infection
that can cause:
ď¤Interstitial inflammation
ď¤Tubular cell necrosis
ď¤Abscess formation in the capsule, cortex, or
medulla
ď¤Temporarily altered renal function, and may
rarely progresses to renal failure
By: Belete N 15
16. PyelonephritisâŚ
ďąRisk Factors
ď¤Women over 65 years of age
ď¤Older men with prostate problems
ď¤Chronic urinary stone disorders
ď¤Spinal cord injury
ď¤Pregnancy
ď¤Congenital malformations
ď¤Bladder tumors
ď¤Chronic illness (diabetes mellitus,
hypertension, chronic cystitis)
By: Belete N 16
17. PyelonephritisâŚ
ďąClinical Manifestation
ď¤Flank pain
ď¤Low back pain
ď¤Costovertebral angle tenderness
ď¤Dysuria (Painful or difficulty of urination)
ď¤Nocturia, hematuria, cloudy urine with fishy
odor
ď¤Burning, urgency, frequency, nocturia
ď¤Shaking chills, generalized fatigue
ď¤Fever, tachycardia, tachypnea
ď¤Anorexia, nausea and vomiting, headache,
malaise By: Belete N 17
18. PyelonephritisâŚ
ďąDiagnosis
ďŚAppropriate history taking, & Physical
examination
ďŚUrinalysis:
ď¤Dark color, cloudy appearance, foul odor
ď¤Proteinuria, glycosuria, rarely ketonuria
ď¤Leucocytes, Few red blood cell
ď¤Casts, decreased urine specific gravity
ď¤Positive leukocyte esterase (85 to 90%
specific)
ď¤Positive nitrate (95% specific)
ďŚUrine culture reveals the causative organism
By: Belete N 18
19. PyelonephritisâŚ
ďąDiagnosisâŚ
ďŚCBC
ď¤Elevated WBC (>10,000mm3), elevated
neutrophils
ďŚErythrocyte sedimentation rate (ESR) will be
elevated
ďŚIntravenous pyelogram
ď¤If functional and structural renal abnormalities
are suspected (calculi, structural, or vascular
abnormalities)
ďŚUltrasound or CT scan
ďŚRadionuclide imaging
ď¤May be useful to identify sites of infection that
By: Belete N 19
21. PyelonephritisâŚ
ďąMedical Management
ďŚAccording to ESTG
ďŚAcute uncomplicated Pyelonephritis in non-pregnant
women:
ď¤Mild and moderate acute uncomplicated
pyelonephritis (able to tolerate oral therapy with no
vomiting, no dehydration, no evidence of sepsis):
ď¤First line
â Ciprofloxacin, 500mg P.O., BID, oral for 7-10
days
ď¤Alternatives
â Cotrimoxazole(Trimethoprim-
sulphamethoxazole), 160/800mg P.O, BID for 14
days
By: Belete N 21
22. PyelonephritisâŚ
ďŚSevere acute uncomplicated pyelonephritis
(high fever, high white blood cell count, vomiting,
dehydration, or evidence of sepsis) or fails to
improve during an initial outpatient treatment
period
ď¤Intravenous therapy should be started and
continued until the patient improves (usually
at 48â72 hours)
ď¤On discharge oral therapy is continued to
complete 10-14 days course
ď¤Antibiotics should be started after urine
culture sample is collected
By: Belete N 22
23. PyelonephritisâŚ
ďŚFirst line
ď¤Ciprofloxacin, 400mg, I.V, BID till patient
improves and continue oral ciprofloxacin
500mg, PO, BID to complete 10-14 days
course
ďŚAlternatives
ď¤Ceftriaxone, 2gm, I.V, daily or 1gm, I.V, BID
till patient improves and continue oral
ciprofloxacin 500mg, PO, BID to complete 10-
14 days course
ďŚIf no response in 48-72 hrs. ultrasound is
warranted therapy to evaluate for obstruction,
abscess, or other complications of pyelonephritis
By: Belete N 23
24. PyelonephritisâŚ
ďŚComplicated UTIs and UTI in men-similar to
uncomplicated UTIs but needs prolonged duration
ďŚRecurrent UTI in women
ď¤First line: Cotrimoxazole, 240mg, P.O., daily or 3x
per week or postcoital
ď¤Alternatives:
â Cephalexin, 125â250mg, P.O., once daily or
postcoital or
â Norfloxacin, 200mg, P.O., once daily or
postcoital or
â Ciprofloxacin, 125mg, P.O., once daily or
postcoital
ďŚDuration of antibiotics-for six months followed by
observation
ďŚIf recurrent UTI comes again the prophylaxis can be
prolonged for 1-2years By: Belete N 24
25. PyelonephritisâŚ
ďżNursing interventions
ďŚAdminister antipyretic & Antibiotics
ďŚFluids (2-3 L/d) to empty the bladder of
contaminated urine & prevent calculus formation
ďŚCatheterize with strict sterile technique
ďŚInstruct the patient to perform appropriate perineal
care
ďŚTeach proper technique for collecting a clean catch
urine specimen
ďŚEmotional support
ďŚPersonal hygiene
ďŚAdvice routine checkups for patient with history of
UTIs By: Belete N 25
26. PyelonephritisâŚ
ďąChronic pyelonephritis
ď¤It is a persistent inflammation of kidneys
ď¤Repeated infections that cause progressive
inflammation & scarring
ďŚEtiology:
ď¤Bacteria
ď¤Urinary obstruction
ď¤Vesicourethral reflux
By: Belete N 26
27. PyelonephritisâŚ
ďŚClinical manifestations
ď¤Usually have no symptoms of infection
ď¤Noticeable signs
â Fatigue
â Headache
â Poor appetite
ď¤Polyuria /Low specific gravity of urine/
ď¤Excessive thirst
ď¤Weight loss
ď¤Flank pain
By: Belete N 27
28. PyelonephritisâŚ
ďąDiagnosis
ďŚHistory taking & physical examination
ďŚLaboratory investigations
ďŚUrinalysis
ď¤Proteinuria (Albuminuria)
ď¤Intermittent bacteriuria
ď¤Leukocytes in urine
ď¤Low specific gravity of urine
ď¤Urine culture to identify the pathogen
ďŚBlood
ď¤ Decreased Hgb
ď¤ Measuring BUN & creatinine/may increase
ď¤ Decrease HCI
ďŚRadiologic IV Urogram
By: Belete N 28
29. PyelonephritisâŚ
ďŚComplications
ď¤End-stage renal disease (from progressive
loss of nephrons secondary to chronic
inflammation and scarring)
ď¤Hypertension
ď¤Formation of kidney stones (from chronic
infection with urea-splitting organisms)
ďŚManagement
ď¤The same as acute pyelonephritis (Long-term
use)
ď¤Monitor HTN
ď¤Monitor intake and out put
By: Belete N 29
The vaginal flora is the bacteria that live inside the vagina. The normal vaginal flora is dominated by various lactobacillus species. Lactobacilli help to keep the vagina healthy by producing lactic acid, hydrogen peroxide, and other substances that inhibit the growth of yeast and other unwanted organisms
The five primary classes of immunoglobulins are IgG, IgM, IgA, IgD and IgE. These are distinguished by the type of heavy chain found in the molecule. IgG molecules have heavy chains known as gamma-chains; IgMs have mu-chains; IgAs have alpha-chains; IgEs have epsilon-chains; and IgDs have delta-chains.
Human urine is composed primarily of water (95%). The rest is urea (2%), creatinine (0.1%), uric acid (0.03%), chloride, sodium, potassium, sulphate, ammonium, phosphate and other ions and molecules in lesser amounts
Congenital malformations
One kidney may be missing (renal agenesis).
One or both kidneys may be abnormally small (renal hypoplasia).
One or both kidneys may have formed abnormally (renal dysplasia).
The kidneys may be joined to form a single arched or horseshoe kidney.
The kidneys may be in the wrong position.
One or both kidneys may have fluid-filled cysts (polycystic kidney disease or multicystic kidney disease