The document provides information on different types of Madhumeha (a type of diabetes) according to Ayurveda. It discusses 12 types of Madhumeha - Vataja, Pittaja, Kaphaja, Sannipatika, Aabhighataja/Raktaja, Sahaja, Asmariaja, Sukshmaja etc. It provides the characteristics, symptoms, management and pathogenesis of each type. The document also covers Madhumeha Gata (a condition similar to Madhumeha) and its 14 types such as Vatakundila, Vatavaisti, Madhoasanga etc.
16. URINARY TRACT INFECTION
A urinary tract infection (UTI) is an infection of any part
of the urinary system. Most infections involve the
lower urinary tract.
UTIs are given different names depending on where
they occur:
• Bladder infection - cystitis
• Urethra infection - urethritis
• Kidney infection - pyelonephritis
The ureters are very rarely the site of infection.
Most UTIs are not serious, but some can lead to serious
problems, particularly with upper urinary tract
infections.
Recurrent or long-lasting kidney infections (chronic)
can cause permanent damage, and some sudden
kidney infections (acute) can be life-threatening,
particularly if septicemia (bacteria entering the
bloodstream) occurs.
17. INCIDENCE
The incidence of UTI is more in females than males.Women
are more likely to develop UTIs than men, due to anatomical
differences; the urethra is shorter in women than in men, and
it is closer to the anus, making it more likely that bacteria are
transferred to the bladder.
Over 50 percent of all women will experience at least one UTI
during their lifetime, with 20-30 percent experiencing
recurrent UTIs.
18. 67%
22%
7%
2% 1% 1%
UTI causing organisms
E.coli Klesiella
Staphylococcus Psuedomonas
Enterococcus Other gram -ve bacteria
19. RISK FACTORS
The following factors can increase the likelihood of
developing a UTI -
Sexual intercourse (especially if more frequent,
intense, and with multiple or new partners)
Diabetes
Poor personal hygiene
Problems emptying the bladder completely
Having a urinary catheter
Bowel incontinence
Blocked flow of urine
Kidney stones
Some forms of contraception
Pregnancy
Menopause
Procedures involving the urinary tract
Suppressed immune system
Immobility for a long period
Use of spermicides and tampons
Heavy use of antibiotics (which can disrupt the
natural flora of the bowel and urinary tract)
20. PATHOGENESIS
The urine is normally sterile. An infection occurs
when bacteria get into the urine and begins to grow.
The infection usually starts at the opening of the
urethra (where the urine leaves the body) and moves
upward into the urinary tract.
The culprit in at least 90% of uncomplicated
infections is a type of bacteria called Escherichia
coli better known as E. coli. These bacteria normally
live in the bowel (colon) and around the anus.
These bacteria can move from the area around the
anus to the opening of the urethra. The two most
common causes of this are improper wiping and
sexual intercourse.
Usually, the act of emptying the bladder (urinating)
flushes the bacteria out of the urethra. If there are too
many bacteria, urinating may not stop their spread.
The bacteria can travel up the urethra to the bladder,
where they can grow and cause an infection.
The infection can spread further as the bacteria move
up from the bladder via the ureters.
If they reach the kidney, they can cause a kidney
infection(pyelonephritis), which can become a very
serious condition if not treated promptly.
21. SIGNS AND SYMPTOMS
General Signs and Symptoms :
Burning sensation while urinating
Pain or Pressure in lower abdomen
Cloudy , Bloody , Strange smelling urine
Fatigue
Clinical Signs and Symptoms :
Lower urinary tract infection
Bladder (cystitis): The lining of the urethra and
bladder becomes inflamed and irritated.
Dysuria: pain or burning during urination
Frequency: more frequent urination (or waking up at
night to urinate, sometimes referred to as nocturia);
often with only a small amount of urine
Urinary urgency: the sensation of having to urinate
urgently
Cloudy, bad-smelling, or bloody urine
Lower abdominal pain or pelvic pressure or pain
Mild fever (less than 101 F), chills, and "just not
feeling well" (malaise)
Urethra (urethritis): Burning with urination
22. Upper urinary tract infection (pyelonephritis)
Symptoms develop rapidly and may or may not
include the symptoms for a lower urinary tract
infection.
Fairly high fever (higher than 101 F)
Shaking chills
Nausea
Vomiting
Flank pain: pain in the back or side, usually on only
one side at about waist level
Symptoms with respect to age=
Newborns- fever or hypothermia (low temperature),
poor feeding, jaundice
Infants- vomiting, diarrhea, fever, poor feeding, not
thriving
Children- irritability, eating poorly, unexplained fever
that doesn't go away, loss of bowel control, loose
bowels, change in urination pattern
Elderly people- fever or hypothermia, poor appetite,
lethargy, change in mental status
23. DIAGNOSIS
Diagnosis will usually be made after proper history
taking and testing a urine sample .
A "clean catch mid flow urine sample " is used, which
is where a person washes their genital area before
collecting a urine sample mid-flow. This helps to
prevent bacteria from around the genital area getting
caught in the sample.
The single most important lab test is urinalysis and
urine culture test. A urine sample will be tested for
signs of infection, such as the presence of white blood
cells and bacteria.
If a person has recurrent UTIs, a doctor may request
further diagnostic testing to determine if anatomical
issues or functional issues are to blame. Such tests may
include:
Urodynamics - a procedure that determines how well
the urinary tract is storing and releasing urine
Cystoscopy - looking inside the bladder and urethra
with a camera lens inserted via the urethra through a
long thin tube
24. Imaging tests are most often needed for the following
groups:
• Children with repeat urinary tract infections,
especially boys.Up to 50% of infants and 30% of older
children with a urinary tract infection have an
anatomic abnormality. The child's pediatrician should
investigate this possibility.
• Adults with frequent or recurrent urinary tract
infections.
Blood tests usually are not required unless a
complicated condition, such as pyelonephritis
or kidney failure, is suspected.
26. NEPHROPATHIES
Nephropathy is a broad medical term used to denote
disease or damage of the kidneys, which can
eventually result in kidney failure.
The primary and most obvious functions of the
kidney are to excrete any waste products and to
regulate the water and acid-base balance of the body
– therefore loss of kidney function is a potentially fatal
condition.
27. TYPES
The list of types of Nephropathy mentioned in various
sources includes:
• Toxin nephropathy - due to toxins damaging the
kidneys
• Obstructive nephropathy
• Diabetic Nephropathy - due to diabetic
hyperglycemia damaging kidneys
• Reflux nephropathy
• IgA nephropathy
• Analgesic nephropathy
28. OBSTRUCTIVE
NEPHROPATHY
Obstructive nephropathy, also know as uropathy,
refers to the syndrome caused by urinary tract
obstruction, either functional or anatomic. It includes
urinary tract dilatation, impedance and the resulting
slowing of urine flow, change in the pressure inside
the kidney tubular system and impaired kidney
function. Blockage to the flow of urine leads to
hydronephrosis and hydroureter.
Obstructive nephropathy is a common condition, and
its incidence rises with advancing age.
In children, the leading cause is ureteropelvic
junction obstruction, with an incidence of one in
1500. Urolithiasis in children occurs in 1-5%
29. 1. CAUSES:-
Obstructive nephropathy may manifest in varying
ways, from asymptomatic to acute renal failure.
It may be acute or chronic, unilateral or bilateral.
Acute obstruction is most often due to ureteral stones.
Chronic causes range include:
• Benign prostatic hyperplasia
• Neurogenic bladder
• urinary tract stones
• ureteral stricture
• congenital anomalies such as uretero-pelvic junction
stenosis
• Fibrosis of the retroperitoneum
• Tumors of the ureter
• Ureteroceles
• Cancers of the colon or of the pelvic viscera
• Metastatic tumors in the abdomen
30. 2. SIGNS & SYMPTOMS:-
The symptoms of obstructive nephropathy may stem from
the cause of obstruction as well as the dilated organ
itself. Thus they include:
• Back and loin pain, or groin pain
• Fever
• Nausea and vomiting
• oliguria
• Edema
• Urgency or frequency of urination
• Incomplete urination
• Dribbling of urine
• Hematuria
31. 3. PATHOGENESIS:-
Because of any anatomical or functional dysfunction
regardless of the specific cause, can cause back
pressure on the kidney by preventing urinary flow.
This can result in decreased renal blood flow,
decreased glomerular filtration rate, and up-
regulation of the renin-angiotensin system. This can
in turn cause atrophy and apoptosis of the renal
tubules and interstitial fibrosis with infiltration of the
interstitial spaces by macrophages. These changes
may lead to decreased re-absorption of solutes and
water, inability to concentrate the urine, and impaired
excretion of hydrogen and potassium.
If left untreated, obstructive nephropathy can cause
irreversible renal damage. Obstruction can ultimately
cause tubulointerstitial fibrosis, tubular atrophy, and
interstitial inflammation.
32. 4. DIAGNOSIS:-
• Diagnosis is based upon clinical examination followed
by imaging tests such as intravenous urography,
retrograde ureterography, ultrasound, CT scans, and
contrast imaging.
• Ultrasound has become the imaging technique of
choice because it is available almost everywhere and
is safe but sensitive.
• CT scans are especially useful in identifying
retroperitoneal or pelvic growths which are
obstructing the ureter.
• Dye excretion urography will show the characteristic
dense nephrogram in case of ureteric obstruction.
• Renal scintigraphy using I123-hippuran or
technetium scans are helpful in assessing kidney
function in a less invasive way, including the
accumulation of the isotope, its transit time and
excretion.
• There are several other methods such as perfusion
pressure studies and renal scintigraphy to help
differentiate obstructed urinary tracts from those
which are only dilated.
• Early diagnosis of urinary obstruction is vital to
prevent further damage or to reverse renal
impairment.
33. DIABETIC
NEPHROPATHY
Diabetic nephropathy (or diabetic kidney
disease) is a progressive kidney
disease caused by damage to
the capillaries in the kidneys' glomeruli It is
characterized by nephrotic syndrome and
diffuse scarring of the glomerulli is due to
longstanding diabetes mellitus
Diabetic nephropathy is damage to
your kidneys caused by diabetes. In severe
cases it can lead to kidney failure. But not
everyone with diabetes has kidney damage.
34. SIGNS & SYMPTOMS
During its early course, diabetic nephropathy
often has no symptoms.
Symptoms can take 5 to 10 years to appear
after the kidney damage begins.
These late symptoms include:-
• severe tiredness
• headaches
• a general feeling of illness
• nausea
• Vomiting
• frequent voiding
• lack of appetite
• itchy skin
• leg swelling
35. PATHOGENESIS
Diabetes causes a number of changes to the
body's metabolism and blood circulation, which likely
combine to produce excess reactive oxygen
species (chemically reactive molecules containing
oxygen).
These changes damage the
kidney's glomeruli (networks of tiny blood vessels),
which leads to the hallmark feature of albumin in the
urine (called albuminuria).As diabetic nephropathy
progresses, a structure in the glomeruli known as the
glomerular filtration barrier (GFB) is increasingly
damaged.This barrier is composed of three layers
including the fenestrated endothelium, the glomerular
basement membrane, and the epithelial podocytes.
The GFB is responsible for the highly selective filtration
of blood entering the kidney's glomeruli and normally
only allows the passage of water, small molecules, and
very small proteins (albumin does not pass through the
intact GFB).
Damage to the glomerular basement membrane allows
proteins in the blood to leak through, leading to
accumulation in Bowman's space .
36. DIAGNOSIS
Diagnosis is usually based on the measurement
of high levels of albumin in the urine or evidence
of reduced kidney function.
Albumin measurements are defined as follows:
• Normal albuminuria: urinary albumin excretion
<30 mg/24h;
• Microalbuminuria: urinary albumin excretion in
the range of 30–299 mg/24h;
• Clinical (overt) albuminuria: urinary albumin
excretion ≥300 mg/24h.
People with diabetes are recommended to have
their albumin levels checked annually, beginning
immediately after diagnosis for type 2 diabetics,
and five years after diagnosis for type 1 diabetics.
To test kidney function, the person's estimated
glomerular filtration rate (eGFR) is measured
from a blood sample. Normal eGFR ranges from
90 to 120 ml/min/1.73 m2.
37. IgA NEPHROPATHY
• IgA nephropathy (IgAN), also known as IgA
nephritis, Berger disease or synpharyngitic
glomerulonephritis, is a disease of the kidney (or
nephropathy), specifically it is a form
of glomerulonephritisor an inflammation of
the glomeruli of the kidney.
• IgA nephropathy is the most common
glomerulonephritis worldwide. Primary IgA
nephropathy is characterized by deposition of
the IgA antibody in the glomerulus. There are
other diseases associated with glomerular IgA
deposits, the most common being IgA
vasculitis (formerly known as Henoch–Schönlein
purpura [HSP]), which is considered by many to
be a systemic form of IgA nephropathy.
• HSP presents with a characteristic purpuric skin
rash, arthritis, and abdominal pain and occurs
more commonly in young adults (16–35 years
old). HSP is associated with a more benign
prognosis than IgA nephropathy.
• In IgA nephropathy there is a slow progression to
chronic kidney failure in 25–30% of cases during a
period of 20 years.
38. SIGNS & SYMPTOMS
Signs and symptoms of IgA nephropathy
when kidney function is impaired
include:
• Cola- or tea-colored urine (caused by
red blood cells in the urine)
• Repeated episodes of cola- or tea-
colored urine, sometimes even visible
blood in your urine, usually during or
after an upper respiratory or other type
of infection
• Pain in the side(s) of your back below
your ribs (flank)
• Swelling (edema) in your hands and feet
• High blood pressure
39. PATHOGENESIS
IgA nephropathy appears to result from
an ordered sequence of events, starting
with galactose-deficient IgA1, which
contains less than a full complement of
galactose residues on the O-glycans in
the hinge region of the heavy chains..
These may act as auto-antigens that
trigger the production of glycan-specific
autoantibodies and the formation of
circulating immune complexes that are
deposited in renal mesangium. These
then induce glomerular injury through
pro-inflammatory cytokine release,
chemokine secretion, and the resultant
migration of macrophages into the
kidney.
40. DIAGNOSIS
For an adult patient with isolated hematuria, tests such
as ultrasound of the kidney and cystoscopy are usually
done first to pinpoint the source of the bleeding. These
tests would rule out kidney stones and bladder cancer,
two other common urological causes of hematuria. A
kidney biopsy is necessary to confirm the diagnosis. The
biopsy specimen shows proliferation of the mesangium,
with IgA deposits on immunofluorescence and electron
microscopy. However, patients with
isolated microscopic hematuria (i.e. without associated
proteinuria and with normal kidney function) are not
usually biopsied since this is associated with an
excellent prognosis. A urinalysis will show red blood
cells, usually as red cell urinary casts.
Other renal causes of isolated hematuria include thin
basement membrane disease and Alport syndrome, the
latter being a hereditary disease associated
with hearing impairment and eye problems.
Other blood tests done to aid in the diagnosis
include CRP or ESR, complement levels, ANA,
and LDH. Protein
electrophoresis and immunoglobulin levels can show
increased IgA in 50% of all patients.