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  1. 1. UTI , ARF , CRF<br />BY: Laura Garcia<br />
  2. 2. UTI ( urinary tract infection) <br /> What is a UTI ?<br />Urinary tract infections are caused by germs, usually bacteria that enter the urethra and then the bladder. This can lead to infection, common in the bladder, which can eventually <br />spread to the kidneys.<br />Most of the time, your body<br />can get rid of these bacteria. <br />However, certain conditions <br />increase the risk of having UTIs.<br />
  3. 3. Causes:<br />Women tend to get them more often because their urethra is shorter and closer to the anus than in men. Because of this, women are more likely to get an infection after sexual activity or when using a diaphragm for birth control. Menopause also increases the risk of a UTI.<br />The following also increase your chances of developing a UTI:<br />Diabetes <br />Advanced age (especially people in nursing homes) <br />Problems emptying your bladder (urinary retention) because of brain or nerve disorders <br />A tube called a urinary catheter inserted into your urinary tract <br />Bowel incontinence <br />Enlarged prostate, narrowed urethra, or anything that blocks the flow of urine <br />Kidney stones <br />Staying still (immobile) for a long period of time (for example, while you are recovering from a hip fracture) <br />Pregnancy<br />
  4. 4. Symptoms:<br /><ul><li>Cloudy or bloody urine, which may have a foul or strong odor
  5. 5. Low fever
  6. 6. Pain or burning with urination
  7. 7. Pressure or cramping in the lower abdomen or back
  8. 8. Strong need to urinate often</li></ul>If the infection spreads to your kidneys, symptoms may include:<br /><ul><li>Chills and shaking or night sweats
  9. 9. Fatigue and a general ill feeling
  10. 10. Fever above 101 degrees Fahrenheit
  11. 11. Flank, back, or groin pain
  12. 12. Flushed, warm, or reddened skin
  13. 13. Mental changes or confusion in the elderly
  14. 14. Nausea and vomiting
  15. 15. Severe abdominal pain</li></li></ul><li>Laboratory Diagnosis:<br /> A urine sample is usually collected to perform test that will help to determine if what the patient has is a UTI or something more serious and to help with knowing what tip of medication to prescribe them. <br /> Urinalysis is done to look for white blood cells, red blood cells, bacteria, and to test for certain chemicals, such as nitrites in the urine. Most of the time, your doctor or nurse can diagnose an infection using a urinalysis. <br />Urine culture - clean catch may be done to identify the bacteria in the urine to make sure the correct antibiotic is being used for treatment. <br />CBCand a blood culture may be done.<br /> The following tests may be done to help rule out problems in the patents urinary system that might lead to infection or make a UTI harder to treat:<br />CT scan of the abdomen <br />Intravenous pyelogram (IVP) <br />Kidney scan <br />Kidney ultrasound <br />Voiding cystourethrogram<br />
  16. 16. Treatment and control: <br /> Commonly used antibiotics include trimethoprim-sulfamethoxazole, amoxicillin, Augmentin, doxycycline, and fluoroquinolones<br />Antibiotics taken by mouth are usually recommended because there is a risk that the infection can spread to the kidneys.<br />For a simple bladder infection, you will take antibiotics for 3 days (women) or 7 - 14 days (men). For a bladder infection with complications such as pregnancy or diabetes, OR a mild kidney infection, you will usually take antibiotics for 7 - 14 days. <br />***Everyone with a bladder or kidney infection should drink plenty of water.<br /> Some women have repeat or recurrent bladder infections. Your doctor may suggest several different ways of treating these.<br />Taking a single dose of an antibiotic after sexual contact may prevent these infections, which occur after sexual activity. <br />Having a 3-day course of antibiotics at home to use for infections diagnosed based on your symptoms may work for some women. <br />Some women may also try taking a single, daily dose of an antibiotic to prevent infections. <br />
  17. 17. ARF (Acute Renal Failure): <br />ARF: Acute renal failure is a rapid decrease in renal function over days to weeks, causing an accumulation of nitrogenous products in the blood. It often results from major trauma, illness, or surgery but is sometimes caused by a rapidly progressive, intrinsic renal disease.<br />Symptoms: Symptoms include anorexia, nausea, and vomiting. Seizures and coma may occur if the condition is untreated. Fluid, electrolyte, and acid-base disorders develop quickly.<br />
  18. 18. Diagnosis:<br /> Diagnosing is based on laboratory tests of renal function, including serum creatinine. Urinary indexes, urinary sediment examination, and often imaging and other tests are needed to determine the cause.<br />Treatment: Treatment is directed at the cause but also includes fluid and electrolyte management and sometimes dialysis. <br />Immediate treatment of pulmonary edema and hyperkalemia<br />Dialysis as needed to control hyperkalemia, pulmonary edema, metabolic acidosis, and uremic symptoms<br />Adjustment of drug regimen<br />Usually restriction of water, Na, and K intake, but provision of adequate protein<br />Possibly phosphate binders and Na polystyrene sulfonate<br />Prevention: ARF can often be prevented by maintaining normal fluid balance, blood volume, and BP in patients with trauma, burns, or major hemorrhage and in those undergoing major surgery. Infusion of isotonic saline and blood may be helpful. If additional BP support is required, at-risk groups (the elderly and those with preexisting renal insufficiency, volume depletion, diabetes, or heart failure).re). <br />
  19. 19. CRF ( Chronic Renal Failure)<br />CRF: Chronic kidney disease is long-standing, progressive deterioration of renal function. It is also known as Chronic kidney disease (CKD) which may result from any cause of renal dysfunction of sufficient magnitude.<br />Signs and Symptoms: <br /> Patients with mildly diminished renal reserve are asymptomatic. Even patients with mild to moderate renal insufficiency may have no symptoms despite elevated BUN and creatinine. Nocturia is often noted, principally due to a failure to concentrate the urine. Lassitude, fatigue, anorexia, and decreased mental acuity often are the earliest manifestations of uremia.<br />
  20. 20. Diagnosing CRF<br /> CRF is usually first suspected when serum creatinine rises. The initial step is to determine whether the renal failure is acute, chronic, or acute superimposed on chronic The cause of renal failure is also determined. Sometimes determining the duration of renal failure helps determine the cause; sometimes it is easier to determine the cause than the duration, and determining the cause helps determine the duration.<br />Test that are used to DX:<br />Electrolytes, BUN, creatinine, phosphate, Ca, CBC, urinalysis (including urinary sediment examination)<br />Ultrasonography<br />Sometimes, renal biopsy<br />
  21. 21. Treatment<br />Control of underlying disorders <br />Possible restriction of dietary protein, phosphate, and K<br />Vitamin D supplements<br />Treatment of anemia and heart failure <br />Doses of all drugs adjusted as needed<br />Dialysis for severer CRF, uremic symptoms, or sometimes hyperkalemia or heart failure <br />Prognosis: <br />Progression of CRF is predicted in most cases by the degree of proteinuria. Patients with nephrotic-range proteinuria (> 3 g/24 h or urine protein/creatinine > 3) usually have a poorer prognosis and progress to renal failure more rapidly Hypertension is associated with more rapid progression as well.<br />