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Pylonephritis,seminar presentation..


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Pylonephritis,seminar presentation..

  1. 1. Definition UTI means infection of any part of urinary tract(Kidney, Ureter, Bladder or Urethra) Infections of the urethra and bladder are oftenconsidered superficial (or mucosal) infections While pyelonephritis, and renal suppurationsignify tissue invasion Asymptomatic bacteriuria, acute cystitis, andacute pyelonephritis are common renal disordersin pregnancy.
  2. 2.  Asymptomatic bacteriuria- is defined as thepresence of actively multiplying bacteria inthe urinary tract excluding the distal urethrain a patient without any obvious symptoms Incidence during 10%. The diagnosis is based upon isolation ofmicroorganisms with a colony count > 105organisms per milliliter of urine in a clean-catch specimen.
  3. 3.  If asymptomatic bacteriuria is left untreatedin pregnancy, up to 40% of patients willdevelop symptoms of UTI. Approximately 25–30% of women will developacute pyelonephritis. With treatment, therate is 10% The increased risk is due to: decreased ureteral tone, decreased ureteral peristalsis, temporary incompetence of thevesicoureteral valves, Bladder catheterization
  4. 4.  Escherichia coli ( 80% ). The Klebsiella-Enterobacter-Serratia group, Staphylococcus aureus, group B Streptococcus, enterococcus Proteus are responsible for the remainderof the case
  5. 5.  Dysuria, urgency and frequency-thesymptom. Pyuria,bacteriuria and microscopichematuria. Frequency, urgency, dysuria ,pyuria buturine culture with no growth may beurethritis caused by C.trachomatis. The bacteria causing acute cystitis aresimilar to those in asymptomatic bacteriuria
  6. 6.  Acute pyelonephritis is the infection of therenal pelvis and the kidneys. It is one of the most common causes ofhospitalization and serious medicalcomplication of pregnancy. Complicates 1-2% of pregnancies. Develops more frequently in secondtrimester. Isolates from urine or blood are-E.coli(75-80%),others K .pnuemonia, enterobacter orproteus
  7. 7.  Asymptomatic bacteruria-the single mostimportant risk factor. aprevious history of pyelonephritis, Gravidity(primi) urinary tract malformation, urinary calculi. Maternal DM Sickle cell trait
  8. 8.  Fever(usually > 390C) shaking chills, bilateral flank pain, Nausea, vomiting and possibly diahrrea headache, increased urinary frequency, and dysuria CVA tenderness.
  9. 9.  chorio-amnionites, appendicites, labor, placental abruption, red degeneration of myoma Renal caliculi
  10. 10. maternal fetal bacterial endotoxemia, endotoxic shock renal insufficiency(ARF) anemia, leukocytosis, thrombocytopenia, Pulmonary dysfunction(mild cough,rispiratoryinfiltrat to sever ARDS) low birth weight(smallfor GA) premature delivery neonatal death
  11. 11.  CBC(Hct,Hgb,WBC(leukocytosis),pletlet) Blood group and RH Serum HCG Blood sugar level U/S,IVP
  12. 12. Urine culture: Significant bacteriuria= 105 cfu/ml symptoms: 1 +ve cuture = infection Symptoms: 102 cfu/ml = propable infection Asymptomatic: 2 +ve cultures = infection False negative : antibiotics, antiseptics, renalTB, diuresis.
  13. 13. Microscopy of urine Assessed with Gram-stained uncentrifuged urine Microscopic bacteriuria is found in >90% of specimenswith colony counts of at least 105 /mL The detection of bacteria by urinary microscopyconstitutes firm evidence of infection, but theabsence of microscopically detectable bacteria doesnot exclude the diagnosis Pyuria (WBC > 5/HPF) is demonstrated in nearly allacute bacterial UTIs and its absence calls for thediagnosis of UTI in question Look also for RBCs, WBC casts Associated hematuria may indicate urinary calculi.
  14. 14. Sterile pyuria Pyuria in the absence of bacteriuria Indicate infection with unusual agents such as C.trachomatis, U. urealyticum, or Mycobacteriumtuberculosis or with fungi May also occur in noninfectious urologicconditions such as calculi, anatomicabnormality, vesicoureteral reflux, interstitialnephritis, or polycystic disease
  15. 15. 1. Hospitalization2. Urine and blood cultures,RFT,electrolyte3. Monitor vital signs frequently, includingurinary output; consider indwelling catheter4. Intravenous crystalloid to establish urinaryoutput to 30 mL/hr5. IV antimicrobial therapy(sulfonamides andcephalosporin are reasonable choices.)
  16. 16. 6. Chest radiograph if there is dyspnea ortachypnea7. Repeat hematology and chemistry studies in48 hours8. Change to oral antimicrobials when afebrile9. Discharge when afebrile 24 hours; considerantimicrobial therapy for 7 to 10 days