Pyelonephritis
It is the inflammation of the kidney & upper urinary tract that usually results from the bacterial infection of the bladder.
Pyelonephritis can be classified in several different catagories:
-acute pyelonephritis
-chronic pyelonephritis
-xanthogranulomatous pyelonephritis
Urinary tract infection
INTRODUCTION:
A urinary tract infection (UTI) is an infection of renal system. The renal or urinary system includes the 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 are men. If an infection is limited to the bladder, it can be painful and annoying. But serious health problems can result if a UTI spreads to the kidneys.
Definition :-
A condition in which bacteria invade and grow in the urinary tract (the kidneys, ureters, bladder, and urethra). Most urinary tract infections occur in the bladder or urethra.
TYPES :
An infection can happen in different parts of your urinary tract. Each type has a different name, based on where it is.
• Cystitis
• Pyelonephritis
• Urethritis
• Uretritis
Incidence: . Every year about 150 million people are being diagnosed with urinary tract infection worldwide. Each and every woman has a lifetime risk of developing UTI is 60%; by contrast, men have a lifetime risk of only 13%. .
Risk Factors/causes:
UTIs are more common in females because their urethras are shorter and closer to the rectum. This makes it easier for bacteria to enter the urinary tract.
Other factors are:-
• A previous UTI
• Sexual activity
• Pregnancy
• Age (older adults and young children are more likely to get UTIs)
• Poor hygiene,
Pathophsiology:
Clinical manifestation:
Pain or burning while urinating
• Frequent urination
• Feeling the need to urinate despite having an empty bladder
• Bloody urine
• Pressure or cramping in the groin or lower abdomen
Symptoms of a kidney infection can include:
• Fever
• Chills
• Lower back pain or pain in the side of your back
• Nausea or vomiting
Diagnostic /evaluation:
History and physical examination
• Urinalysis:
• Urine culture:
• Imaging your urinary tract:
• Cystoscopy:
• Blood tests:
• Pelvic exam:
• Rectal exam:
Medical management:
Symptomatic treatments includes :
• Urinary analgesic to control pain such as urspass,pyridium.
• P.C.M to control fever and high temperature.
• Anti emetics such as emeset .perinorm to control vomiting.
• Plenty of water and fluids.
Commonly used antibiotics are
• Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS)
• Fosfomycin (Monurol)
• Nitrofurantoin (Macrodantin, Macrobid, Furadantin)
• Cephalexin
• Often, UTI symptoms clear up within a few days of starting treatment. But may need to continue antibiotics for a week or more
• For an uncomplicated UTI , may recommended a shorter course of treatment. That may mean taking an antibiotic for 1 to 3 days.
• If you have frequent UTIs, may get recommended :Low-dose antibiotics. might be taken for six months or longer.
• And other measures includes :Taking a single dose of antibiotic after sex if UTIs are related to sexual activity.Vaginal estrogen therapy if you've reached menopause.
. Prevention
• Should void or Urinate after
I bought this file from (FB name: Dee Dee). The files are extremely helpful, visit his Facebook account or Facebook page.
https://web.facebook.com/groups/670462807397676/
Pyelonephritis
It is the inflammation of the kidney & upper urinary tract that usually results from the bacterial infection of the bladder.
Pyelonephritis can be classified in several different catagories:
-acute pyelonephritis
-chronic pyelonephritis
-xanthogranulomatous pyelonephritis
Urinary tract infection
INTRODUCTION:
A urinary tract infection (UTI) is an infection of renal system. The renal or urinary system includes the 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 are men. If an infection is limited to the bladder, it can be painful and annoying. But serious health problems can result if a UTI spreads to the kidneys.
Definition :-
A condition in which bacteria invade and grow in the urinary tract (the kidneys, ureters, bladder, and urethra). Most urinary tract infections occur in the bladder or urethra.
TYPES :
An infection can happen in different parts of your urinary tract. Each type has a different name, based on where it is.
• Cystitis
• Pyelonephritis
• Urethritis
• Uretritis
Incidence: . Every year about 150 million people are being diagnosed with urinary tract infection worldwide. Each and every woman has a lifetime risk of developing UTI is 60%; by contrast, men have a lifetime risk of only 13%. .
Risk Factors/causes:
UTIs are more common in females because their urethras are shorter and closer to the rectum. This makes it easier for bacteria to enter the urinary tract.
Other factors are:-
• A previous UTI
• Sexual activity
• Pregnancy
• Age (older adults and young children are more likely to get UTIs)
• Poor hygiene,
Pathophsiology:
Clinical manifestation:
Pain or burning while urinating
• Frequent urination
• Feeling the need to urinate despite having an empty bladder
• Bloody urine
• Pressure or cramping in the groin or lower abdomen
Symptoms of a kidney infection can include:
• Fever
• Chills
• Lower back pain or pain in the side of your back
• Nausea or vomiting
Diagnostic /evaluation:
History and physical examination
• Urinalysis:
• Urine culture:
• Imaging your urinary tract:
• Cystoscopy:
• Blood tests:
• Pelvic exam:
• Rectal exam:
Medical management:
Symptomatic treatments includes :
• Urinary analgesic to control pain such as urspass,pyridium.
• P.C.M to control fever and high temperature.
• Anti emetics such as emeset .perinorm to control vomiting.
• Plenty of water and fluids.
Commonly used antibiotics are
• Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS)
• Fosfomycin (Monurol)
• Nitrofurantoin (Macrodantin, Macrobid, Furadantin)
• Cephalexin
• Often, UTI symptoms clear up within a few days of starting treatment. But may need to continue antibiotics for a week or more
• For an uncomplicated UTI , may recommended a shorter course of treatment. That may mean taking an antibiotic for 1 to 3 days.
• If you have frequent UTIs, may get recommended :Low-dose antibiotics. might be taken for six months or longer.
• And other measures includes :Taking a single dose of antibiotic after sex if UTIs are related to sexual activity.Vaginal estrogen therapy if you've reached menopause.
. Prevention
• Should void or Urinate after
I bought this file from (FB name: Dee Dee). The files are extremely helpful, visit his Facebook account or Facebook page.
https://web.facebook.com/groups/670462807397676/
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. CONTENTS
• INTRODUCTION
• MICROBIOLOGY
• PREDISPOSING FACTORS
• PATHOGENESIS AND PATHOLOGY
• CLINICAL FEATURES
• CLASSIFICATION
• DIAGNOSIS
• TREATMENT
• IMAGING STUDIES
• PREVENTING RECURRENT UTI
3. INTRODUCTION
• Urinary tract infection is a common medical problem in
children, affecting 3-10% in girls and 1-3% in boys.
• They are an important cause of morbidity and mortality
result in renal damage,often in association with
VESICOURETERIC REFLEX.
• During infancy,UTIs are equally common in boys and
girls because the route of infection is often
hematogenous and boys have a higher incidence of
urinary tract anomalies.
• As the age progress girls are more prone to UTI than
boys.
4. MICROBIOLOGY
• UTIs are chiefly caused by E.coli the
predominant peri urethral flora, others include
KLEBSIELLA, ENTEROBACTER, and
STAPHYLOCOCCUS SAPROHLPHYTICUS.
• PROTEUS and PSEUDOMONAS infection occur
following obstruction or instrumentation.
• CANDIDA infection occurs in immuno
compromised children or after prolonged
antimicrobial therapy.
5. PREDISPOSING FACTORS
• Recurrent UTIs are observed in 30-50% children,
usually within 3 months of the first episode.
• Predisposing factors for recurrent UTIs include
female sex,age below 6months,obstructive
uropathy,severe VUR,voiding dysfunction,
constipation, repeated catheterization.e.g
NEUROGENIC BLADDER.
• Children with malnutrition and those receiving
Immunosuppressive therapy are also susceptible.
6. HOST FACTORS THAT
PROTECT UT FROM UTI
•Unobstructed urine transport
•Unidirectional urine flow
•Operative antimicrobial urothelial
activity
•Regular,complete bladder emptying
•Normal perineal resistance
8. PATHOGENESIS AND
PATHOLOGY
• Nearly all UTIs are ascending infections.
• The bacteria arise from the fecal flora,colonize the
perineum,and enter the bladder via the urethra.
• In uncircumcised males,the bacterial pathogens arise
from the flora beneath the prepuce.
• In some cases,the bacteria causing cystitis ascend to
the kidney to cause pyelonephritis.
• Rarely,renal infection occurs by hematogenous
spread, as in endocarditis or in some
bactetemicneonates.
9. PATHOGENESIS AND
PATHOLOGY CONTND...
• If bacteria ascend from the bladder to the kidney,acute
pyelonephritis can occur.
• Normally,the simple and compound papillae in the
kidney have an antireflux mechanism that prevents
urine in the renal pelvis from entering the collecting
tubules.
• However some compound papillae,typically in the
upper and lower poles of the kidney,allow intra renal
reflux.
• Infected urine stimulates an immunologic and
inflammatory response, causing renal injury and
scarring.
11. CLINICAL FEATURES
• Neonates show features of sepsis with
fever,vomiting,Diarrhea,jaundice, poor
weight gain and lethargy.
• Gross haematuria is uncommon.
• The presence of crying or straining during
voiding, dribbling weak or abnormal urine
stream and palpable bladder suggest
urinary tract obstruction.
12. CLINICAL FEATURES
CONTND...
• It is difficult to distinguish between infection
localised to the bladder (cystitis) and upper
tracts (pyelonephritis)
• The distinction is not necessary since most UTI
in children below 5 years of age involve the
upper tracts.
• Patients with high fever(>37°C),systemic
toxicity, Persistant vomiting,dehydration,renal
angle tenderness or raised creatinine are
considered as complicated.
13. CLINICAL FEATURES
CONTND...
•Patients with low grade fever,
dysuria,frequency and urgency and
absence of symptoms of complicated
UTI are considered to have simple UTI.
•This distinction is important for
purposes of therapy.
14. CLINICAL FEATURES
CONTND...
• Important features on evaluation include
history of straining at micturition,incontinence
or poor urinary stream,voiding postponement
and surgery for meningomyelocele or
anorectal malformation.
• Finding of palpable kidneys,distended
bladder,tight phimosis,vulval synechiae and
neurological deficet in lower limbs suggest a
predisposing cause.
15. CLASSIFICATION OF UTI
•The two basic forms of UTI (defined as
symptoms and a positive culture) are
PYELONEPHRITIS AND CYSTITIS.
•Focal pyelonephritis (Lobar nephronia)
and renal abscesses are less common.
16. CLASSIFICATION OF UTI
CON...
• PYELONEPHRITIS
• Pyelonephritis is characterized by any or all of
the following:
• Abdominal,back,or flank
pain;fever;malaise;nausea;vomiting;and
occasionally diarrhoea.
• Fever may be the only
manifestation;particularly consideration
should occur for a temperature>39°c without
another source lasting more than 24 hrs for
males and more than 48 hrs for females.
18. CLASSIFICATION OF UTI
CON...
• CYSTITIS
• Cystitis indicates that there is only bladder
involvement;symptoms include
dysuria,urgency,frequency,suprapubic
pain,incontinence,and possibly malodourous
urine.
• Cystitis does not cause high fever and does not
result in renal injury.
• Malodourous urine is not specific for a UTI.
19. CYSTITIS CONTND...
• Acute hemorrhagic cystitis,though uncommon in
children,is often caused by E.coli;it also has been
attributed to adenovirus types 11 and 21.
• Adenovirus cystitis is more common in boys;it is
self limiting,with haematuria lasting approximately
4 days.
• Patients receiving Immunosuppressive therapy are
at higher risk for hemorrhagic cystitis.
• Adenovirus and polyomaviruses are important
causes in immuno compromised populations.
20. DIAGNOSIS
• The diagnosis of UTI is based on growth of
significant number of a organisms in the
urine.
• Significant bacteriuria is a colony count of
>105/ml of a single species in a clean catch
sample.
• Urine may be obtained by suprapubic
bladder aspiration or urethral catheterization
in children below 2 years.
21. DIAGNOSIS CONTND...
•Any colonies on suprapubic aspiration
and >50000/ml on urethral
catheterization are considered
significant.
•The occurrence of significant bacteriuria
in absence of symptoms is termed
ASYMPTOMATIC BACTERURIA.
22. DIAGNOSIS CONTND...
• The presence of >10 leukocytes per mm3
in fresh uncentrifuged sample,or >5
leukocytes per high power field in
centrifuge sample is useful for screening.
• Dipstick examination, combining
leukocyte esterase and nitrite, has
moderate sensitivity and specificity for
detecting UTIs.
23. TREATMENT
• Once UTI is suspected,a urine specimen is sent
for culture and treatment started.
• Infants <3 months of age and children with
complicated UTI should initially receive
parenterel antibiotics.
• The initial choice of antibiotics is emperic and is
modified once culture result is available.
• Therapy with CEPHALOSPORINS is preffered but
single daily dose of AMINOGLYCOSIDES is aslo
safe and effective.
24. ANTIMICROBIALS FOR
TREATMENT OF UTI
MEDICATION DOSE(mg/kg/day)
CEFTRAIXONE 75-100,in 1-2 divided doses IV
CEFOTAXIME 100-150,in 2-3 divided doses IV
AMIKACIN 10-15,single dose IV or IM
CEFIXIME 8-10,in 2 divided doses oral
COAMOXICLAV 30-50 of amoxicillin,in 2 doses oral
CIPROFLOXACIN 10-20,in 2 divided doses oral
OFLOXACIN 15-20, in 2 divided doses oral
CEPHALEXIN 50-70,in 2-3 divided doses oral
25. TREATMENT CONTND...
• Once oral intake improves and symptoms
abate,usually after 48-72hrs,therapy is switched to an
oral antibiotics.
• The duration of treatment for complicated UTI is 10-
14 days.
• Older infants and patients with simple UTI should
receive treatment with an oral antibiotics for 7-10
days
• Adolescents with cystitis may receive shorter
duration of antibiotics,lasting for 72 hrs
• Asymptomatic bacteriuria do not require treatment.
26. TREATMENT CONTND...
• All Children with UTI are encouraged to take enough fluids
and empty bladder frequently.
• Routine alkalization of the urine is not necessary.
• With appropriate therapy fever and systemic toxicity reduce
and urine culture is sterile within 24-36 hrs.
• Failure to obtain such results suggests either lack of
bacterial sensitivity to the medication or presence of an
underlying anomaly of the urinary tract.
• A repeat urine culture is not required during or following
treatment,unless symptoms fail to resolve despite 72 hrs of
therapy symptoms recur,or contamination of initial culture
is suspected.
27. EVALUATION OF UTI
•Following treatment of the first episode
of UTI,plans are made for evaluation of
the urinary tract.
•The aim of the imaging studies is to
identify urological anomalies that
predispose to pyelonephritis,such as
obstruction or VUR,and detect evidence
of renal scarring.
28. EVALUATION OF UTI
AGE EVALUATION
Below 1 year Ultrasound
MCU
DMSA
1-5 years Ultrasound
DMSA
MCU, if usg or DMSA is
abnormal.
Above 5 years Ultrasound
If ultrasound
abnormal:MCU,DMSA.
29. EVALUATION OF UTI CON...
• The goal of imaging studies in children with a
UTI is to identify anatomic abnormalities that
predispose to infection,determine whether
there is active renal involvement,and assess
whether renal function is normal or at risk.
• There are two historical approaches to
imaging,the traditional
• 1 BOTTOM-UP
• 2 TOP-DOWN
30. EVALUATION OF UTI CON...
• BOTTOM-TOP:
• This method was a renal sonogram plus a voiding
cystourethrogram, which will identify upper and
lower urinary tract abnormalities,including
VUR,bladder-bowel dysfunction and bladder
abnormalities,such as para urethral diverticulum.
• TOP-DOWN
• This approach was intended to reduce the number of
VCUG examinations
• It begins with a DMSA renal scan,to identify areas of
acute pyelonephritis.
31. PREVENTION OF
RECURRENT UTI
• Prophylactic antibiotics are administered to young
infants until results of imaging are available.
• The medication used should be effective,nontoxic
and not alter the gut flora or induce bacterial
resistance.
• The medication is given as a single bedtime dose.
• Long term antibiotic prophylaxis is also
recommended in patients with VUR and in those with
frequent febrile UTI(3 or more episodes in a year),
even if the urinary tract is normal.
32. PREVENTION OF UTI CON...
• Circumcision reduces the risk of recurrent UTI in
Infant boys,and might have benefits in patients with
high grade VUR.
• Children with recurrent UTI and/or VUR might have
dysfunctional voiding and require appropriate advice.
• Constipation should be managed with dietary
modifications and medications as required.
• Some patients may require bladder
retraining,anticholinergic medication and/or
intermittent catheterization.
33. ANTIMICROBIALS FOR
PROPHYLAXIS OF UTI
MEDICATION DOSE(mg/kg/day) REMARKS
COTRIMAXAZOLE 1-2 of trimethoprim Avoid in Infants <3 months
old, G6PD deficiency.
NITROFURANTOIN 1-2 May cause vomiting and
nausea;avoid in <3 months
old, G6PD deficiency,renal
insufficiency.
CEPHALEXIN 10 Drug of choice in first 3-6
months of life.
CEFADROXIL 5 Alternative agent in early
infancy.
34. REFERENCES
1 NELSONS TEXTBOOK OF PEDIATRICS
2 PIYUSH GUPTA TEXTBOOK OF PEDIATRICS
3 OP GHAI ESSENTIALS OF PEDIATRICS