This document discusses urinary tract infections (UTIs), acute kidney injury (AKI), and chronic kidney disease (CKD). It begins by defining UTIs, describing their risk factors, clinical manifestations, diagnosis, treatment and prevention. It then defines and classifies AKI according to RIFLE, AKIN and KDIGO criteria. The document reviews the epidemiology, etiologies including prerenal, intrinsic renal and postrenal causes, clinical findings, management principles and risk factors for AKI. It concludes by stating the learning objectives were to understand definitions and classifications of AKI and UTI, approaches to diagnosis and management, and strategies for prevention.
UTI IN PREG in Obstetrics and Gynecology.pptxByamugishaJames
This document discusses urinary tract infections (UTIs) during pregnancy. It notes that UTIs are common in pregnancy due to physiological changes that cause dilatation of the kidneys and ureters. Asymptomatic bacteriuria occurs in 2-7% of pregnancies and can lead to complications if untreated. Symptomatic UTIs include cystitis and pyelonephritis. Risk factors include diabetes, urinary stasis, and vesicoureteral reflux. Treatment involves antibiotics effective against common uropathogens like E. coli, with nitrofurantoin being widely used for asymptomatic bacteriuria and cystitis. Acute pyelonephritis requires hospitalization and IV hydration in addition
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/
ASYMTOMATIC BACTERIURA & UTI IN PREGNANCY.pptugonnanwoke
This document discusses urinary tract infections (UTIs) during pregnancy. It covers the types of UTIs including asymptomatic bacteriuria and acute cystitis. Pregnancy increases risk of UTIs due to hormonal and anatomical changes. Screening for and treatment of asymptomatic bacteriuria is important to prevent complications like acute pyelonephritis. Symptoms, investigations, and management are described for different UTIs. Complications can include maternal anemia, preterm labor, and fetal growth issues if left untreated.
Urinary tract infections (UTIs) are common, especially in females and young children. UTIs are caused by bacterial invasion of the urinary tract and result in inflammation. Common symptoms include fever, urinary urgency, and abdominal pain. UTIs are usually treated with antibiotics like trimethoprim-sulfamethoxazole or fluoroquinolones. Severe or recurrent UTIs may require imaging and long-term preventative management to address risk factors and complications like renal scarring.
This document provides an overview of urinary tract infections (UTIs). It defines UTIs and lists the parts of the urinary tract. The pathophysiology and most common causes are described. Risk factors, signs and symptoms, diagnosis, and management approaches are outlined for both uncomplicated and complicated UTIs in different populations like children, adults, pregnant women. Imaging tests and their appropriate uses are also summarized. Treatment options for UTIs in various groups are provided.
This document provides an overview of urinary tract infections (UTIs). It defines UTIs and lists the parts of the urinary tract. The pathophysiology and most common causes are described. Risk factors, signs and symptoms, diagnosis, and management approaches are outlined for both uncomplicated and complicated UTIs in different populations like children, adults, pregnant women. Imaging tests and their appropriate uses are also summarized. Treatment options for UTIs in various groups are provided.
This document discusses prostatitis, an inflammation of the prostate gland. It describes the different classifications of prostatitis including acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis. Treatment options are provided for different types, including antibiotics for acute bacterial prostatitis and supportive care. Diagnostic tests like urinalysis, EPS examination, and imaging are also outlined.
1. Urinary tract infections (UTIs) are common in women, increasing after adolescence and sexual activity. They can lead to medical complications and increased healthcare costs.
2. UTIs are classified as lower or upper tract infections. Common causes are E. coli and other bacteria. Risk factors include sexual activity and use of diaphragms.
3. Symptomatic UTIs require treatment, while asymptomatic bacteriuria often does not. Treatment depends on the type and severity of infection. Recurrent infections may require long-term preventative antibiotics.
UTI IN PREG in Obstetrics and Gynecology.pptxByamugishaJames
This document discusses urinary tract infections (UTIs) during pregnancy. It notes that UTIs are common in pregnancy due to physiological changes that cause dilatation of the kidneys and ureters. Asymptomatic bacteriuria occurs in 2-7% of pregnancies and can lead to complications if untreated. Symptomatic UTIs include cystitis and pyelonephritis. Risk factors include diabetes, urinary stasis, and vesicoureteral reflux. Treatment involves antibiotics effective against common uropathogens like E. coli, with nitrofurantoin being widely used for asymptomatic bacteriuria and cystitis. Acute pyelonephritis requires hospitalization and IV hydration in addition
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/
ASYMTOMATIC BACTERIURA & UTI IN PREGNANCY.pptugonnanwoke
This document discusses urinary tract infections (UTIs) during pregnancy. It covers the types of UTIs including asymptomatic bacteriuria and acute cystitis. Pregnancy increases risk of UTIs due to hormonal and anatomical changes. Screening for and treatment of asymptomatic bacteriuria is important to prevent complications like acute pyelonephritis. Symptoms, investigations, and management are described for different UTIs. Complications can include maternal anemia, preterm labor, and fetal growth issues if left untreated.
Urinary tract infections (UTIs) are common, especially in females and young children. UTIs are caused by bacterial invasion of the urinary tract and result in inflammation. Common symptoms include fever, urinary urgency, and abdominal pain. UTIs are usually treated with antibiotics like trimethoprim-sulfamethoxazole or fluoroquinolones. Severe or recurrent UTIs may require imaging and long-term preventative management to address risk factors and complications like renal scarring.
This document provides an overview of urinary tract infections (UTIs). It defines UTIs and lists the parts of the urinary tract. The pathophysiology and most common causes are described. Risk factors, signs and symptoms, diagnosis, and management approaches are outlined for both uncomplicated and complicated UTIs in different populations like children, adults, pregnant women. Imaging tests and their appropriate uses are also summarized. Treatment options for UTIs in various groups are provided.
This document provides an overview of urinary tract infections (UTIs). It defines UTIs and lists the parts of the urinary tract. The pathophysiology and most common causes are described. Risk factors, signs and symptoms, diagnosis, and management approaches are outlined for both uncomplicated and complicated UTIs in different populations like children, adults, pregnant women. Imaging tests and their appropriate uses are also summarized. Treatment options for UTIs in various groups are provided.
This document discusses prostatitis, an inflammation of the prostate gland. It describes the different classifications of prostatitis including acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis. Treatment options are provided for different types, including antibiotics for acute bacterial prostatitis and supportive care. Diagnostic tests like urinalysis, EPS examination, and imaging are also outlined.
1. Urinary tract infections (UTIs) are common in women, increasing after adolescence and sexual activity. They can lead to medical complications and increased healthcare costs.
2. UTIs are classified as lower or upper tract infections. Common causes are E. coli and other bacteria. Risk factors include sexual activity and use of diaphragms.
3. Symptomatic UTIs require treatment, while asymptomatic bacteriuria often does not. Treatment depends on the type and severity of infection. Recurrent infections may require long-term preventative antibiotics.
An 40 year old woman presented with complaints of painful urination, urgency, lower back pain and burning urination. Urine culture showed 105 colony-forming units/ml of bacteria. She was treated with an antibiotic (Trimethoprim–sulfamethoxazole) twice daily for 3 days and pain medication, which reduced her symptoms. Urinary tract infections are common and occur when bacteria or other microbes infect the urethra, bladder, ureters, or kidneys. Symptoms include painful urination and back pain. Diagnosis involves a urine test and culture. Treatment is usually a short course of antibiotics along with pain medication and hydration.
This document discusses urinary tract infections (UTIs). It begins by introducing UTIs as a common cause of morbidity, particularly among women. It then defines different types of UTIs like cystitis, urethritis, and pyelonephritis. The document discusses the most common causative organisms of UTIs and their antibiotic susceptibility. It provides details on clinical features, diagnosis, and treatment recommendations for acute uncomplicated cystitis, acute complicated cystitis, recurrent cystitis, uncomplicated pyelonephritis, prostatitis, catheter-associated UTIs, and asymptomatic bacteriuria. It emphasizes the importance of treating asymptomatic bacteriuria during pregnancy to prevent complications.
This document discusses various disorders of micturition including lower urinary tract symptoms, urinary incontinence, urinary tract infections, and other related conditions. It covers the anatomy, innervation, blood supply, and various disorders such as urinary incontinence, UTIs, pelvic organ prolapse, and fistulae. Specific conditions discussed in more detail include stress incontinence, urge incontinence, acute and recurrent cystitis, acute and chronic pyelonephritis, and urethritis. The causes, risk factors, presentations, investigations, and management of each condition are summarized.
This document provides information about urinary tract infections (UTIs). It begins with an introduction to UTIs, noting they are common and usually responsive to antibiotics. The document then covers classification of UTIs, risk factors, symptoms, diagnostic tests, treatment including antibiotics, and complications. It also provides details on specific types of UTIs like cystitis, urethritis and pyelonephritis. The document concludes with a section on renal calculi/kidney stones, discussing causes, types, diagnosis and treatment.
This document discusses urinary tract infections (UTIs). It defines UTIs as infections of the urinary system from the kidneys to the bladder. UTIs are generally caused by bacteria like E. coli entering the urinary tract. Factors like female anatomy, sexual activity, and catheters can predispose individuals to UTIs. UTIs are classified as uncomplicated or complicated depending on patient risk factors. Symptoms include urinary problems and in severe cases fever. Diagnosis involves urine tests and cultures. Treatment differs based on infection type but generally involves antibiotics like trimethoprim-sulfamethoxazole over 3-7 days. Prevention focuses on hygiene and prophylaxis in recurrent cases.
This document discusses various urological disorders including urinary tract infections, pyelonephritis, renal calculi, urologic trauma, urological cancers, acute kidney injury, chronic kidney disease, and renal transplantation. It provides information on the pathophysiology, signs and symptoms, diagnostic studies, medical and nursing management of each condition. Key points include that urinary tract infections are most commonly caused by E. coli, pyelonephritis involves inflammation of the kidneys that causes fever and flank pain, renal calculi form stones in the urinary tract causing pain, and nursing care focuses on symptom management, fluid balance, and monitoring for complications of related conditions and treatments.
UTI power point about urinary tract infection .pptxBekaluTemesgen2
Urinary tract infections are common, especially in women. Escherichia coli is the most common cause. Risk factors include female anatomy, sexual activity, catheter use, diabetes, and anatomical abnormalities. Symptoms range from urinary frequency and pain to systemic manifestations like confusion in elderly patients. Diagnosis involves a urine culture and treatment depends on infection severity and location. Recurrent infections require identifying and addressing risk factors. Prevention strategies center on proper catheter care and management of underlying conditions.
Urinary Tract Infection with Nursing ManagementSwatilekha Das
Urinary Tract Infection introduction, definition, common microorganisms, classification, predisposing factors, clinical manifestations, pathophysiology, diagnostic studies, medical management and nursing management along with assessment, nursing diagnosis, goal, nursing interventions and expected outcome after the intervention.
The document discusses urinary tract infections (UTIs). It defines UTIs as infections that affect any part of the urinary system, with most involving the lower tract. The types discussed are pyelonephritis (kidney infection), cystitis (bladder infection), urethritis (urethra infection), and prostatitis (prostate infection). Signs and symptoms, causes, diagnostic tests, and treatment options are described for each type of UTI. The document emphasizes the importance of antibiotic therapy and fluid management in treatment.
The document discusses various topics related to the genitourinary system including renal anatomy and physiology, common conditions like urinary tract infections and kidney stones, and nursing considerations for related assessments, procedures, and treatments. Specific conditions covered include acute renal failure, chronic renal failure, nephrolithiasis, urinary tract infections, and dialysis.
This document outlines catheter-associated urinary tract infections (CA-UTIs). It defines CA-UTIs and asymptomatic bacteriuria in patients with indwelling catheters. The incidence of CA-UTIs is high, around 3-10% per day of catheterization. Risk factors include longer catheterization duration, female sex, older age, and diabetes. CA-UTIs are usually caused by bacteria that enter around or through the catheter. Common organisms include E. coli, Candida, Enterococcus, Pseudomonas, and Klebsiella. Symptoms of CA-UTIs are often nonspecific like fever. Diagnosis involves urine culture and treatment involves antibiotics, with choices dependent on resistance risk factors
This document discusses urinary tract infections (UTIs) in children. It covers the classification of UTIs as uncomplicated or complicated, the symptoms and diagnosis of cystitis and pyelonephritis. Treatment involves antibiotics, with ceftriaxone, cefotaxime and amoxicillin being recommended options. For pyelonephritis specifically, the document outlines the acute vs chronic forms and how they are diagnosed based on symptoms, lab tests and imaging. Differential diagnosis with other conditions like acute appendicitis is also addressed.
This document discusses urinary tract infections (UTIs). It defines UTIs and describes their causes, symptoms, classifications, pathophysiology, diagnosis, and treatment. UTIs are caused by bacteria invading the urinary tract. Symptoms include burning during urination, increased frequency and urgency. The document outlines nursing management of UTIs which includes relieving pain, encouraging fluid intake, and teaching patients to promote prevention and proper treatment.
UTIs are common in pregnancy due to physiological changes that cause urine stasis. The main types of UTI in pregnancy are asymptomatic bacteriuria, acute cystitis, and acute pyelonephritis. Escherichia coli is the most common causative organism. It is important to collect a midstream clean catch urine sample to accurately diagnose a UTI through urine analysis and culture.
Liver Abscess by Dr Mudassir Baig PIMS.pptxmuddu baig
Liver abscess is a collection of purulent material in the liver parenchyma forming a cavity. It is one of the most common types of visceral abscesses. There are different types including bacterial, parasitic, and fungal abscesses. Amoebic liver abscess is the most common worldwide, while pyogenic liver abscess is more common in the US. Pyogenic liver abscess is usually caused by bacteria like E. coli and involves the right lobe of the liver in males ages 20-40. Abscesses less than 5mm can often be treated medically with antibiotics, while larger abscesses are generally better managed with percutaneous drainage which provides faster clinical improvement and shorter hospital stays compared to needle aspiration
Urinary tract infections are common and are usually caused by bacteria that enter the urinary tract and cause an infection. Women are more likely than men to get UTIs. Risk factors include gender, age, pregnancy, structural abnormalities, diabetes, and vesicoureteral reflux. Common bacteria that cause UTIs include E. coli, Klebsiella, Pseudomonas, and Enterococcus. UTIs are classified as either lower UTIs, which involve the urethra and bladder, or upper UTIs, which involve the kidneys and ureters. Diagnosis involves urine testing and culture. Treatment depends on whether the infection is complicated or uncomplicated. Catheter-associated UTIs are a
8.presentation on male reproductive system [autosaved]PoojaDagar3
1. The document discusses various male reproductive disorders including prostate disorders like benign prostatic hyperplasia and prostate cancer. It describes the anatomy, risk factors, clinical presentation, diagnostic evaluation and treatment options for these disorders.
2. Prostatitis is also covered, including the types, causes, symptoms, tests used for diagnosis and treatment approaches for bacterial versus chronic pelvic pain syndrome.
3. Other topics include testicular disorders like cancer and torsion, as well as scrotal conditions, infertility and disorders affecting the male reproductive system. Surgical and minimally invasive procedures are described for treatment of many of these conditions.
Presentation on male reproductive system by poojaPoojaDagar3
1. The document discusses various male reproductive disorders including prostate disorders like benign prostatic hyperplasia and prostate cancer. It describes the anatomy, risk factors, clinical presentation, diagnostic evaluation and treatment options for these disorders.
2. Prostatitis is also covered, including the types, causes, symptoms, tests used for diagnosis and treatment approaches for bacterial versus chronic pelvic pain syndrome.
3. Other topics include testicular disorders like cancer and torsion, as well as scrotal conditions, infertility and disorders affecting the male reproductive system. Surgical and medical management are described for many of these conditions.
therputics 2 chapter4 urinary tract infections noor batarseh.pptDuaaMichael
The document discusses urinary tract infections (UTIs). It defines UTIs and classifies them as either uncomplicated or complicated. It describes the signs and symptoms of lower and upper UTIs. The most common causative organism of uncomplicated UTIs is E. coli. Risk factors, diagnosis, treatment options, and appropriate antibiotic therapy durations are discussed. Fluoroquinolones are recommended for resistant infections while nitrofurantoin and TMP-SMX are first-line options for uncomplicated cystitis.
The integumentary system consists of the skin, hair, nails, and glands. The skin is the largest organ of the body and has several key functions, including protection, temperature regulation, sensation, and excretion. It is composed of three main layers - the epidermis, dermis, and hypodermis. The epidermis contains keratinocytes, melanocytes, Merkel cells, and Langerhans cells. Sweat and sebaceous glands are located within the dermis and produce sweat or sebum. Hair follicles also reside in the dermis and each hair is made of a shaft, root, and bulb. Nails cover the tips of fingers and toes and
Allergic rhinitis is an inflammation of the nasal mucosa caused by an allergen, affecting 10-25% of the population. It is classified as intermittent or persistent based on duration of symptoms. Common symptoms include sneezing, nasal congestion, and rhinorrhea. Diagnosis involves skin prick tests and nasal smears. Treatment includes avoidance of allergens, oral antihistamines, intranasal corticosteroids, immunotherapy for refractory cases, and occasionally surgery for sinusitis or septal deviations. Prognosis is generally good with treatment and symptoms often improve with age.
An 40 year old woman presented with complaints of painful urination, urgency, lower back pain and burning urination. Urine culture showed 105 colony-forming units/ml of bacteria. She was treated with an antibiotic (Trimethoprim–sulfamethoxazole) twice daily for 3 days and pain medication, which reduced her symptoms. Urinary tract infections are common and occur when bacteria or other microbes infect the urethra, bladder, ureters, or kidneys. Symptoms include painful urination and back pain. Diagnosis involves a urine test and culture. Treatment is usually a short course of antibiotics along with pain medication and hydration.
This document discusses urinary tract infections (UTIs). It begins by introducing UTIs as a common cause of morbidity, particularly among women. It then defines different types of UTIs like cystitis, urethritis, and pyelonephritis. The document discusses the most common causative organisms of UTIs and their antibiotic susceptibility. It provides details on clinical features, diagnosis, and treatment recommendations for acute uncomplicated cystitis, acute complicated cystitis, recurrent cystitis, uncomplicated pyelonephritis, prostatitis, catheter-associated UTIs, and asymptomatic bacteriuria. It emphasizes the importance of treating asymptomatic bacteriuria during pregnancy to prevent complications.
This document discusses various disorders of micturition including lower urinary tract symptoms, urinary incontinence, urinary tract infections, and other related conditions. It covers the anatomy, innervation, blood supply, and various disorders such as urinary incontinence, UTIs, pelvic organ prolapse, and fistulae. Specific conditions discussed in more detail include stress incontinence, urge incontinence, acute and recurrent cystitis, acute and chronic pyelonephritis, and urethritis. The causes, risk factors, presentations, investigations, and management of each condition are summarized.
This document provides information about urinary tract infections (UTIs). It begins with an introduction to UTIs, noting they are common and usually responsive to antibiotics. The document then covers classification of UTIs, risk factors, symptoms, diagnostic tests, treatment including antibiotics, and complications. It also provides details on specific types of UTIs like cystitis, urethritis and pyelonephritis. The document concludes with a section on renal calculi/kidney stones, discussing causes, types, diagnosis and treatment.
This document discusses urinary tract infections (UTIs). It defines UTIs as infections of the urinary system from the kidneys to the bladder. UTIs are generally caused by bacteria like E. coli entering the urinary tract. Factors like female anatomy, sexual activity, and catheters can predispose individuals to UTIs. UTIs are classified as uncomplicated or complicated depending on patient risk factors. Symptoms include urinary problems and in severe cases fever. Diagnosis involves urine tests and cultures. Treatment differs based on infection type but generally involves antibiotics like trimethoprim-sulfamethoxazole over 3-7 days. Prevention focuses on hygiene and prophylaxis in recurrent cases.
This document discusses various urological disorders including urinary tract infections, pyelonephritis, renal calculi, urologic trauma, urological cancers, acute kidney injury, chronic kidney disease, and renal transplantation. It provides information on the pathophysiology, signs and symptoms, diagnostic studies, medical and nursing management of each condition. Key points include that urinary tract infections are most commonly caused by E. coli, pyelonephritis involves inflammation of the kidneys that causes fever and flank pain, renal calculi form stones in the urinary tract causing pain, and nursing care focuses on symptom management, fluid balance, and monitoring for complications of related conditions and treatments.
UTI power point about urinary tract infection .pptxBekaluTemesgen2
Urinary tract infections are common, especially in women. Escherichia coli is the most common cause. Risk factors include female anatomy, sexual activity, catheter use, diabetes, and anatomical abnormalities. Symptoms range from urinary frequency and pain to systemic manifestations like confusion in elderly patients. Diagnosis involves a urine culture and treatment depends on infection severity and location. Recurrent infections require identifying and addressing risk factors. Prevention strategies center on proper catheter care and management of underlying conditions.
Urinary Tract Infection with Nursing ManagementSwatilekha Das
Urinary Tract Infection introduction, definition, common microorganisms, classification, predisposing factors, clinical manifestations, pathophysiology, diagnostic studies, medical management and nursing management along with assessment, nursing diagnosis, goal, nursing interventions and expected outcome after the intervention.
The document discusses urinary tract infections (UTIs). It defines UTIs as infections that affect any part of the urinary system, with most involving the lower tract. The types discussed are pyelonephritis (kidney infection), cystitis (bladder infection), urethritis (urethra infection), and prostatitis (prostate infection). Signs and symptoms, causes, diagnostic tests, and treatment options are described for each type of UTI. The document emphasizes the importance of antibiotic therapy and fluid management in treatment.
The document discusses various topics related to the genitourinary system including renal anatomy and physiology, common conditions like urinary tract infections and kidney stones, and nursing considerations for related assessments, procedures, and treatments. Specific conditions covered include acute renal failure, chronic renal failure, nephrolithiasis, urinary tract infections, and dialysis.
This document outlines catheter-associated urinary tract infections (CA-UTIs). It defines CA-UTIs and asymptomatic bacteriuria in patients with indwelling catheters. The incidence of CA-UTIs is high, around 3-10% per day of catheterization. Risk factors include longer catheterization duration, female sex, older age, and diabetes. CA-UTIs are usually caused by bacteria that enter around or through the catheter. Common organisms include E. coli, Candida, Enterococcus, Pseudomonas, and Klebsiella. Symptoms of CA-UTIs are often nonspecific like fever. Diagnosis involves urine culture and treatment involves antibiotics, with choices dependent on resistance risk factors
This document discusses urinary tract infections (UTIs) in children. It covers the classification of UTIs as uncomplicated or complicated, the symptoms and diagnosis of cystitis and pyelonephritis. Treatment involves antibiotics, with ceftriaxone, cefotaxime and amoxicillin being recommended options. For pyelonephritis specifically, the document outlines the acute vs chronic forms and how they are diagnosed based on symptoms, lab tests and imaging. Differential diagnosis with other conditions like acute appendicitis is also addressed.
This document discusses urinary tract infections (UTIs). It defines UTIs and describes their causes, symptoms, classifications, pathophysiology, diagnosis, and treatment. UTIs are caused by bacteria invading the urinary tract. Symptoms include burning during urination, increased frequency and urgency. The document outlines nursing management of UTIs which includes relieving pain, encouraging fluid intake, and teaching patients to promote prevention and proper treatment.
UTIs are common in pregnancy due to physiological changes that cause urine stasis. The main types of UTI in pregnancy are asymptomatic bacteriuria, acute cystitis, and acute pyelonephritis. Escherichia coli is the most common causative organism. It is important to collect a midstream clean catch urine sample to accurately diagnose a UTI through urine analysis and culture.
Liver Abscess by Dr Mudassir Baig PIMS.pptxmuddu baig
Liver abscess is a collection of purulent material in the liver parenchyma forming a cavity. It is one of the most common types of visceral abscesses. There are different types including bacterial, parasitic, and fungal abscesses. Amoebic liver abscess is the most common worldwide, while pyogenic liver abscess is more common in the US. Pyogenic liver abscess is usually caused by bacteria like E. coli and involves the right lobe of the liver in males ages 20-40. Abscesses less than 5mm can often be treated medically with antibiotics, while larger abscesses are generally better managed with percutaneous drainage which provides faster clinical improvement and shorter hospital stays compared to needle aspiration
Urinary tract infections are common and are usually caused by bacteria that enter the urinary tract and cause an infection. Women are more likely than men to get UTIs. Risk factors include gender, age, pregnancy, structural abnormalities, diabetes, and vesicoureteral reflux. Common bacteria that cause UTIs include E. coli, Klebsiella, Pseudomonas, and Enterococcus. UTIs are classified as either lower UTIs, which involve the urethra and bladder, or upper UTIs, which involve the kidneys and ureters. Diagnosis involves urine testing and culture. Treatment depends on whether the infection is complicated or uncomplicated. Catheter-associated UTIs are a
8.presentation on male reproductive system [autosaved]PoojaDagar3
1. The document discusses various male reproductive disorders including prostate disorders like benign prostatic hyperplasia and prostate cancer. It describes the anatomy, risk factors, clinical presentation, diagnostic evaluation and treatment options for these disorders.
2. Prostatitis is also covered, including the types, causes, symptoms, tests used for diagnosis and treatment approaches for bacterial versus chronic pelvic pain syndrome.
3. Other topics include testicular disorders like cancer and torsion, as well as scrotal conditions, infertility and disorders affecting the male reproductive system. Surgical and minimally invasive procedures are described for treatment of many of these conditions.
Presentation on male reproductive system by poojaPoojaDagar3
1. The document discusses various male reproductive disorders including prostate disorders like benign prostatic hyperplasia and prostate cancer. It describes the anatomy, risk factors, clinical presentation, diagnostic evaluation and treatment options for these disorders.
2. Prostatitis is also covered, including the types, causes, symptoms, tests used for diagnosis and treatment approaches for bacterial versus chronic pelvic pain syndrome.
3. Other topics include testicular disorders like cancer and torsion, as well as scrotal conditions, infertility and disorders affecting the male reproductive system. Surgical and medical management are described for many of these conditions.
therputics 2 chapter4 urinary tract infections noor batarseh.pptDuaaMichael
The document discusses urinary tract infections (UTIs). It defines UTIs and classifies them as either uncomplicated or complicated. It describes the signs and symptoms of lower and upper UTIs. The most common causative organism of uncomplicated UTIs is E. coli. Risk factors, diagnosis, treatment options, and appropriate antibiotic therapy durations are discussed. Fluoroquinolones are recommended for resistant infections while nitrofurantoin and TMP-SMX are first-line options for uncomplicated cystitis.
The integumentary system consists of the skin, hair, nails, and glands. The skin is the largest organ of the body and has several key functions, including protection, temperature regulation, sensation, and excretion. It is composed of three main layers - the epidermis, dermis, and hypodermis. The epidermis contains keratinocytes, melanocytes, Merkel cells, and Langerhans cells. Sweat and sebaceous glands are located within the dermis and produce sweat or sebum. Hair follicles also reside in the dermis and each hair is made of a shaft, root, and bulb. Nails cover the tips of fingers and toes and
Allergic rhinitis is an inflammation of the nasal mucosa caused by an allergen, affecting 10-25% of the population. It is classified as intermittent or persistent based on duration of symptoms. Common symptoms include sneezing, nasal congestion, and rhinorrhea. Diagnosis involves skin prick tests and nasal smears. Treatment includes avoidance of allergens, oral antihistamines, intranasal corticosteroids, immunotherapy for refractory cases, and occasionally surgery for sinusitis or septal deviations. Prognosis is generally good with treatment and symptoms often improve with age.
This document discusses body temperature regulation and fever. It begins by describing how the hypothalamus controls normal body temperature and defines fever as an elevation of the hypothalamic temperature set point. It then discusses the mechanisms by which the body increases temperature during a fever, including heat conservation and increased heat production. Pyrogenic cytokines like IL-1, IL-6 and TNF are produced in response to infection or inflammation and trigger prostaglandin E2 release in the hypothalamus, elevating the temperature set point. The document provides detailed information on normal temperature variations, methods of temperature measurement, causes of fever and hyperthermia, and the molecular mechanisms that induce fever.
Atlas of Rashes Associated with Fever.pptxTigabuAgmas1
This atlas presents images of rashes caused by various infectious diseases that are commonly associated with fever to help clinicians more rapidly diagnose patients presenting with fever and rash. It shows examples like petechial lesions of Rocky Mountain spotted fever and pustular rashes of smallpox to illustrate key features of different rashes that can help narrow the diagnostic differential and lead to prompt, potentially life-saving treatment.
- Body temperature is regulated by the hypothalamus, which integrates signals from the skin, blood, and peripheral nerves to maintain the core body temperature within a narrow range.
- Fever is caused by an elevation of the hypothalamic set point in response to pyrogens like bacterial toxins and cytokines, which trigger the release of prostaglandin E2 in the hypothalamus. This prostaglandin acts on receptors in the hypothalamus to raise the set point and induce heat-conserving mechanisms that increase the body's temperature.
This document discusses the mechanisms of action, side effects, and clinical management of anticoagulant drugs including heparin, warfarin, and newer oral anticoagulants. It describes how heparin and related drugs act as indirect thrombin inhibitors by enhancing the effects of antithrombin, while direct thrombin inhibitors and factor Xa inhibitors act by directly binding to and inhibiting specific coagulation proteins. The side effects of bleeding and heparin-induced thrombocytopenia are reviewed for heparin, as are methods for reversing its effects. Drug interactions and toxicity are discussed for warfarin along with reversal of its anticoagulant effects.
Fibrinolytic , Antiplatelet and Vt K.pptxTigabuAgmas1
Fibrinolytic drugs such as streptokinase and urokinase catalyze the formation of plasmin from plasminogen, allowing plasmin to lyse thrombi. Tissue plasminogen activators like alteplase preferentially activate fibrin-bound plasminogen. Aspirin inhibits thromboxane A2 synthesis to reduce platelet aggregation. Clopidogrel and prasugrel irreversibly block the ADP receptor on platelets. Abciximab, eptifibatide, and tirofiban inhibit the glycoprotein IIb/IIIa receptor, the final pathway for platelet aggregation. Vitamin K is required for the biological activity of coagulation factors and its administration
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVedanta A
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
More@: https://tinyurl.com/2shrryhx
More@: https://tinyurl.com/5n8h3wp8
English Drug and Alcohol Commissioners June 2024.pptxMatSouthwell1
Presentation made by Mat Southwell to the Harm Reduction Working Group of the English Drug and Alcohol Commissioners. Discuss stimulants, OAMT, NSP coverage and community-led approach to DCRs. Focussing on active drug user perspectives and interests
Health Tech Market Intelligence Prelim Questions -Gokul Rangarajan
The Ultimate Guide to Setting up Market Research in Health Tech part -1
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
This lays foundation of scoping research project what are the
Before embarking on a research project, especially one aimed at scoping and defining parameters like the one described for health tech IT, several crucial considerations should be addressed. Here’s a comprehensive guide covering key aspects to ensure a well-structured and successful research initiative:
1. Define Research Objectives and Scope
Clear Objectives: Define specific goals such as understanding market needs, identifying new opportunities, assessing risks, or refining pricing strategies.
Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
3. Review Existing Literature and Resources
Literature Review: Conduct a thorough review of existing research, market reports, and relevant literature to build foundational knowledge.
Gap Analysis: Identify gaps in existing knowledge or areas where further exploration is needed.
4. Select Research Methodology and Tools
Methodological Approach: Choose appropriate research methods such as surveys, interviews, focus groups, or data analytics.
Tools and Resources: Select tools like Google Forms for surveys, analytics platforms (e.g., SimilarWeb, Statista), and expert consultations.
5. Ethical Considerations and Compliance
Ethical Approval: Ensure compliance with ethical guidelines for research involving human subjects.
Data Privacy: Implement measures to protect participant confidentiality and adhere to data protection regulations (e.g., GDPR, HIPAA).
6. Budget and Resource Allocation
Resource Planning: Allocate resources including time, budget, and personnel required for each phase of the research.
Contingency Planning: Anticipate and plan for unforeseen challenges or adjustments to the research plan.
7. Develop Research Instruments
Survey Design: Create well-structured surveys using tools like Google Forms to gather quantitative data.
Interview and Focus Group Guides: Prepare detailed scripts and discussion points for qualitative data collection.
8. Sampling Strategy
Sampling Design: Define the sampling frame, size, and method (e.g., random sampling, stratified sampling) to ensure representation of target demographics.
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9. Data Collection and Analysis Plan
Data Collection: Implement methods for data gathering, ensuring consistency and validity.
Analysis Techniques: Decide on analytical approaches (e.g., statistical
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This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
4. Introduction
• UTI is infection of the urinary tract causing inflammatory
response.
• When normal flora of the periurethral area are replaced by
uropathogenic bacteria.
• Then ascend to cause cystitis,pyelonephritis.
• Third comment infection experianced by human.
• Respiratory tract infection > Gastro-intestinal infection > urinary
tract infection.
• Women are more afected than men.
2/4/2023
4
5. Terminology.
• Asymptomatic bacteruria.
• Upper UTI and Lower UTI.
• Complicated and Uncomplicated UTI.
• Recurrent UTI
• Relapse
• Reinfection.
• Treatment Failure
• Catheter associated UTI.
2/4/2023
5
6. Risk factors for UTI
Patients with voiding abnormalities related to:
Diabetes
Neurogenic bladder
Spinal cord injury
Pregnancy
Prostatic hypertrophy(BPH)
7. Cont….
Urinary tract instrumentation Premenopausal women: sexual
intercourse, spermicides; previous UTI; history maternal UTI & age at
1st UTI (genetic component)
Perimenopausal women: changes in vaginal microbial flora
Postmenopausal women: mechanical & physiologic factors affecting
bladder emptying
8. What organisms are generally
found in UTI?
Uncomplicated cystitis and pyelonephritis
E. coli: >90%; S. saprophyticus: 5%-10%
Other coliforms (Klebsiella, Proteus)
Short-term catheters
E. coli and typical hospital-acquired pathogens
Klebsiella, Citrobacter, Enterobacter, Pseudomonas, coagulase-
negative staphylococci, enterococci, Candida
Long-term catheters
Typically polymicrobial
Proteus, Morganella, and Providenciacommon, as well as
pathogens above
9. Clinical Manifestation.
In noncatheterized individuals
Dysuria, urinary frequency, urgency
History provided by patient has high predictive value
In catheterized patients
Fever, rigors, altered mental status, malaise or lethargy with no
other identified cause
Flank pain, CVA tenderness, acute hematuria, or pelvic discomfort
If ≤48h since catheter removed: dysuria, urgency, frequent
urination, suprapubic pain or tenderness
10. Differential Diagnosis.
Vaginitis
Candida, Trichomonasvaginalis, Bacteroidesspecies, Gardnerellavaginalis
Vaginal discharge, odor, or itching; “external” dysuria
Urethritis
Chlamydia trachomatis, Neisseriagonorrhoeae, or HSV
Gradual onset of symptoms ± vaginal discharge; ± urinary frequency or
urgency
11. Diagnosis.
Urine Microscopy.
Urine Culture.
Indications
1. Patient with sign symptom of UTI.
2. Follow up of recntly treated UTI.
3. Removal of Induelling catheter.
4. Screening for asymptomatic bacteruria.
5. Patient with obstructive uropathy before procedure.
Imaging study
1. Plain x-ray.
2. Ultrasound.
3. Intravenous urography.
4. Computed tomography.
12. Is there a role for screening for UTI
or asymptomatic bacteriuria?
Early in pregnancy
High rate progression to symptomatic UTI
Associated with low birthweight and preterm labor
Men undergoing transurethral resection of prostate
Risk for bacteremia, with associated sepsis syndrome
Urinary tract instrumentation causing mucosal bleeding
Simple catheter placement does not warrant screening
Renal transplant and neutropenic patients
13. Indication For Hospital
Admission.
Sepsis
Unable to take oral therapy
Vomiting
Intolerance for available oral agents
Upper urinary tract condition requires drainage or surgery
Abscesses, emphysematous pyelonephritis, papillary necrosis,
xanthogranulomatouspyelonephritis
Multidrug-resistantorganism susceptible only to parenterally
administered antimicrobials
Serious comorbid condition, including pregnancy
15. What are the usual reasons for
failure of UTI therapy?
Antibiotic resistance
Urologic complications
Urinary tract stones
Voiding disorder
Indwelling catheter
Stent
Urinary obstruction,
Anatomical abnormalities
Vesicoureteral reflux
16. How can UTI be prevented?
Postcoital antibiotic prophylaxis
For women with 3 to 4 UTIs/yr, particularly if associated with coitus
Continuous prophylaxis
For more frequent recurrences
Patient-initiated prophylaxis
For recurrent, uncomplicated UTI unrelated to coitus
Taken at symptom onset
Intravaginal estriol cream
Daily topical application for postmenopausal women
Supports vaginal flora, acid vaginal pH, and reduced vaginal
colonization with E. coli
17. Follow up
Uncomplicated cystitis
No specific follow-up as long as symptoms resolve
Pregnant women
Urine culture to confirm bacteriuria eradicated
Repeat urinalyses or urine cultures at intervals to confirm sterility
of urine through delivery
Complicated UTI
Monitor for symptomatic resolution
Reevaluate if symptoms don’t improve ≤48h, worsen, or recur
quickly
In CAUTI: monitor response by symptoms not by repeated urine
cultures
19. Learning Objectives
• Definitions and classification of AKI
• Epidemiology and clinical outcome
• Diagnosis and etiology
• Approach and management of AKI
• Risk factors and preventive strategies
2/4/2023
19
21. To function properly
kidneys require:
• Normal renal blood flow
• Functioning glomeruli and tubules
• Clear urinary outflow tract for drainage and
elimination of formed urine
2/4/2023
21
22. Definition of AKI
• a sudden, sustained, and usually
reversible decrease in the glomerular
filtration rate (GFR) occurring over a
period of hours to days.
> 35 definitions used in published
studies
2/4/2023
22
24. DefinitionofAKIbasedonAKIN
“AcuteKidneyInjuryNetwork”(2007 )
Stage Increase in Serum
Creatinine
Urine Output
1 1.5-2 times baseline
OR
0.3 mg/dl increase
from baseline
<0.5 ml/kg/h for >6 h
2 2-3 times baseline <0.5 ml/kg/h for >12 h
3 3 times baseline
OR
0.5 mg/dl increase if
baseline>4mg/dl
OR
Any RRT given
<0.3 ml/kg/h for >24 h
OR
Anuria for >12 h
2/4/2023
24
25. KDIGO Definition of AKI
(2012 )
Defined by any of the following:
• Increase in SCr by ≥0.3 mg/dL within 48 hours
• Increase in Scr by ≥1.5 times baseline, which is known or
presumed to have occurred within the prior seven days
• Urine volume <0.5 mL/kg/h for six hours
2/4/2023
25
26. KDIGO Classificationof AKI(2012 )
Stage Serum creatinine Urine output
1 1.5-1.9× baseline
OR
>0.3 mg/dL
<0.5 ml/kg/hr for 6-12 hrs
2 2-2.9× baseline
<0.5 ml/kg/hr > 12 hrs
3 3 times baseline
OR
increase in Cr to ≥4.0 mg/dL
OR
Initiation of RRT
<0.3 ml/kg/hr > 24 hrs
OR
Anuria > 12 hrs
KDIGO Clinical Practice Guideline for AKI. Kidney Int 2012
2/4/2023
26
30. Prerenal AKI
• Intravascular volume depletion:
-bleeding, GI loss, Renal loss, Skin loss (burn), Third space loss, poor oral
intake (NPO, AMS, anorexia)
• Decreased effective circulating volume:
-congestive heart failure, cirrhosis, nephrotic syndrome, sepsis
• Decreased flow through renal artery:
-pharmacologic impairment (RAAS blocker, NSAIDs, CNI)
2/4/2023
30
31. Pre renal Azotemia treatment.
• In early stages can be rapidly corrected by aggressive
normalization of effective arterial volume.
• Correction of volume deficits
• Optimization of cardiac function
• Discontinuation of antagonizing medications
• NSAIDs/COX-2 inhibitors
• Diuretics
• RAAS blockers
2/4/2023
31
38. Etiologies: Lower tract obstruction
• BPH or prostate cancer
• Bladder cancer
• Urethral strictures
• Bladder stones
• Blood clots
• Functional obstruction as a result of
neurogenic bladder
2/4/2023
38
39. Postrenal AKI treatment.
• Prompt recognition and relief of obstruction can prevent the
development of permanent structural damage.
• Lower tract obstruction (bladder catheter)
• Upper tract obstruction
• ureteral stents
• percutaneous nephrostomies
• Recovery of renal function dependent upon duration of
obstruction.
2/4/2023
39
40. • U/A, Urine protein/Cr, Urine Eosinophilla
•Urine microscopy:
• Muddy brown casts in ATN
• WBC casts in AIN
• RBC casts in AGN
• CPK, uric acid
• Post-void residual (>100-150 ml c/w voiding dysfunction)
• bladder catheterization
• renal ultrasound
2/4/2023
40
41. ManagementofAKI:generalprinciple
• Identify the etiology and treat the underlying cause
• Optimization of hemodynamics to increase renal
perfusion
• Lack of benefit – low dose dopamine, loop diuretics
only if markedly fluid overload
• Identify and aggressively treat infection (early removal
of Foley catheters, and minimize indwelling lines)
2/4/2023
41
42. Cont….
• Correct fluid imbalances: strict I/O’s, daily wts. determine fluid
balance goals daily, fluid selection or diuresis, readjust for UOP
recovery, post diuresis or dialysis
• Electrolyte imbalances
• Metabolic acidosis (Bicarb deficit, mode and rate of replacement)
• Nutritional support
• Medication dose adjustment:
• Holding of offending drugs.
• Procedural considerations (prefer non-contrast CT, appropriate to
delay contrast exposure)
2/4/2023
42
43. Be aware of pts who are at risk for AKI
Volume depletion or Hypotension
Sepsis
Pre-existing renal, hepatic, or cardiac disease.
Diabetes mellitus
Elderly
Exposure to nephrotoxins
Aminoglycosides, amphotericin,
immunosuppressive agents, chemo., NSAIDs,,
RAAS blockers, intravenous contrast media
Post cardiac or vascular Surgery pts or ICU pts with
multiorgan failure
2/4/2023
43
45. CKD
Definition:
final stage of numerous renal diseases resulting from
progressive loss of glomerular, tubular and endocrine
function in both kidneys. This leads to
accumulation of toxins that normally undergo renal
excretion, including products of protein metabolism;
those consequent to the loss of other kidney functions,
such as fluid and electrolyte homeostasis and
hormone regulation; and
progressive systemic inflammation and its vascular and
nutritional consequences
2/4/2023
45
46. Epidemiology
Regional and racial incidence of CRF
• Britain 70-80/per million
• China 100/per million
• USA 60-70/per million
2/4/2023
46
55. Cont….
Hematologic disorders
• Anemia, bleeding disorder, platelet dysfunction
Causes:
• Relative deficiency of erythropoietin
• Decreased erythropoietin production
• Reduced red cell survival
• Increased blood loss
• Folate and Iron deficiency
2/4/2023
55
56. Cont….
Neurologic Manifestation.
• Central nervous system
Tiredness, insomnia, agitation, irritability,
depression,
• Peripheral nervous system
Restless leg syndrome - the patient’s legs are
jumpy during the night, painful paresthesis of extremities,
twitching, loss of deep tendon reflexes , musclar weakness,
sensory deficits.
2/4/2023
56
57. Cont….
Renal osteodystrophy
Type I: high turn-over bone disease
Ostitis fibrosa cystica.
Brown tumor
Type II: low turn-over bone disease
Adynamic bone disease
Osteomalacia
Calcyphylaxis
Tuberous calcinosis.
Type III: mixture
2/4/2023
57
58. Cont….
Causes of renal osteodystrophy
• 1, 25(OH)2D3
• calcium phosphate
• malnutrition
• iron and aluminum overload
2/4/2023
58
60. Cont….
Causes of hyperkalemia.
Increased intake:
Impaired excretion
chronic renal failure(GFR<15ml/min)
Shift of K out of cells.
metabolic acidosis
2/4/2023
60
61. Diagnosis:
• History
• Physical examination
• Laboratory studies including
urinalysis , renal function tests ,
biochemical analysis of blood
• X-ray, ultrasound and Imaging Study.
2/4/2023
61
63. Cont….
Non-dialysis
1. Diet therapy
2. Treatment of reversible factors
3. Treatment of the underlying disease
4. Treatment of complications of uremia
2/4/2023
63
64. Cont….
Diet therapy
• Protein restriction (0.5-0.8mg/kg/d)
• Adequate intake of calories(30-35kcal/kg/d)
• Low phosphate diet(600-1000mg/d)
2/4/2023
64
70. Cont….
Treatment of anemia
• Recombinant human erythropoietin(rhEPO)
• Target hemoglobin 10-11.5g/L
• Restore iron store.
• Folate supplementation.
2/4/2023
70
71. cont….
Side effects of rhEPO
• Hypertension
• Hyper coagulation
• Thrombosis of the AVF
2/4/2023
71
72. Cont….
rhEPO resistant
• Iron deficiency
• Active inflamation
• Malignancy
• Secondary hyperparathyroid
• Aluminum overload
• Pure red cell aplasia
2/4/2023
72
73. Cont….
Treatment of renal osteodystrophy
Low phosphate diet
Calcium carbonate (1-6g/d)
Vitamin D (0.25ug/d for prophylactic, 0.5ug/d for symptomatic, pulse
therapy 2-4ug/d for severe cases)
Parathyroidectomy
2/4/2023
73
90. GLOMERULARDISEASESWITH
NEPHROTICSYNDROME
Nephrotic synd:
1. Edema,
2. Nephrotic-range proteinuria) greater than 50 mg/kg per
day or 40 mg/h/m2 in children and 3.5 g/24 h in adults ,
3. Hyperlipidemia
4. Hypoalbuminemia.
Causes are
Minimal change disease (MCD)
Focal Segmental Glomerulosclerosis (FSGS)
Membranous nephropathy (MN)
2/4/2023
90
91. MINIMALCHANGEDISEASE(MCD)
• characterized initially by dramatic increases in glomerular
permeability in association with little or no structural abnormalities
by light microscopy.
• lipoid nephrosis Munk (1913) nill disease.
• MCD is most common in children, In adults, especially in elderlies
associated with secondary causes
• 70% to 90% of cases of nephrotic syndrome in children younger
than age 10 years and 50% of cases in older children.
• Minimal change glomerulopathy also causes 10%-15% of cases of
primary nephrotic syndrome in adults.
• 15-20% nephritic features may occur
• MCD in children mostly (%80-90) idiopatic
2/4/2023
91
92. HISTOPATHOLOGY
• The principal target of injury is the podocyte, ***podocytopathies
• Light microscopy: lack of definitive alteration in glomerular structure.
Lipid droplets in the tubuler cells
• Immunofluorescence: also shows no change
• Electron mic: fusion of epithelial foot processes
2/4/2023
92
93. Laboratory findings of MCD
• Heavy proteinuria.
• Microscopic hematuria is seen in fewer than 15% of patients.
• Volume contraction may lead to a rise in both the hematocrit and hemoglobin.
• Hypoalbuminemia & dyslipedemia
• The serum albumin <2 g/dL and, in more severe cases, <1 g/dL.
• Total cholesterol, LDL, and triglyceride levels are increased.
• Pseudohyponatremia has been observed in the setting of marked
hyperlipidemia.
• Renal function is usually normal, although a minority of patients have
substantial AKI.
• Complement levels are typically normal in patients with minimal change
glomerulopathy
2/4/2023
93
94. Secondarycauses of MCD
• Drugs
-NSAID
-penicillin
-trimetoprim
• Toxins
-Mercury
-lead
• Infection
-Mononucleosis
- HIV
Tumors
Hodgkins lymphoma
Other lymhoproliferative dis.,
2/4/2023
94
95. • Emprical steroid theraphy for children <10
• In children who have received empirical treatment, a renal
biopsy is indicated when there is failure to respond to a 4- to
6-week course of prednisone.
• oral prednisone be administered as a single daily dose
starting at 60 mg/m2 /day
• or 2 mg/kg/day to a maximum 60 mg/day
Specific treatment: corticosteroids
2/4/2023
95
96. Clinical course of MCD as related to
steroid theraphy
• STEROID-SENSITIVE NEPHROTIC SYNDROME (SSNS)
Complete remission of proteinuria within 8-12 weeks with
infrequent relapses
• FREQUENTLY RELAPSING and STEROID DEPENDENT
(FR-SD)
Relapses occur during the taper of steroids
• STEROID-RESISTANT NEPHROTIC SYNDROME (SRNS)
Failure to obtain a remission within 12 weeks
2/4/2023
96
97. PROGNOSIS
• 85-90 % survival rate
• Untreated idiopathic MCD was associated with a risk of
mortality due to infection and less commonly
thromboembolism
2/4/2023
97
98. complications
• Related to persistent NS (peritonitis, ARF, CKD in steroid
resistant patients)
• Side effect of therapy( cataracts, acne, cushingoid face,
hyperglycemia, Hhypertension)
2/4/2023
98
99. FOCALSEGMENTALGLOMERULOSCLEROSIS(FSGS)
• Common cause of nephrotic syndrome in adults and a frequent
lesion in children and adolescents
• Pathology: a focal process; not all glomeruli are involved, the
glomeruli are segmentally sclerotic, and portions of the
involved glomeruli may appear normal by light microscopy.
• The ultrastructural features of FSGS on electron microscopy
include focal foot process effacement.
2/4/2023
99
102. Clinical manifestations
Peripheral edema,
Hypoalbuminemia, and
Nephrotic range proteinuria.
Patients with FSGS also commonly have
hypertension, and many have microscopic
hematuria.
The level of kidney function may vary.
2/4/2023
102
103. The relative frequencies of clinical
manifestations :
Nephrotic range proteinuria - 60 to 75 %
Microscopic hematuria - 30 to 50 %
Hypertension - 45 to 65 %
Renal insufficiency - 25 to 50 %
2/4/2023
103
104. Laboratory findings
• Hypoproteinemia is common in patients with
FSGS and the serum albumin concentration may
fall to below 2 g/dL, especially in patients with
the collapsing variant.
• Hypogammaglobulinema and hyperlipidemia are
typical; serum complement components are
generally in the normal range.
• Serologic testing for HIV infection should be
obtained for all patients with FSGS, especially
those with the collapsing pattern.
2/4/2023
104
105. Treatment of FSGS
• Prednisone theraphy: not to exceed 60 mg/day
• 50% responding 2-6 wk
• Cyclosporine therapy is the second choice for
FSGS
2/4/2023
105
106. Cont….
• ACEI may provide a substantial reduction in
proteinuria and a long-term renoprotective
effect that may be equal to,or greater than, that
of immunosuppressive therapy.
• Response rates to immunosuppressive therapy in
primary FSGS
45% for complete remission,
10% for partial remission,
45% for no response.
2/4/2023
106
107. Response to therapy
• The strongest prognostic indicator is the degrees of
reduction in proteinuria
• Complete response : <200 to 300 mg/day.
• Partial response reduction ≥ 50 %
• Relapse is return of proteinuria to ≥ 3.5 g/day after a
complete or partial remission.
• Steroid-dependence relapse while on therapy or
requirement for continuation of steroids
• Steroid-resistance little or no reduction in
proteinuria after 12 to 16 weeks of prednisone
therapy
2/4/2023
107
108. PROGNOSIS OF FSGS
• Untreated primary FSGS often follows a
progressive course to end-stage renal disease
(ESRD).
• The rate of spontaneous complete remission
among patients with nephrotic syndrome is
unknown, but is probably less than 10 percent.
• Spontaneous remission is more likely to occur
among patients with normal kidney function and
non-nephrotic proteinuria.
2/4/2023
108
109. Membranous GN
• Idiopathic membranous glomerulopathy is the most common cause of
nephrotic syndrome in adults (25% of adult cases) and can occur as an
idiopathic (primary) or secondary disease.
• Secondary membranous glomerulopathy is caused by autoimmune
diseases (e.g., lupus erythematosus, autoimmune thyroiditis),infection
(e.g., hepatitis B, hepatitis C), drugs (e.g., penicillamine,gold), and
malignancies (e.g., colon cancer, lung cancer).
2/4/2023
109
110. Membranous GN
• In patients over the age of 60, membranous glomerulopathy is associated
with a malignancy in 20% to 30% of patients.
• The peak incidence of membranous glomerulopathy is in the fourth or
fifth decade of life.
Pathology
• The characteristic histologic abnormality in MGN is diffuse global capillary
wall thickening and the presence of subepithelial immune complex
deposits.
2/4/2023
110
111. Clinical manifectations
• Nephrotic syndrome 80%
• Asymtomatic non-nephrotic proteinuria 20%
• Proteinuria (5-15 g/day)
• Microscobic hematuria may be seen 50% of adults
• Renal vein thrombosis 40%
• Renal function usually well preserved at the on set of disease.
2/4/2023
111
112. Laboratory findings in MGN
• Proteinuria is usually more than 3 g of protein per 24 hours and may
exceed 10 g/day in 30% of patients.
• Microscopic hematuria is present in 30% to 50% of patients
• Renal function is typically preserved at presentation.
• Hypoalbuminemia is observed if proteinuria is severe.
• Complement levels are normal; however, the complex of terminal
complement components known as C5b-9 is found in the urine in
some patients.
• Tests for hepatitis B, hepatitis C, syphilis, and immunologic disorders
such as lupus, mixed connective tissue disease, and cryoglobulinemia
should be obtained to exclude secondary causes.
2/4/2023
112
113. Theraphy of MGN
• Supportive care including ACEI, lipid-lowering therapy
• Corticosteroids
• Cyclosporine
• The high prevalence of deep vein thrombosis in patients with
membranous glomerulopathy (up to 45%) has led to the use of
prophylactic anticoagulation for patients with proteinuria greater than
10 g/day
2/4/2023
113
114. Management of MGN
• Adult patients with good prognostic features, with less than 4 g/day
proteinuria and normal renal function, should be managed
conservatively.
• Patients at moderate risk (persistent proteinuria between 4 and 6
g/day after 6 months of conservative therapy and normal renal
function) or high risk of progression (persistent proteinuria greater
than 8 g/day with or without renal insufficiency) should be considered
for immunosuppressive therapy
• Individuals who have advanced chronic kidney disease and in whom
serum creatinine exceeds 3 to 4 mg/dL are best treated by supportive
care awaiting dialysis and renal transplantation
2/4/2023
114
115. Prognosis of MGN
• Spontaneous complete remission of proteinuria occurs in 5 to
30 %
• Spontaneous partial remission (≤ 2 g of proteinuria per day)
occurs in 25 to 40 %
• ESRD in untreated patients is
14 % at 5 years,
35 % at 10 years,
41 % at 15 years
2/4/2023
115
117. GLOMERULARDISEASESTHATCAUSE
NEPHRITICSYNDROME
IgA nephropathy (IgAN)
• Most common lesion found to cause primary glomerulonephritis
throughout most developed countries of the world.
• IgA nephropathy common among Asians and Caucasians,
• 2:1 male to female predominance.
• The etiology of IgA nephropathy is unknown, but infections and/or
genetic characteristics may predispose to the development of kidney
disease.
• IgA nephropathy is often suspected on the basis of the clinical
history, but can be confirmed only by kidney biopsy.
2/4/2023
117
118. Clinical findings
Most patients with IgAN present with
• gross hematuria (single or recurrent), usually following an
upper respiratory infection (40–50%)
• microscopic hematuria with or without mild proteinuria
incidentally detected on a routine examination. (40%)
• Malignant hypertension (<5%)
• Rarely, patients may develop AKI with or without oliguria,
due either to crescentic IgAN, or to gross hematuria causing
tubular occlusion and/or damage by red cells.
2/4/2023
118
119. Cont….
• Episodes of macroscopic hematuria tend to
occur with a close temporal relationship to
upper respiratory infection,including tonsillitis or
pharyngitis.
• The timing differs from that for PSGN, which has
an interval period of 7 to 14 days between the
onset of infection and overt hematuria.
2/4/2023
119
120. Cont….
• Systemic symptoms are frequently found,
including nonspecific symptoms such as malaise,
fatigue, muscle aches and pains, and fever.
• Microscopic hematuria and proteinuria persist
between episodes of macroscopic hematuria.
• Associated hypertension is common
2/4/2023
120
121. Cont….
• Although IgA nephropathy was previously thought to carry a
relatively benign prognosis, it is estimated that renal
insufficiency may occur in 20% to 30% of patients within 2
decades of the original presentation.
• Renal failure typically follows a slowly progressive course,
a minority of patients with IgA nephropathy
manifests a fulminant course resulting in a rapid
progression to end-stage renal disease.
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123. Laboratory Findings of IgAN
• microscopic hematuria and dysmorphic erythrocytes
• Proteinuria majority of subjects have less than 1 g/day of
protein.
• There are no specific serologic or laboratory tests diagnostic of
IgA nephropathy.
• Although serum IgA levels are elevated in up to 50% of
patients, the presence of elevated IgA in the circulation is not
specific for IgA nephropathy.
• Complement levels such as C3 and C4 are typically normal
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124. PATHOLOGY
Immunofluorescence microscopy
• globular deposits of IgA (often accompanied by C3 and IgG) in the
mesangium and, to a lesser degree, along the glomerular capillary
wall.
large, globular mesangial IgA deposits
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125. Treatment of IgA N
• ACE-I or ARB treatment (1B) in IgAN, use blood pressure treatment
goals of 130/80mmHg in patients with proteinuria <1 g/day, and
125/75mmHg when initial proteinuria is >1 g/day
• Corticosteroids(2C)in IgAN patients with persistent proteinuria>1
g/day, despite 3–6 months of optimized supportive care (including
ACE-I or ARBs and blood pressure control), and GFR >50 ml/min per
1.73m2, receive a 6-month course of corticosteroid therapy.
• Fish oil in treatment(2D)of IgAN with persistent proteinuria >1 g/d,
despite 3–6months of optimized supportive care (including ACE-I or
ARBs and blood pressure control).
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126. Poststreptococcal
glomerulonephritis (PSGN)
• affects primarily children, with peak incidence between the ages of
2 and 6 years.
• It may occur as part of an epidemic or sporadic disease, and only
rarely do PSGN and rheumatic fever occur concomitantly.
• A latent period is present (7–21 days) from the onset of pharyngitis
to that of nephritis.
• The hematuria is microscopic in more than two thirds of cases.
• Hypertension occurs in more than 75% of patients
• The clinical manifestations of acute PSGN typically resolve in 1 to 2
weeks as the edema and hypertension disappear after diuresis.
• Both the hematuria and proteinuria may persist for several months,
but are usually resolved within a year.
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127. Laboratory findings
• presence of dysmorphic red blood cells or red
blood cell casts.
• Proteinuria is nearly always present, typically
in the subnephrotic range.
• Nephrotic-range proteinuria may occur in as many as 20% of
patients and is more frequent in adults than in children.
• Throat or skin cultures may reveal group A streptococci
• elevated ASO titer above 200 units may be found in 90% of
patients;
• CH50 and C3 are reduced
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128. Treatment of acute PSGN
• Supportive
• Supportive therapy may require the use of loop diuretics such
as furosemide and
• Hypertension treatment
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130. Discriptions….
• The presence of arteritis in a biopsy specimen with pauci-
immune crescentic glomerulonephritis indicates that the
glomerulonephritis is a component of a more widespread
vasculitis, such as microscopic polyangiitis,
• Wegener granulomatosis,or the Churg-Strauss syndrome.
• The pathogenesis of pauci-immune crescentic
glomerulonephritis is currently not fully understood.
• Many patients have a circulating ANCA, it has not been
conclusively proved that ANCA are involved in the
pathogenesis of pauci-immune small vessel vasculitis or
glomerulonephritis.
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131. Laboratory Findings
• Approximately 80% to 90% of patients with pauci-immune
necrotizing and crescentic glomerulonephritis will have a circulating
ANCA.
• By indirect fluorescence microscopy on alcohol fixed neutrophils,
ANCA yields two patterns of staining:
• Perinuclear (P-ANCA)
• Cytoplasmic (C-ANCA)
TREATMENT= Immunosuppresive Therapy.
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132. Lupus nephritis
• Renal involvement is common in idiopathic systemic lupus
erythematosus (SLE).
• An abnormal urinalysis with or without an elevated plasma
creatinine is present in a large proportion of patients at the
time of diagnosis, and may eventually develop in more than
75 % of cases.
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133. EPIDEMIOLOGY
• The prevalence of clinically evident renal disease in patients
with SLE ranges from 40 to 75 percent.
• Most renal abnormalities emerge soon after diagnosis
(commonly within the first 6 to 36 months)
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134. PATHOGENESIS
• The pattern of glomerular injury seen in systemic lupus
erythematosus (and in other immune complex-mediated
glomerular diseases) is primarily related to the site of
formation of the immune deposits, which are primarily due
to anti-DNA.
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