UTI Simple uncomplicated cystitis Acute pyelonephritis Urinary tract infections in patients with a pre existing structural renal abnormalities such as polycystic kidneys reflux nephropathy and obstructive uropathy

Simple uncomplicated cystitis Recurrent urinary tract infections (UTIs) are common in young women, there is no evidence that recurrent UTI leads to health problems such as hypertension or renal disease, in the absence of anatomic or functional abnormalities of the urinary tract.

Simple uncomplicated cystitis These infections are generally caused by the same organisms and share clinical features, diagnostic testing, and treatment Recurrent uncomplicated UTIs are common among young, healthy women even though they generally have anatomically and physiologically normal urinary tracts

cystitis Escherichia coli is the causative pathogen in approximately 70 to 95 percent of episodes of acute uncomplicated cystitis; Staphylococcus saprophyticus is responsible for most other episodes. Proteus mirabilis, Klebsiella species, enterococci or other uropathogens are isolated from a small proportion of patients

Cystitis pathogenesis Urinary tract infections in women develop when uropathogens from the fecal flora colonize the vaginal introitus, enter the urethra and bladder, and stimulate a host response. Migration of the organisms from the introitus into the bladder is facilitated by other factors such as sexual intercourse.

Cystitis Features Acute uncomplicated cystitis is manifested primarily by dysuria, usually in combination with frequency, urgency, suprapubic pain, and/or hematuria Fever (>38°C), flank pain, costovertebral angle tenderness, and nausea or vomiting suggest upper tract infection and warrant more aggressive diagnostic and therapeutic measures [13].

Cystitis Diagnosis A directed history and physical examination provide sufficient data to make an accurate diagnosis in most cases of acute dysuria. The examination should include temperature, abdominal examination, and assessment of the costovertebral angle examination for tenderness

Treatment of cystitis

Case presentation A 23 year old lady c/o dysurea frequency and dark urine there was no fever but she had lower abdominal discomfort Urinalysis showed 30—40 pus cells and few red cells but no protein and no casts   1 what investigation is needed 2 is u/s needed 3 what is the best treatment 4 is prophylactic antibiotic needed

Acute pyelonephritis Associated more with abnormal renal tract or renal stones Mainly Gram negative bacteria and enterococcus D M is a predisposing factor Obstructive uropathy with prostatic hypertrophy is a factor in old males

pyelonephritis Fever Loin pain Occasionally septic shock and DIC Dysuria and hematuria May be complicated by perinephric abscess

Pyelonephritis investigation Urinalysis culture CBC renal function Ultrasound kidneys to role out obstruction or abnormal tract Hospitalization is usually required

pyelonephritis Intravenous antibiotics are required I V fluids are essential Urinalysis culture and renal function are important Ultrasound abdomen is indicated

Case presentation A 35 year old lady known to have DM for the last five years maintained on insulin presented with high grade fever dysurea and loin pain on examination she looked ill temp. 39.4 BP 110/60 with bilateral loin tenderness what investigation is required for this lady

Case presentation What therapy should be given Appropriate was given and fever subsided within 48 hours but came back 5 days later What would be the cause of her fever

UTI in pregnancy The homodynamic changes in pregnancy predispose to UTI The attacks can be sever and prolonged Longer antibiotic therapy is required Amoxycillin and ceftrixone are save

Polycystic kidneys