1. 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

2. 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.

3. 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

4. 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

5. 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.

6. 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].

7. 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

8. Treatment of cystitis

9. 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

10. 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

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

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

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

14. 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 BP 110/60 with bilateral loin tenderness
what investigation is required for this lady

15. 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

16. 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

17. Polycystic kidneys