Alterations in Urinary Tract Function
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What is a UTI?
A urinary tract infection is the presence of pathogenic microorganisms in the urinary tract.
Name of infection when located in the...
- bladder= cystitis
- urethra= urethritis
- prostate= prostatitis
- kidney= pyelonephritis
Are UTIs the most common bacterial infection health care providers see?
No, they are the second most common with Respiratory tract infections being the first.
What bacteria cause UTIs?
- E.Coli is the most common.
- Others= Staph, Proteus, Klebsiella and Enterococcus
What are the predisposing factors of a UTI?
- 1. Obstruction- stones
- 2. Urinary stasis
- 2. Foreign body- foley, stones.
- 3. Neurogenic bladder- lack of bladder control due to a brain or nerve condition
- 4. Disease of blood vessels- ischemia, damage to structure
- 5. Underlying conditions- pregnant, sickle-cell trait, hypertension, diabetes
- 6. Female- shorter urethra
What are the symptoms of a UTI?
- -Pain in back, abdomen, thighs, genitalia.
- -Dysuria (painful urination) or Burning with urination
- -Tenesmus (ineffective or involuntary straining during urination)
- - Change in voiding patterns: frequency, hesitancy
- - Hematuria - could also mean bigger problem
- - N & V, anorexia, diarrhea, paralytic ileus (psuedo-obstruction)
How are UTI's diagnosed?
- Symptoms plus...
- a clean catch culture shows 100,000 or more colonies
- Orif catheter is in
- a culture from a foley that shows 10,000 colonies
How do we treat a UTI?
- Depends on underlying disorder.
- 1. Antibiotics
- 2. Surgery
How can we prevent UTIs in our patients?
- 1. Decrease use of foleys
- 2. Teach - females wipe from front to back
- 3. Bladder training for neurogenic bladder
- 4. Hygiene measures- incontinence
- 5. Hydration - if no fluid restriction
A normal adult voids ___ times in 24 hours with a urinary output of ___ ?
5 to 10 x per day and once at night
Total UO = 1200-1500ml/day
What is Cystitis?
- -Inflammation of the urinary bladder- most common site of UTI.
- -May occur alone or with pyelonephrititis or prostatis
- - Symptoms are: same as a regular UTI- pain, frequency, urgency, dysuria, cloudy urine
- - Treatment: antibiotics, pain relievers, force fluid, encourage frequent void, good hygiene- shower or stand to clean genitalia, void after sex, encourage follow up
What are the differences between acute and chronic pyelonephritis?
- Acute pyelonephritis is an infection of the renal pelvis and interstitium in one or both kidneys, commonly caused by E. coli, Proteus or Pseudomona but can be caused by fungus or virus. It RARELY leads to renal failure and onset is rapid. Occurs mostly in women. Its symptoms are similiar to UTI. can be none to severe. Treatment is IV antibiotics, hydration, pain relief, follow-up; May need hospitalization.
- Chronic pyelonephritis is a progressive process of scarring and deformation of the kidneys. It is silent until renal insufficiency and CAN lead to renal failure. This occurs in people with reoccuring acute pye and is more likely in ppl with obstructions. Treatment is ongoing- years of evaluation.
What is the pathology of Acute vs. Chronic Pyelonephritis?
Acute= ascending pathway is the most common route for spread of infection but it also may occur in bloodstream; Inflammatory process- patchy irregular location- renal parenchyma, tubules, kidneys.
Chronic= progressive inflammation, scarring and fibrosis; dilation of renal pelvis and calyces; destruction of tubules with areas of atrophy and scarring.
What are the common Glomerular disorders?
- 1. Glomerulonephritis= inflam. of capillary loops in glomeruli
- 2. Diabetic Nephropathy= "Kimmelstiel-Wilson syndrome" common in Type I diabetes
- 3. Nephrotic Syndrome= damage to glomerulus which leads to excessive excretion of protein in urine.
Glomeruli = A cluster of capillaries around the end of a kidney tubule, where waste products are filtered from the blood
What is Glomerulonephritis?
- An acute, subacute, or chronic condition characterized by inflammation of the capillary loops in the glomeruli of the kidney.
- Chronic is seen mostly in adults
What is the most common non-infectious renal disease in children?
Acute post-streptococcal glomerulonephritis -- although most strep do NOT cause glomer.
- poorly understood. Common in Type I. Most common cause of ESRD.
- Glomerulus and Glomerulus basement membrane enlarge which lead to glomerulosclerosis. Kimmelsteil-Wilson nodules are thickening at center of glomerular and peripheral basement membrane.
- -Excretion of an excessive amount of protein in urine due to alteration in glomerulus permeability
- -Caused by damage from glomerulonephritis or glomerulosclerosis secondary to systemic diseases like diabetes, amyloidosis, SLE, and associated with drugs, malginancies, and vascular disorders.
- Policystic Kidney Disease
- - One of most common hereditary disease in U.S.
- - May cause pain from enlarging cysts, hematuria, UTI, and hypertension
- - Progression is slow but can lead to ESRD (not common before 40)
- - More likely to develop renal cell carcinoma
- - Cysts can be decompressed but once ESRD is developed dialysis and transplant are used
- 1. Wilms' Tumor - most common tumors in children
- 2. Renal cell carcinoma - accounts for 80-85% of kidney tumors. Most often in older men.
- -Some causes are chronic kidney stone irritation, smoking and obesity, exposure to protroleum, heavy metals and asbestos.
- -Symptoms are asymptomatic until late then hematuria, costovertebral pain, flank mass, fever, polycythemia (increase in RBC).
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