RENAL DISEASE HEMATURIA UTI

HEMATURIA 

Present of blood in urine is called hematuria .The character of the hematuria may give a clue to the site of origin.

      Initial hematuria:  The presence of blood at the beginning of the urinary steam that clears during the stream , implies ,an urethral source.

    Terminal hematuria:  The presence of blood at the end of the urinary stream , implies a bladder neck or prostatic urethral source .

Types of hematuria 

1 Microscopic hematuria : presence of more than 5 RBCs per high power  field (HPF) is considered significant and warrants further investigations.

2.Microscopic hematuria : Grossly visible red urine .

CAUSES

A.  Kidneys

    1. Renal calculus 

2. Renal tumours 

⁃ Hypernephroma ( Renal cell)

 carcinoma in adult.

⁃ Wilms tumour ( Nephroblastoma)

3. Renal TB

4. Renal injury

5. Renal infection 

B.  Ureter

• calculus 

• Neoplasm of the                            ureter    

•Injury to the ureter

C.  Urinary bladder 

• Bladder ( vesicles) calculus 

• Bladder ( vesicles) tumuors

• TB 

• Cystitis

• Trauma

• Bilharziasis ( Schistosomiasis) ( Schistosome haematobium infection)

D. Prostate gland ( In male )

• prostatitis 

• Benign hypertrophy                of prostate 

• Malignancy 

E. Urethra 

• Urethral injury 

• Urethral calculus

F. Other causes 

• Anticoagulant                           therapy

• Blood dyscrasiasis

• Sickle cell anemia

Clinical features 

• Family history of hematuria e.g polycystic kidney disease 

• Painful hematuria is a suggestive of neoplasia

• Loin pain or ureteric colic suggests bladder stone

• Terminal bleeding with pain suggests a urethral lesions 

• Palpable bladder

• Palpable kidneys

• Check drug therapy e.g Raifampicine, phenolphthalein etc

• Spontaneous brushing 

• Enlarged, tender prostate on Rectal examination 

Three test tube test 

The patient is asked to pass the urine in the three test tube . At the beginning,the urine is collected in the first test tube ,the midstream in the second and the last stream in the third .

The collected samples are examined 

• Blood presence in the first test - tube = likely source is urethra 

• Blood presence in third test -tube = likely source is urinary bladder 

• Blood presence in the all test - tubes = likely sources are ureters and kidneys 

Investigations 

1. Urine R/M/E : RBC , WBC, Malignant cells.

2. X- ray KUB : calculus, Enlarged kidneys.

3. Blood Hb% TC ,DC,ESR, Grouping and cross match in massive gross hematuria.

4. Clotting profile : BT ,CT, PT platelets 

5. USG abdomen: polycystic kidney, renal calculus, renal mass.

6. Cystoscopy : to visualized uretheral and bladder pathology.

Treatment 

• All gross hematuria should be referred to higher center to find out cause and treat accordingly.

• If patient is stable no anemia , hypovolemic - find out cause

• If patient is unstable 

⁃ ABC clear

⁃ IV fluid resuscitation 

⁃ Transfer to higher center 

⁃ Monitoring of vitals ( Blood pressure and pulse rate)

⁃ Three always catheterization irrigation.

Complications 

• Massive bleeding : Hypovolemic shock

• Severe anemia

• Retension of urine due to clot formation.

Urinary tract infection (UTI)

Infection of urinary tract is called urinary tract  infection 

Types 

A. Upper urinary tract infection : urethritis pyelonephritis 

B. Lower Urinary tract infection: Cystitis , Urethritis 

 Causes by

UTIs are usually caused by bacteria from poo entering the urinary tract. The bacteria enter through the tube that carries pee out of the body (urethra). Women have a shorter urethra than men. This means bacteria are more likely to reach the bladder or kidneys and cause an infection 

Causative agent :

•  klebsiella pneumonia 

• Proteus

• E. Coli

• Pseudomonas

• Staphylococcus 

Cause of renal infection 

1. Hematogenous infection from a urinary site in the tonsil or caries tooth or from cutaneous infection particularly boils and carbuncle.

2. Ascending infection 

• vesicouterine reflux 

• Urinary stasis

• Presence of calculi 

Classification of renal infection 

• Acute pyelonephritis 

• Chronic pyelonephritis 

• Renal abscess 

• Pyonephrosis

• Perinephric  abscess 

Acute pyelonephritis 

    

     Inflammation of renal pelvis and associated with small abscess in the renal parenchyma is called acute pyelonephritis.

C/ F

• Sudden onset of pain in both loins radiating to the iliac fossae and suprapubic area .

• Dysuria

• Fever

• Chills and rigors

• Tenderness and guarding in lumbar area

Investigations 

• Urine R/M/E : pus ,cells ,bacteria,red cells and epithelial cells 

• Total count:leucocytosis 

• Urine culture and sensitivity 

• USG abdomen 

Different Diagnosis 

• Acute appendicitis 

• Cholecystitis

• Salpingitis 

• Perinephric abscess 

Treatment 

In less severe cases 

• Trimethoprim 300 mg * daily or 

• Nitrofurantoin 100 mg * 12 hourly 

• Amoxicillina 500 mg * 8 hourly or 

• Cipro flora in 500 mg * hourly 

Duration : 7 days 

 

In severe cases 

• parenteral antibiotic 

• Urine cultural and sensitivity after 7 and 21 days of treatment 

Complication 

• Renal failure

• Chronic pyelonephritis 

• Renal abscess 

Acute cystitis 

   

     Acute  inflammation of urinary bladder is called acute cystitis 

Causative agent : 80% of bladder infections in women are caused by E. Coli followed by other gram negative organisms like klebsiella, proteus species.

Clinical features 

• Increased frequency of micturation

• Urgency 

• Dysuria

• Low back pain

• Suprapubic pain

• Fever with chills and rigors

Investigations 

1. Urine R/M/M :

• more than 5 WBC / HPF ( in females)

• 2-3 WBC / HPF ( in males)

2. Urine culture and sensitivity test 

3. X- ray KUB ruled out stone in situ 

Treatment 

• Trimethoprime  300 mg daily *of 3days or 

• Norfloxacin 400 mg* 12 hourly* 3 days 

• Ciprofloxacin 250 - 500 mg * 12 hourly * 3 days

• Plenty of water and fluid 

• Antispasmodics

• Antipyretic 

Urethritis 

Urethritis may be gonococcal or non - gonococcal .

A. Gonococcal urethritis: It is an acute suppurative condition caused by Neisseria gonorrhoea . The mucous and sun mucosa are eventually converted into granulation tissue which becomes fibrosed and scarred resulting in urethral structure.

B. Non - gonococcal urethritis is more common and is frequently caused by E. Coli . The infection of urethra often accompanies in female and prostatitis in male .

C/F

• pain during micturition 

• Burning micturition 

• Early morning white flakes in urine 

• Urinary retention 

• Urethral discharge 

• Increased frequency of micturition 

• History of unsafe sexual contact 

Investigations 

• urine R/M/E 

• Urine culture and sensitivity 

Treatment 

• Find out and treat accordingly

• Treat : Gonococcal infections 

⁃ Cefexime 400 mg oral single dose or

⁃ Spectinomycin 2g  as a single dose i.m or

⁃ Ceftriaxone 250 mg as a single dose I.M 

For E. Coli 

• Ciprofloxacin 500 mg * 12 hourly * 3 days

• Norfloxacin  400 mg * 12 hourly * 5 days 

Qno 1. Will UTI go away on its way ?

Antibiotics are an effective treatment for UTIs. However, the body can often resolve minor, uncomplicated UTIs on its own without the help of antibiotics. By some estimates, 25–42 percent of uncomplicated UTI infections clear on their own.