Urinary Tract Infections and Hematuria

7/26/2019 Urinary Tract Infections and Hematuria

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URINARY TRACT INFECTAND HEMATURIA

DR. MERVINCHRISTO



URINARY TRACT

INFECTIONS



INTRODUCTION

• More common in women than men

• Younger women have higher incidence(!"#$

• E%der%& ma%e' more rone )or in)ection'



ASYMPTOMATIC BACTER

• * #+ ! co%on& )orming unit' o) a 'ing%e athogen on two 'uc

urine cu%ture'

• No '&mtom'

• Treatment " ,regnant women - Inva'ive rocedure'



URETHRITIS

• ower urinar& tract in)ection

• /''ociated with STD

• Vagina% di'charge 0 irritation

•

Ma%e'" d&'uria with urethra% di'charge



CYSTITIS

• 1ithout &e%onehriti'" 2enign condition

• Surau3ic ain- increa'ed )re4uenc&- urgenc&- 'urau3ic

• 5ever uncommon with 'im%e c&'titi'



PYELONEPHRITIS

• 6er urinar& tract in)ection

• Invo%ve' rena% arench&ma and e%vica%&cea% '&mtem

• 5%an7 0 a3domina% ain- co't verte3ra% ang%e tenderne''

•

5ever- chi%%'- nau'ea- vomiting

• ,rogre'' to rena% a3ce''- nehriti'- emh&'ematou' &e%on





COMPLICATED UT

• Ma%e'" 8o to STD

• /natomic a3norma%itie'" o%&c&'tic rena% d0'- neurogenic 3%

• Indwe%%ing catheter- uretera% 'tent- recent in'trumentation

•

Nehro%ithia'i'

• /dvanced age" 2,H- ro'tate 3io'&- in'trumentation

• Dia3ete' me%%itu' - Sic7%e ce%% d0'



COMPLICATED UT

• Neonate'

• ,regnanc&

• Immuno'ure''ion

•

Neuro%ogic d0' " 'ina% cord in9ur&- 'tro7e with di'a3i%it&

• /t&ica% athogen " non E:co%i

• Re'i'tance to t&ica% anti3iotic' (Ci%o;$



COMPLICATED UT

• C%inica% )eature' ma& var& or 3e a3'ent

• Catheter a''ociated 6TI

• New on'et )ever- rigor- ma%ai'e- <an7 ain and tenderne

• /%tered menta% 'tatu'

• /cute hematuria

• ,e%vic di'com)ort



RECURRENT UTI

• Two com%icated 6TI in =month' 0 three or more in #8 mont

• RE/,SE " recurrence within 8 wee7' ('ame athogen$ > Tr

)ai%ure

• RE5IN5ECTION"

• Di?erent athogen

• ,reviou'%& i'o%ated athogen" a)ter negative cu%ture 0 mo

wee7'

• Rein)ection more common than re%a'e



DIFFERENTIAL DIAGNO

FOR DYSURIA

• 6TI

• Vaginiti'0 cerviciti'

• Trauma

• Ma%ignanc&

• Nehro%ithia'i'



DIFFERENTIAL DIAGNO

FOR DYSURIA

• 6rethera% 'tricture 0 o3'truction

• 6rethera% diverticu%um

• /%%erg& or Chemica% irritation (h&giene roduct' 'erm

• 6terine03%adder ro%a'e



MICROBIOLOGY

ORGANISM INCID

E COI *

BE2SIE/- ,ROTE6S-ENTERO2/CTER- ,SE6DOMON/S !:

CH/MYDI/ TR/CHOM/TISST/,HYOCOCC6S S/,RO,HYTIC6SMYCO2/CTERI6M T62ERC6OSIS (HIV,/TIENTS$



URINE ANALYSIS

•C%ean- mid'tream 'am%e

• Centri)uged 'ecimen'

R2C- (5EM/E$ +:!0H,5

R2C- (M/E$ +:0H,5

12C +:0H,5

2/CTERI/ NONE0H,5



URINE ANALYSIS

•

NITRITE TEST 0 DI, STICB TEST"

• Organi'm' that convert nitrate to nitrite'

• E co%i

• Negative te't " enterococcu'-- 'eudomona'- acineto3ac

• ow 'en'itivit& (!+A$



URINE ANALYSIS

• 12C count 0 &uria

• * !ce%%' 0 h) in '&mtomatic atient'

• S&mtomatic atient' with ! 0 h) " artia%%& treated-

uncentri)uged 'am%e- '&'temic %eu7oenia

• Men " * #:8 0 h) - when 3acteria i' re'ent



URINE ANALYSIS•

MICROSCO,Y

• * # 3acteria 0 h) " corre%ate' to redict a cu%ture o) * #+

• 5a%'e negative re'u%t'" Ch%am&dia

• 5a%'e o'itive" vagina% 0 )eca% contamination



URINE CULTURE

• 6RINE C6T6RE

• Denitive diagno'i' *#+ ! C560m%

• Deending on t&ica% '&mtom' - %e''er va%ue' can 3e co

• Not indicated

• T&ica% '&mtom' F o'itive urine ana%&'i' nding'



URINE CULTURE• Indication'

• Men and chi%dren

• S&mtom' * := da&'

• Com%icated 6TI

• Immunocomromi'ed

• ,regnanc&

• Re%a'e rein)ection

• Su'ected &e%onehriti'

• Ho'ita%iGed atient'



IMAGING•

6'ua%%& not indicated

• /t&ica% re'entation - 'evere '&mtom' and 'ign'

• Su'ected &e%onehriti'- rena% a3ce''- 'e'i'

• 5ir't ei'ode chi%dren &ear' " r0o 'tructura% a3norma%itie'

• 5ema%e with mu%ti%e ei'ode'

• Dimini'hing rena% )unction

• Rena% co%ic ( o3'tructive 'tone $



IMAGING•

6%tra'onograh&

• Ine;en'ive and no radiation e;o'ure

• H&drourteronehro'i' - intrarena%0erinehric a3ce''

• ,&e%onehriti'- congenita% anoma%ie'

• e'' ecient in detecting uretera% 'tone

• CT 'can"

• 2e't te't )or detecting a3ce''- o3'truction and in<amma





TREATMENT• O6T ,/TIENT M/N/EMENT

• /D6TE 5EM/E " 6MCOM,IC/TED CYSTITIS

Nitro)urantoin #++mg 2D ; !da&'

TM, J SMK DS (#=+0@++$ 2D K da&'

5o')om&cin gm in 'ing%e do'e

Intia% cu%ture not needed

/mo;ci%%in J c%avu%anate - ce)odo;imecan 3e con'idered



TREATMENT• /D6TE 5EM/E 0 M/E " COM,IC/TED CYSTITIS- ,YEONE,

Ci%o<o;acin !++mg 2D ; Lda&'

evo<o;acin L!+mg OD ; !da&'

Ce)odo;ime ++mg 2D ; L : #da&'

I) 'u'ceti3i%it& i' 7nown" Cotrimo;aGo%e 2D ; #da&'

/mo;ici%%in J c%avu%anate #

6rine cu%ture 'hou%d 3e ta7en



TREATMENT• /D6TE 5EM/E (6RETHRITIS$

Su'ect ch%am&dia0gonnorhea

Ce)tria;one 8!+mg IM

%u'

/Githrom&cin #gm 'ing%e do'e 0 Do;&c&c%ine #++mg 2D ;

Cu%ture' have to 3e ta7en

I) c&'titi' i' 'u'ected - treat according%&



IN PATIENT MANAGEM• Se'i'

• Ina3i%it& to ta7e ora% medication'

• Immuno comromi'ed

• 5ai%ure o) O, thera&

• Third trime'ter regnanc&

• 6ro%ogic a3norma%itie'

• Mu%ti%e comor3idtie'



IN PATIENT MANAGEM

• Ciro<o;acin ++mg iv 2D

• Ce)tria;one #:8gm iv od

• Ce)ota;ime #:8gm iv 4@h

• entamicin 0 To3ram&cin mg07g in divided do'e'



IN PATIENT MANAGEM

• ,itaG .L! gm iv 4=h

• Ce)eime #:8gm iv 4@h

• Ertaenem #gm OD

• Meroenem #gm iv 4@h 0 Imienem !++mg iv 4@h



HEMATURIA



INTRODUCTION

• ro'' hematuria " vi'i3%e to e&e ( #m% o) who%e 3%ood0%iter o)

• Micro'coic hematuria " * or R2C' 0 h)



LOWER TRACT

• /NY OC/TION

• In)ection

• Stone

• Trauma

• ,o't rocedure

• Tumour

• 6RETER /ND 2/DDER

• Stricture di%atation

• Ca 3%adder

• Va'cu%ar

ma%)ormation'

• C&'titi'

• ,ROST/TE /

6RETHER/

• 2,H

• ,ro'tatiti'

• 6rethera%

• 5oreign 3

DIFFERENTIAL DIAGN



DIFFERENTIAL DIAGNO

• OMER6/R

• %omeru%onehr

iti'

• Ig/

nehroath&

• uu' nehriti'

• NON OMER6/

• ,&e%onehriti'

• Inter'titia% ne

• Ma%ignanc&

• Trauma

• T2

• ,o%&c&'tic 7idnUPPER TRACT



DIFFERENTIAL DIAGNO

• HEM/TOOIC

• ,rimar& coagu%oath&

• ,harmaco%ogic

anticoagu%ation

• Sic7%e ce%% d0'

• MISCE/NO6S

• Eroding a3domi

aortic aneur&'m

• Ma%ignant

h&erten'ion

• Rena% vein throm

• E;erci'e induce

hematuria



CLINICAL FEATURE• /E

• Younger age grou " nehro%ithia'i'

• O%der age grou " neo%a'm'- 2,H

• HISTORY

• ,ain " 6TI- Ca%cu%u'- g%omeru%onehriti'

• S&mtom' " )ever- '7in ra'h- weight %o''- night 'weat'- 'ore th

• Ri'7 )actor' " 'mo7ing- e%vic irradiation

• 5ami%& hi'tor&" 'ic7%e ce%% d0'- 3%eeding diathe'i'

• ,regnanc& and men'trua% hi'tor&



CLINICAL FEATURE• HISTORY

• Recent trauma- rocedure'- Catheri'ation

• ,a''age o) c%ot' " e;tra g%omeru%ar d0'

• ,erior3ita% odema- ear%& morning une''- odema- dar7 co%oug%omeru%ar d0'

• Sternou' e;erci'e

•

5a%'e hematuria• Medication' " ri)amicin- 4uinine- hen&toin

• 5ood' and d&e'" 3errie'- 3eet root

• Serratia in)ection

• Hemog%o3inuria- m&og%o3inuria



DIAGNOSIS• /2OR/TORY TESTIN

• C%ean mid'tream catch

• 2rown 'mo7e co%oured urine " g%omeru%ar d0'

• Red c%otted urine" 3e%ow the 7idne&

•6rine di'tic7" detect' #!+microgrm'0 o) )ree haemog%o

5a%'e o'itive" haemog%o3in- m&og%o3in



DIAGNOSIS• MICROSCO,Y

• R2C- 2acteria- ce%%u%ar ca't'- d&'morhic R2C- h&a%ine ca

• 2OOD INVESTI/TIONS

• 2%ood count'- haemog%o3in- coagu%ation ro%e

• IM/IN

•

6%tra'ound" o3'truction- h&droureteronehro'i'- regnan• CT Scan" 3e't )or detecting 'tone'- ma''- in9urie'

• Other" c&'to'co&- Intravenou' &e%ogram



DISPOSITION• Eva%uation within 8 wee7'

• /ge * !+ &ear'• ro'' hematuria

• Smo7ing

• Trauma

• Bnown ma%ignanc&

• Rena% in'ucienc&

• Sic7%e ce%% d0'

• Odema - roteinuria



DISPOSITION• Inatient treatment

• Intracta3%e ain• Into%erance to <uid' and medication'

• Mu%ti%e comor3iditie'

• Hemod&namic in'ta3i%it&

• 2%adder out%et o3'truction

• Treatment 'hou%d 3e directed 3& the cau'e o) hematuria



THANK YOU

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Urinary Tract Infections and Hematuria