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Urinary tract Infections:. -At least 20% of all women experience an incident of Urinary tract infection (UTI) by the age of 30 years, and over 50% have one or more lifetime UTIs. One in ten women experience frequent recurrent infections for at least some period.

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urinary tract infections

Urinary tract Infections:

-At least 20% of all women experience an incident of Urinary tract infection (UTI) by the age of 30 years, and over 50% have one or more lifetime UTIs.

One in ten women experience frequent recurrent infections for at least some period.

-An estimated 3 million office visits for this infection take

place each year in the United States.

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N

-Nosocomial UTI accounts for about 40% of all infections

acquired in acute care facilities.

-From 25 to 50% of nursing home patients have

bacteriuria at any time.

Urinary tract infection UTI is more common in Women

due to:

1-Anatomy of female Urinary tracts:

Short urethra, and proximity of the urethral opening to the

anus.

2-Lack of antibacterial prostatic secretions.

3-Bacterial invasion by sexual intercourse.

slide3

N

-UTI could be established in different sexes due to the

following risk factors:

1-Poorpersonal hygiene.

2-Insertion of contaminated Catheter.

-Physical and chemical barriers that protect human

urinary tracts from infection:

1-The frequent flushing action of urine.

2- Urine acidity ( pH from 4.5 to 8 ).

3- The prostatic secretions (lysozyme and IgA).

definitions

Definitions:

UTI could occur at any site of urinary tract; including Kidney, bladder, and in men, the prostate.

Upper UTI: Kidney infection.

Lower UTI: 1-Urinary bladder infection.

2-Urethra infections are classified as sexually

transmitted diseases.

Pyelonephritis: (Pyelum: Renal pelvis, Nephro: kidney) :

is an ascending urinary tract infection that has reached the pelvis of the kidney.

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Pyelonephritis:

1-Acute non-obstructive pyelonephritis:

Acute inflammation of renal pelvis and medullary

tissue due to bacterial invasion.

2-Complicated pyelonephritis:

-Underlying structural or functional abnormalities of

Kidney.

-Could be associated with obstruction of renal pelvis.

-Tissue dysfunction or Renal abscess.

slide6

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-Urinary tract Reinfection:

Recurrent infection when a previously isolated organism

is reintroduced into the urinary tract from the colonizing

gut or genital flora.

-Relapse:

Recurrent infection with bacteria that persist within the

urinary tract due to indwelling urologic devices; such as

urethral catheter or nephrostomy tube.

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-Biofilm: is a layer of bacteria, their extracellular

substances, and urine components (protein, calcium,

Mg+2) contaminating drainage bag grow along the

exterior or internal catheter surface.

-Biofilm is strongly associated with establishment of

complicated pyelonephritis.

pathogenesis

Pathogenesis:

Source of infecting organisms:

1-The colonizing flora from the periurethral area or, in

woman, the vagina.

2-Bacteria originate from the normal gut flora.

3-Contaminated urologic devices.

Pathogenesis:

A-Lower urinary tract infection

(UropathogenicEscherichia coli).

slide9

N

B-Adherence of E.coli to mannosylated glycoprotein that

line the bladder mucosa due to mannose sensitive

fimbria FimH.

C-Ascend to the kidney due to:

1-Reflux of infected urine up the

ureter.

-Short intravesicalureter.

-Incompetent ureteral sphincters.

2-PMN cell influx up the ureter.

D- Bacterial entry through the papillae into the renal

parenchyma.

slide10

N

E-Adhesion of microbes to interstitial tissue surrounding

the tubules and renal cells in kidney medulla due to

P Fimbria (K polysaccharide) – glycosphingolipid

disaccharide receptor interaction.

slide11

N

F-Damage of interstitial tissue due to:

1-Cytokines production, cellular infiltration;

inflammation (Toxic O2 radicals, and lysozymes ).

2-Activation of clotting factors; ischemia.

3-Microbial virulence: Hemolysin, and urease activity.

G-Tubulointerstitial nephritis.

types of tubulointerstitial nephritis

Types of Tubulointerstitial Nephritis:

1-Acute TIN:

-Inflammatory infiltrate and edema affecting the renal

interstitial tissue that often develops during days to

months.

-Over 95% of cases result from infectionor an allergic

drugreaction.

- Renal abscess could be illustrated microscopically in

some cases (Rare).

- Renal abscess (uncommon) mainly caused by

bacteremic spread of infection from other body site.

slide14

N

-Interstitial renal abscesses :

Necrosiscontains neutrophils, and central germ colonies

(hematoxylinophils).

-Tubules are damaged and may contain neutrophil casts.

-In the early stages, the glomerulus and vessels are normal.

causes of pyelonephritis and tin

Causes of Pyelonephritis and TIN:

1- Escherichia coli.

The most common cause of UTI ( 85-90%).

2- Staphylococcus saprophyticus.

It is considered as a second causative agent of UTI (5-20%).

3- Other genera of Enterobacteriaceae :

Klebsiella, Enterobacter, Proteus, and Serratia.

4- Pseudomonas aeruginosa( Hospital-acquired infection).

5- Enterococcus faecalis( Hospital-acquired infection).

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2-Chronic TIN:

-Gradual interstitial infiltration and fibrosis, tubular atrophy

and dysfunction, and a gradual deterioration of renal tissue,

usually over years.

-Glomerular involvement is much more common in chronic

nephritis than acute type.

-Causes:

immunologically

mediated disorders,

infections, and

drug interaction.

glomerulonephritis gn

Glomerulonephritis : GN:

GN: is the inflammation of the Glomeruli of the nephron.

Types:

1-Infective:

Source of infection: Hematogenous dissemination.

Pathologic feature: One or more renal cortical abscesses.

Pathogenesis:

Insoluble antigen trapped in the glomerulus

Antibodies attack the

Inflammatory structural components

destruction of the of the kidney and antigen.

Glomeruli.

slide18

N

2-Non-Infective GN:

Soluble antigenin blood stream;

Antibodies react with soluble antigen;

Serum sickness disease; Precipitation of complexes in

glomeruli; inflammatory destruction.

Types of soluble antigen:

1- Exogenous:

A-Drugs, toxoid, or serum.

B-Infectious agent antigen:

- Post-Streptococcal glomerulonephritis:

Anti-Streptolysin-O complexes.

slide19

n

Other infections:

Bacterial: Staphylococci, Streptococcus pneumoniae,

Klebsella, Yersinia enterocolitica, Treponema,

Salmonella.

Parasites: Malaria, Schistosoma, and Toxoplasma.

Viral : Hepatitis, and E.B.V.

Fungal: Candidiasis.

2- Endogenous:

Self antigen.

differential diagnosis

Differential Diagnosis:

Urine analysis:

1- Physical properties:

-Appearance: turbidity or milky: pus in urine

-Color: 1-white color: Pusin urine:

Pyuria :infection

2-Red color: RBCs in urine: (Hematuria):

kidney stones, infections , or tumors?

slide21

N

2-Chemical properties:

-Glucose in urine: (Glycosuria) :

: considered as a risk factor for bacterialinfection;

bacteria utilize glucose during binary fission.

-Nitrite in urine: (Nitrituria):

: indicates the presence of Coliform bacteria in urine.

Note: Enterobacteriaceae species reduce Nitrate to Nitrite.

slide22

n

Protein in urine: Proteinuria:

- In Pyelonephritis, and lower UTI:

Proteinuria (trace from pus or bacterial origin) and Pyuria.

- In interstitial nephritis and Glomerulonephritis:

Proteinuria , Hematuria, lower number of Pus in urine.

3-Microscopic properties:

-WBCs: Normal : 2-3 /HPF. -RBCs: Normal : 3-4 cells/HPF.

- Casts:

A- Granular,fatty cast,Hemoglobin,and RBCs cast:

Acute Glomerulonephritis due to immune system response.

C- WBCs cast: acute pyelonephritis,

acute tubulointerstitial nephritis due to infection.