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Urinary tract infection (UTI):

Urinary tract infection (UTI):. Urinary tract infection (UTI) can be divided into the following: 1- Upper UTI : Pyelonephritis and Ureteritis. 2- Lower UTI : Cystitis, Urethritis, and Prostatitis in men. Urinary tract infection is more common in females due to the following factors:

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Urinary tract infection (UTI):

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  1. Urinary tract infection (UTI): Urinary tract infection (UTI) can be divided into the following: 1-Upper UTI: Pyelonephritis and Ureteritis. 2-Lower UTI: Cystitis, Urethritis, and Prostatitis in men. Urinary tract infection is more common in females due to the following factors: 1-The short urethra, and proximity of the urethral opening to the anus. 2-Lack of antibacterial prostatic secretions. 3-Facilitation of bacterial migration by sexual intercourse. Other risk factors for UTI: 1- Poor personal hygiene. 2-The insertion of contaminated catheters.

  2. Physical and chemical barriers that protect human urinary tracts: Human urinary tracts are protected from infectious microbes by : 1-The frequent flushing action of urination. 2- The acidity of urine ( pH from 4.5 to 8 ). 3- The prostatic secretions (lysozyme and IgA). Factors that play a role in establishment of UTI: 1-The microbial virulence. 2-The pathogenic dose. 3-The antibiotic resistance ability (Hospital-dwelling bacteria). 4-The immune system (weakness of Humoral immunity in urinary tracts).

  3. Pyelonephritis: Pyelonephritis: (Pyelum: Renal pelvis, Nephro: kidney) : is an urinary tract infection that has reached the pelvis of the kidney. Severe cases of pyelonephritis leads to pyonephrosis(accumulation of Pus in kidney pelvis). Etiology of Pyelonephritis: 1- Escherichia coli. 2- Staphylococcus saprophyticus. 3- Other genera of Enterobacteriaceae : Klebsiella, Enterobacter, Proteus, and Serratia. 4- Pseudomonas aeruginosa( Hospital-acquired infection). 5- Enterococcus faecalis( Hospital-acquired infection).

  4. a Escherichia coli: E.coli: The most common cause of UTI ( 70-95%). Complicated UTI (Pyelonephritis) mainly caused by nonuropathogenic strains of E.coli. Source of bacteria: Fecal contamination. Staphylococcus saprophyticus: It considered as a second causative agent of UTI (5-20%). Frequent cause of urinary bladder infection in female due to its occurrence as part of normal vaginal flora. Others microbes : Enterobacteriaceae: -Species of Enterobacteriaceae form the other percentage of infection.

  5. Microbial Pathogenesis : Pyelonephritis is established according to the following arranged Consequences: 1-The bacterial lower urinary tract infection. 2-PMNs influx from lower urinary bladderto ureter and kidney. 3-Reflux of infected urine up the ureters into the renal pelvis due to: A-Congenital abnormality ( short intravesical ureter). B- Obstruction of ureters ( ureter stone or carcinoma). If PMN cell proliferation occurs in Renal Pelvis;Pyelonephritis will be established.

  6. n 3- Bacterial entry through the papillae into the renal parenchyma. 4- adhesion of microbes to interstitial tissue surrounding the tubules in kidney medulla. 5- Activation of PMN cells, infiltration of interstitial tissue by B, and T -lymphocytes, and eosinophils, proliferation of cells, inflammation . 6- Tubulointerstitialnephritis.

  7. Microbial pathogenesis: n

  8. Tubulointerstitialnephritis ( TIN): Types: 1-Acute TIN: -involves an inflammatory infiltrate and edema affecting the renal interstitium that often develops over days to months. -Over 95% of cases result from infectionor an allergic drug reaction. - interstitium abscesses : necrosis contains neutrophils, fibrin, cell debris and central germ colonies (hematoxylinophils). -Tubules are damaged by exudate and may contain neutrophil casts. - In the early stages, the glomerulus and vessels are normal.

  9. Acute Tubulointerstitialnephritis: a

  10. n 2- Chronic TIN: -Gradual interstitial infiltration and fibrosis, tubular atrophy and dysfunction, and a gradual deterioration of renal function, usually over years. -Glomerular involvement is much more common in CTIN than in ATIN. - Causes:immunologically mediated disorders, infections, obstructive nephropathy, and drug interaction. -A perinephric abscess (infection around the kidney) and/or pyonephrosis may be developed in chronic pyelonephritis (chronic TIN).

  11. n Chronic TIN: Normal, andDestroyed Glomeruli with cellular infiltration. Fibrosis, cellular infiltration, tubules could be absent or atrophied.

  12. Signs and Symptoms of Pyelonephritis: The symptoms of acute bacterial pyelonephritis are summarized as : 1- High fever ( Pyrogenic infection) , flank pain, and pain in the joints and muscles including flank pain. 2-Burning sensation during urination (dysuria: Difficult and painful urination) , and increased frequency of urination (polyuria). 3- Pyuria (pus in urine; pyogenic infection). 4- As the kidney becomes more inflamed, pain, loss of appetite, and headache could be present.

  13. Diagnosis of Urinary tract infection: Urine analysis: 1- Physical properties: -Appearance: turbidity or milky: suggested pus in urine or others. -Color: white color: Pus in urine: Pyuria :infection? Red color: RBCs in urine: (Hematuria):kidney stones, infections , or tumors?

  14. n 2-Chemical properties: -Glucose in urine: (Glycosuria) : In Diabetes mellitus patients. : considered as a risk factor for bacterial infection; because 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.

  15. n Protein in urine: Proteinuria: Albuminuria: - 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 and fatty cast: in tubulointerstitial nephritis, glomerular disease. B- Hemoglobin and RBCs cast: Acute Glomerulonephritis due to immune system response. C- WBCs cast: acute pyelonephritis, acute tubulointerstitial nephritis due to infection.

  16. Microscopic appearance of Pus, RBCs, and Casts in urine: a

  17. Glomerulonephritis: GN: GN: is the inflammation of the Glomeruli of the nephron. Causes: 1- Insoluble antigen: trapped in the glomerulus; antibodies attack the structural components of the kidney and antigen. 2- Soluble antigen: in blood stream: antibodies react with soluble antigen: Immune- complexes formation: precipitation in glomeruli. Both antigen-antibodies reactions cause GN or TIN.

  18. Types of soluble antigen: 1- Exogenous: A-Drugs, toxoid, or serum. B-Infectious agent antigen: - Post-Streptococcal glomerulonephritis: Anti-Streptolysin-O- Ag complexes. -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.

  19. a Proliferative Post-Infectious Glomerulonephritis. Diagnosis of GN of immune-complexes origin.

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