Prevention of urinary organs disease

1. Prevention of urinary organs disease Prevention of urinary organs disease Lecturer: Nykytyuk S.O.

7. Plan of the lecture • Definition of pyelonephritis • Pyelonephritisclassification • Clinical manifestation • Methods of examinations • Treatment of the different kinds of pyelonephritis

8. Pyelonephritis • Is an infectious inflammatory disease of tubulointerstitial renal tissue

9. E coli is the most common by far, causing 75-90% of UTIs. • Klebsiella species • Proteus species • Enterococcus species • Staphylococcus saprophyticus

10. Etiology • Hospital patients: • Escherichia coli: 40% • Coagulase-negative staphylococci: 3% • 'Other' Gram-negative bacteria: 25% • 'Other' Gram-positive bacteria: 16% • Candida albicans: 5% • Proteus mirabilis: 11% • Community-acquired Urinary Tract Infections: • Escherichia coli: 80% • Coagulase-negative staphylococci: 7% • 'Other' Gram-negative bacteria: 4% • 'Other' Gram-positive bacteria: 3% • Proteus mirabilis: 6%

11. Classification of pyelonephritis • Form • Primary • Secondary • Obstructive • Dysembriogenetic • dysmetabolic • Course • Acute • Chronic • Manifest recurrent form • Latent form

12. Classification of pyelonephritis • Period • Active • Period of partial remission • Period of full clinical and laboratory remission • Renal function • Without disorders of renal function • With disorders of renal function • Chronic renal insufficiency

13. Clinical Manifestation • Extrarenal • Syndrome of intoxication • Pain syndrome • Disuria • Renal • Leukocyturia • Bacteriuria (colony count over 100 000/ml) • Mild proteinuria • Slight hematuria • TLC and ESR are high • Decreasing of total diuresis • Decreasing of specific gravity

14. Clinical Manifestation Preschoolers and schoolchildren • Vomiting, diarrhea, abdominal pain • Fever • Strong-smelling urine, enuresis, dysuria, urgency, frequency, flank pain or new enuresis

15. Clinical Manifestation Neonates • Jaundice • Hypothermia or fever • Failure to thrive • Poor feeding • Vomiting Infants • Poor feeding • Fever • Vomiting, diarrhea • Strong-smelling urine

16. Physical: • Hypertension should raise suspicion of hydronephrosis or renal parenchyma disease. • Costovertebral angle (CVA) tenderness • Abdominal tenderness or mass • Palpable bladder • Dribbling, poor stream, or straining to void • Examine external genitalia for signs of irritation, pinworms, vaginitis, trauma, or sexual abuse.

17. Plan of examination • Fool blood count • urinanalysis • Nechepurenko’s test • Kakovsky-Addis test • Ambyrze’s test • urine culture (more than 10,000 CFU from bladder) • Zimnitskiy’s test • Biochemical test of blood • Serum level of electrolytes • total protein, albumin and globulin level • residual nitrogen, blood urea, creatinine • Creatinine clearance • Ultrasonography of kidneys and urinary bladder. • Excretory urography • Nuclear cystography

18. Data of excreatory urography • Acute pyelonephritis • Kidney is enlarged • Hypotonia of the ureters • Chronic pyelonephritis • Asymmetry of the kidneys • Deformation of calyco-pelvic system • Irregular excretion of contrast substance up to adynamia of calico-pelvic system • chronic secondary pyelonephritis • Obstruction of the urinary tract • Congenital malformations • Refluxes • Renal dysplasia

19. double kidney

20. dystopia

21. dystopia and nephroptosis

22. L- and S-like kidneys

23. Renal multicystosis polycystic kidney

30. Ultrasound examination of an 18-mo-old boy with autosomal dominant polycystic kidney disease

34. Treatment of pyelonephritis • Complete bed rest for 3-4 days. • Diet N 5a (quantity of liquid is 1.5 times more than age necessities. Fresh fruits and vegetables with diuretic properties are desirable, especially melons) At exacerbation period it is necessary to give milk-vegetable food with limitation of protein (1.5-2 g/kg) and salt (2-3 g) than diet 5 a

35. Antibacterial treatment (for 8-10 days, two cycles) - BENZYLPENICILLIN Na - 20.000-50.000 U/kg – 7-10 days • amoxiclav 25-50 mg/kg, • or cefotaxim 100-150 mg/kg, • or ceftriaxon 100 mg/kg, • or ciprophloxacin 10-20 mg/kg per day in 2 equal doses. • or macropen 30-50 mg/kg • Gentamicyn 4-7 mg/kg

36. Uroseptics • Furadonin, furagin 5-8 mg/kg 4 times per day • Nalidixic acid (negram, nevigramon) 50-60 mg/kg 4 times per day • 5-NOK, nitroxolin 8-10 mg/kg 4 times per day • Biseptol (sulfamethoxazole, trimetoprim 2 mg/kg) twice a day

37. Phytotherapy • Canefron 10-40 dr. or dragee 3 times/day • Urolesan 10-40 dr. 3 times/day

38. Definition of theglomerulonephritis • Is an infectious allergic renal disease with primary lesions of glomeruli. • immunologically mediated inflammation of renal glomerules accompanied by hematuria, proteinuria and azotemia

39. Etiology: • a) bacterial ( staphylococcal) infection;b) Viral ( hepatitis B, mononucleosis);c) Fungal ( histoplasmosis );d) Parasitic (toxoplasmosis)

40. Classification of glomerulonephritis • acute • chronic • subacute (malignant) glomerulonephritis

41. Classification of acute glomerulonephritis • FORM • With nephritic syndrome • With nephrotic syndrome • With isolated urinary syndrome • With nephrotic syndrome, hematuria and hypertension • Activity of renal process • Period of initial manifestations • Period of comprehensive manifestations • Period of reverse development • Transition to chronic glomerulonephritis

42. Classification of acute glomerulonephritis • Without disorders of renal function • With disorders of renal function • Acute renal insurfficiency

43. nephritic syndrome • edema, • arterial hypertension, • urinary syndrome (proteinuria, hematuria, casturia)

44. nephrotic syndrome • massive edema • significant proteinuria (more than 3 g/l) • hypoproteinemia • hypercholesterolemia

45. Classification of chronic glomerulonephritis • FORM • Nephrotic form • Hematuric form • Mixed form • Activity of renal process • Period of exacerbation • Period of partial remission • Period of full clinical and laboratory remission • Renal function • Without disorders of renal function • With disorders of renal function • Chronic renal insurfficiency

46. Subacute (malignant) glomerulonephritis • Without disorders of renal function • With disorders of renal function • Chronic renal insurfficiency

47. Clinical manifestation • Extrarenal symptoms • edema • arterial hypertension • renal symptomes • oliguria and anuria • hematuria • proteinuria (mild, moderate, significant) • leucocyturia (rare) • casts (cylinders): hyaline, epithelial, granular, waxy • metabolic syndrome • disorder of water-electrolyte metabolism • disorder of protein metabolism • disorder of lipid metabolism

48. Clinical manifestation of acute glomerulonephritis • Diagnosis can generally be established on the basis of the following clinical and laboratory criteria: • Acute onset; • Edema; • Hematuria with red blood cell casts in the sediment; • Hypertension; • Evidence of antecedent streptococcal infection; • Lowered serum betaC globulin concentration; • Spontaneous improvement in a few days or weeks.

49. Plan of examination • Fool blood count • urinanalysis • Nechepurenko’s test • Kakovsky-Addis test • Ambyrze’s test • urine culture • Zimnitskiy’s test • Biochemical test of blood • Serum level of electrolytes • total protein, albumin and globulin level • cholesterole • residual nitrogen, blood urea, creatinine • Creatinine clearance • Ultrasonography of kidneys and urinary bladder. • Excretory urography

50. Creatinine clearance • newborn 40-65 ml/min/1.73 m2 • 1 yr and older 60-120 ml/min/1.73 m2