Urinary Tract
Diseases
Isabelita M. Samaniego MD
Session Objectives
1. To describe the present health status of
kidney problem in the Philippines.
2.To review the common types of kidney
diseases.
3. To describe the national objectives for
the control and prevention of kidney
diseases.
Situationer
6,500 yearly deaths in the country
secondary to various kidney diseases
Renal Diseases threaten to be one of the
leading causes of death
Health consequence of chronic kidney
disease is renal failure
DOH reported that there are about 6,000
new cases of ESRD a year
Situationer
ESRD –causes are as follows:
Chronic glomerulonephritis (CGN) is the
most common (47 percent )
Chronic pyelonephritis (17 percent),
diabetes mellitus (13 percent), and
hypertensive nephrosclerosis (5 percent)
(Kidney center of the Philippines, Medical
City 1975-1981
Situationer
Dialysis patients:
b) Chronic glomerulonephritis (39 percent)
c) Diabetes mellitus (22 percent)
d) Hypertension (14 percent) (RDR,1998).
Other conditions that cause Chronic renal failure
f) vasculitis,
g) interstitial nephritis
h) genetic and congenital disorders
i) polycystic kidney disease.
Situationer
ESRD affects persons of all ages
Chronic glomerulonephritis (CGN) usually
affects children, adolescent and young
adults in their reproductive years
One primary reason for CGN progression
is failure to diagnose the disease in its
early stage
Situationer
Three interventions have been effective
in defined populations:
b) Increase case finding and treatment for
CGN
c) Good glycemic control (for patient with
diabetes mellitus)
d) Optimum blood pressure control
Situationer
Interventions to slow down the ESRD
Simple urinalysis can detect symptoms of
urinary tract infection in asymptomatic
individuals
Acute Uncomplicated Cystitis in
Women
Definition: Growth of > 100 colony- forming units ( cfu)/
ml of mid stream urine in non pregnant women ( 18-50
yrs old)
Symptoms Presented:
c) Dysuria
d) Frequency
e) Urgency
f) Gross hematuria
g) Hypogastric pain
h) Without symptoms of vaginitis , pyelonephritis or risk
factors for subacute pyelonephritis or complicated UTI
( Grade A)
Risk Factors for subacute
pyelonephritis or complicated UTI
Hospital Acquired Infection
Indwelling Catheter
Recent UTI
Recent urinary tract instrumentation ( 2 weeks)
Functional or anatomic abnormality of the
urinary tract
Recent antimicrobial use ( 2 weeks)
Symptoms > 7 days at presentation
DM
Immunosuppresion
Treatment & Duration
3 day course of the ff:
TMP/SMX 160/800
Nitrofurantoin 100 mg QID
Norfloxacin 200 mg BID
Cirpofloxacin 250 mg BID
Ofloxacin 200 mg BID
Co amoxyclav 375 mg TID
Acute uncomplicated
Pyelonephritis
Definition : Fever , chills flank pains,
costovertebral angle tenderness , nausea,
vomiting, with or without symptoms of
lower urinary tract infection in an
otherwise healthy female with no clinical
or historical evidence or functional or
anatomic urologic abnormalities
Acute uncomplicated
Pyelonephritis
Definition :
Laboratory: pyuria> 5wbc/ hpf in a
centrifuge urine
Acute uncomplicated
Pyelonephritis
Etiologic diagnosis:
Gram stain ( grade C)
Quantitative C/s ( grade C)
Acute uncomplicated
Pyelonephritis
Treatment:
Indications for admission:
Inability to maintain oral hydration or medication
Concern about compliance
Uncertainty about the diagnosis
Severe illness with high grade fever
Severe pain
Marked debility
Signs of sepsis
Acute uncomplicated
Pyelonephritis
Characteristic Pathogens Clinical Situation Empiric treatment