ABSTRACT
Urinary tract infection (UTI) is the most common infection experienced by humans after respiratory and gastro-intestinal infections, and also the most common cause of both community-acquired and nosocomial infections for patients admitted to hospitals. For better management and prognosis, it is mandatory to know the possible site of infection, whether the infection is uncomplicated or complicated, re-infection or relapse, or treatment failure and its pathogenesis and risk factors. Asymptomatic bacteriuria is common in certain age groups and has different connotations. It needs to be treated and completely cured in pregnant women and preschool children. Reflux nephropathy in children could result in chronic kidney disease; otherwise, urinary tract infections do not play a major role in the pathogenesis of end-stage renal disease. Symptomatic urinary tract infections occur most commonly in women of child-bearing age. Cystitis predominates, but needs to be distinguished from acute urethral syndrome that affects both sexes and has a different management plan than UTIs. The prostatitis symptoms are much more common than bacterial prostatic infections. The treatment needs to be prolonged in bacterial prostatitis and as cure rates are not very high and relapses are common, the classification of prostatitis needs to be understood. The consensus conference convened by National Institute of Health added two more groups of patients, namely, chronic prostatitis/chronic pelvic pain syndrome and asymptomatic inflammatory prostatitis, in addition to acute and chronic bacterial prostatitis. Although white blood cells in urine signify inflammation, they do not always signify UTI. Quantitative cultures of urine provide definitive evidence of UTI. Imaging studies should be done 3-6 weeks after cure of acute infection to identify abnormalities predisposing to infection or renal damage or which may affect management. Treatment of cystitis in women should be a three-day course and if symptoms are prolonged, then a seven day course of antibiotics should be given. Selected group of patients benefits from low-dose prophylactic therapy. Upper urinary tract infection may need in-patient treatment. Treatment of acute prostatitis is 30-day therapy of appropriate antibiotics and for chronic bacterial prostatitis a low dose therapy for 6-12 months may be required. It should be noted that no attempt should be made to eradicate infection unless foreign bodies such as stones and catheters are removed and correctable urological abnormalities are taken care of. Treatment under such circumstances can result only in the emergence of resistant organisms and complicate therapy further.
ABSTRACT
All patients admitted with pregnancy related acute renal failure (PRAKI) from June 2005 to May 2007 were studied with respect to etiology, clinical features, and outcome of PRAKI. Of 569 cases of acute kidney injury (AKI), 40 (7.02%) cases were related to gestational problems; the age of the patients ranged from 15 to 45 years. Septic abortion was the most common cause of PRAKI, accounting for 20 (50%) cases of which 15 (75%) cases occurred in the first and five (25%) in the second trimester. Other causes were antepartum hemorrhage: six cases (15%), toxemia of pregnancy: six cases (15%), acute gastroenteritis: three cases (7.5%), postpartum hemorrhage: two cases (5%), acute pyelonephritis: two cases (5%), and postpartum, acute kidney injury: one case (2.5%). Dialysis was needed in 60% of the cases and mortality was observed in 20% of the cases. PRAKI continues to be a major concern in our society, causing a high maternal mortality. Septic abortion which has virtually disappeared from developed countries, continues to be a major cause of PRAKI in our society. Hence, there is a need to halt the practice of illegal abortions and improve antenatal care.
