Asymptomatic Bacteriuria

Defination

When a bacterial count of same species over

10^5 per ml in mild stream clean catch

specimen of urine on two occasion is

detected without the symptom of urinary

infection it is called asymptomatic

bacteriuria

Causes

Asymptomatic bacteriuria occurs in a small number of healthy individuals. It more often affects women than men. The reasons for the lack of symptoms are not well understood.

Most patients with asymptomatic bacteriuriado not need treatment because the bacteria are not causing any harm. Persons who have urinary catheters often will have bacteriuria, but most will not have symptoms.

The following increases your risk:

Diabetes

Infected kidney stones

Kidney transplant

Older age

Pregnancy -- up to 40% of pregnant women with untreated asymptomatic bacteriuria will develop a kidney infection

Vesicoureteral reflux in young children

Symptoms

By definition, asymptomatic bacteriuria

causes no symptoms. The symptoms of a

urinary tract infection include burning

during urination, an increased urgency to

urinate, and increased frequency of

urination.

Exams and Tests

Asymptomatic bacteriuria is detected by the

discovery of significant bacterial growth in

a urine culture taken from a urine sample.

Treatment

Pregnant women, kidney transplant recipients, children with vesicoureteralreflux, and those with infected kidney stones are more likely to be given antibiotics.

Giving antibiotics to persons who have long-term urinary catheters in place may cause additional problems. The bacteria may be more difficult to treat and the patients may develop a yeast infection.

If asymptomatic bacteriuria is found before

a urinary tract procedure, it should be

treated to prevent complications. The course

of treatment in these cases depends on the

person's risk factors.

Possible Complications

Untreated, asymptomatic bacteriuria can

lead to a kidney infection in high-risk

individuals

When to Contact a Medical

Professional

Call your health care provider if the

following symptoms occur:

Difficulty emptying your bladder

Fever

Flank or back pain

Pain with urination

PROTEINURIA

INPREGNANCY

When 2+protein in deepstick test it is

called proteinuria

CAUSES

Pre-eclampsia and eclampsia

Urinary tract infection

Chronic Renal disease :Nephritis and

Nephrotic Syndrome

Essential hypertension

Orthostatic- Due to increased lumbar

lordosis there is increased pressure on the

inferior Venacava by the uterus or left renal

vein

Is compressed by the aorta this leads to congestion of one or both kidney leading to proteinuria.

In late pregnancy,the enlarged gravid utrerus may compress es the left renal vein when the patient is lying on supine position .lying down on lateral position relieves the pressure and congestion and makes the urine free of protein

Investigations (microscopic examination of

Pus cells RBCs Cast cells)

Management depends upon etiology

Hematuria in Pregnancy

Painful - infection

Painless – neoplastic, hyperplastic, vascular

Gross – urine appears ―RED‖; lower tract

prob.

Microscopic – > 5 RBC’s/hpf; kidney dz

False hematuria = urine appears bloody, but

dipstick results are neg. for blood and no

RBC’s on micro

Free hgb, myoglobin, porphyrins

1.Physological—menstruation

2. Infection—Pyelonephriitis , cystitis , urethritis , Tuberculosis of kidney and bladder

3. Trauma– Renal injury, Foreign body in bladder and urethra including catheter.

4.Inflammatory / autoimmune—Glomerulonephritis , Polyarteritis nodosa , Ch. Interstitial nephritis, radiatinalinflammation of renal tract.

5.Accidental haemorrhage

6.Rupture uterus

7. Obstructed labour

8 .DIC

9. Traumatic PPH

10.Heparine therapy for DVT

11.Eclampsia

12. HellP syndrome

13. Mismatched blood transfusion

14.Pregnancy associated with hematological diseases

15.Drug induced

16. Instrumental delivery

17.Traumatic VVF

5.Stones– renal , ureteric , bladder and

urethra.

6 .Tumors– benign /malignant of renal tract.

7.General—drugs including anticoagulants

Bleeding disorders , caruncle and prolapse

of urethral mucosa.

Diagnosis:

H & P

Clean catch midstream urine for U/A

Cath urine if woman has vag. d/c, menstrual or vag. Bleeding (cath urine will rarely exceed 3 RBC’s/hpf)

Can screen with dipstick but false negs/pos may result

Abnormal RBC morphologic characteristics, RBC casts & proteinuria suggest glomerular source

If normal RBC’s then infection probable

Imaging (IVP, CT, renal US)

When haematuria(micro / Macro ) is noted

Nephrologist’s consultation should be

shout.

Clinical Assessment

Check the catheter, clinical examination of

renal tract , genital tract any other bleeding

sites

Investigations:

Complete urine examination, CBC, platelet

count , bleeding – clotting factor

profile, liver enzyme study should be

immediately ordered.

MANAGEMENT

It depends upon the causes of hematuria