Uti PDF

by: dr.
seenaa alsadyi
 To understand and demonstrate appropriate knowledge,
skills and attitudes in relation to pregnant women with
kidney disease.
 Understand the epidemiology, aetiology, pathophysiology,

clinical characteristics, prognostic features and management
of women with kidney disease.
 Appreciate the importance of preconceptual counselling and
its impact on improving pregnancy outcomes
 Understand the impact of renal disease on pregnancy.
 .
1. Kidney enlarges during pregnancy.
2.increase circulating hormones (progesterone) &
mechanical (pressure of pregnant uterus on
bladder ) will lead to dilatation of ureters & pelvi
– calcyeal system (97% had hydronephrosis ).This
occur from the first trimester , more on right side
- stasis – increase UTI (asym.&symptomatic
bacteruria ) .
3. Vesico- ureteric reflux occurs in 3% will lead to
increase incidence of pyelonephritis in pregnancy.
 50% increase in R.P.F & G.F.R from the first
trimester.
 Increase G.F.R will lead to glycosuria 10 times
more than non pregnant .2/3 had glycosuria.
 Increase GFR will lead to decrease blood urea
& uric acid due to increase renal clearance.

Risk of pregnancy will depend on:-
1. Rate of disease progress.
2. Amount of renal damage.
3. Hypertension is a major risk factor.
 CKD is classified into five stages based on the
level of renal function.
 Women with CKD stages 1–2 have mild renal
dysfunction and usually have an uneventful
pregnancy and good renal outcome.
 Women with moderate to severe disease
(stages 3–5) are at highest risk of complications
during pregnancy and of an accelerated decline
in their renal function.
 Safe contraception until pregnancy advised.
 Fertility issues if indicated.
 Genetic counselling if inherited disorder.
 Risks to mother and fetus during pregnancy.
 Avoid known teratogens and contraindicated
drugs.
 Treatment of blood pressure and adjustment of
antihypertensives.
 Low-dose aspirin.
 Need for anticoagulation once pregnant in
women with significant proteinuria.
 possibility of accelerated decline in maternal
renal function.
 need for postpartum follow-up.
Frequent ANC check B.P to detect H.T or
superimposed P.E.T.
 MSG to detect UTI should be treated and
proteinuria.
 Full blood count: haemoglobin; ferritin.
 Renal function: creatinine.
 Renal ultrasound.
U/S to detect IUGR (common sequale).

Deterioration of renal function, if more than 15-
20% needs immediate delivery.
 The incidence of pregnancy on dialysis (stage 5
CKD) is increasing.
 Dialysis must be adjusted to allow for the
physiological changes of pregnancy (plasma
volume, fluid retention, electrolytes),
 and haemodialysis is usually more effective
than peritoneal dialysis in achieving this.
 Complications include preterm delivery,
 polyhydramnios (30–60%), pre-eclampsia (40–
80%) and caesarean delivery (50%).
 0.3 /1000 pregnant.
 Single x-ray for the purpose of diagnosis is not
contraindicated at any stage of pregnancy.
 Treatment is conservative: - I.V fluid, AB &
systemic analgesia.
 Usually non- obstructive stone:-AB until after
delivery.
 Obstructive stone: - need surgery.

 Commonest cause in pregnancy is UTI.
 Other causes: - stone, tumors must be excluded
by renal U/S or cystoscopy.
1. Important the transplanted kidney should be stable, so
wait 18 months after transplantation prior to
pregnancy.
2. Women should be normotensive prior to pregnancy
even by therapy.
 3. Immunosuppressive treatment should be at
maintenance dose. Tacrolimus, azathioprine,
ciclosporin and prednisolone are generally considered
safe in pregnancy and for the breastfed infant.
mycophenolate and sirolimus should be avoided in
transplant recipients considering pregnancy
 . and women should be switched to alternative regimes
before pregnancy; a period of 3–6 months’ stability on
a new medication regime prior to pregnancy is
advised.
4. Most important that renal function should be
adequate to allow increase demand of
pregnancy.
5. Risk associated with pregnancy:-
a.H.T, renal failure,& infection (CMV& herpes
due to immunpsuppresion).
B.preterm delivery 50%.
C.IUGR 20%.
 U/o less than 400 ml /day.
 The common obstetrical causes: - septic
abortion, severe PET, abruption, placenta
previa & PPH.
 Treatment: - I.V fluid monitored by CVP, AB,
corticosteroid & renal dialysis.

 Common in pregnancy .8% of Pregnant women
had asymptomatic, (100000 organism/ml of
urine).If untreated, half (50%) will develop
pyelonephritis.
 All bacteriuria in pregnancy requires treatment
to prevent pyelonephritis and preterm delivery
(Cochrane guideline A)
¨ Oral antibiotics
¨ Amoxicillin 500 mg three times daily
¨ Cefadroxil 500 mg twice daily
¨ Cephalexin 250 mg three times daily
¨ Nitrofurantoin 100 mg three times daily (not
third trimester)
¨ Trimethoprim 200 mg twice daily (not first
trimester)
¨ Intravenous antibiotics for pyelonephritis
¨ Cefuroxime 750 mg to 1.5 g three times daily
¨ Amoxicillin 1 g three times daily
¨ Gentamicin 5–7 mg/kg daily as one dose and then further
doses as determined by serum gentamicin concentrations
(for organisms resistant to, or women allergic to, penicillins
and cephalosporins)
¨ Duration of treatment
¨ Asymptomatic bacteriuria: 3 days
¨ Acute cystitis: 7 days
¨ Pyelonephritis: 10–14 days
¨ Prophylaxis of UTI
¨ Cephalexin 250 mg once daily
¨ Amoxicillin 250 mg once daily
1-2% of pregnancy .Fever, loin pain, vomiting
.Increase preterm labour, & IUGR.
Treatment: hospital Admission, MSG: microscopy
& culture, but AB starts immediately (usually
start I.V
1. AB: ampicilline or cephalosporin, sometime
amino glycoside may be needed.
2. I.V fluid 1.5-2 litters /day.
3. Systemic analgesia.
Increase frequency of micturition (7 times/day).
Increase nocturia (2 night voids).
Causes (combination)I
1. Pressure effect of pregnant uterus on the
bladder.
2. Increase bladder capacity from 12-32 weeks up
to 1300ml.
3. ↑ Urine production especially in 1st & 2nd
trimesters
¨ 67% of pregnant get stress incontinence.
¨ More common in multiparous.
¨ In most cases reversible & resolve postpartum.
¨ During pregnancy the cause is detrusor
instability, & in postpartum period the cause is
genuine stress incontinence because of pelvic
floor denervation (stretching of the supporting
structures as a result of labour may lead to
damage & weakening of the sphincter
mechanism).
¨
¨ During pregnancy:-
¨ Urinary retention at 14-16 weeks by retroverted
uterus incancerated in the pelvis.
¨ Treatment by catheter drainage, patient lie
prone, occasionally uterus manipulated under
anesthesia.
¨
¨ During labour:-
¨ Causes of retention are epidural, prolonged
traumatic delivery, forceps.
¨ Treatment by catheterization.
¨
¨ Obstructed prolonged labour lead to tissue
necrosis.
¨ Small fistula may heal spontaneously by
continuous catheter drainage & AB.
¨ Large fistula: need surgical repair after 10-
12weeks so that edema & infection resolved.
¨ Low fistula: repair vaginally.
¨ High fistula or complex fistula: need
abdominal operation.
¨
Thank you

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by: dr.

 Understand the epidemiology, aetiology, pathophysiology,

 Renal function: creatinine.

U/S to detect IUGR (common sequale).

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