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Urinary tract disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Chronic symptoms, for example, urinary incontinence, increased frequency, urgency and nocturia are common in older adults and may be misinterpreted as evidence of acute disease. Studies have suggested that chronic urinary symptoms are prevalent in 25–40% of men and women over the age of 70 years.30,31 In a study of older people, the presence of bacteriuria was found to not correlate with the urinary tract symptoms of incontinence, frequency, urgency, suprapubic pain, flank pain or fever (patients with dysuria were excluded).32
Catheter-Associated Urinary Tract Infection
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Emily M. Ramasra, Richard T. Ellison
The 2009 Infectious Disease Society of America (IDSA) guidelines define CAUTI as symptomatic bacteriuria, without another infectious source, with a single specimen urine culture growth of 1000 colony forming units of one or more bacteria, in a patient with an indwelling catheter or catheter removal within 48 hours prior to specimen collection. The guidelines further defined catheter-associated asymptomatic bacteriuria (CAASB) as 10,000 colony forming units of one or more bacteria, without symptoms of urinary tract infection, in a patient with an indwelling catheter. The constellation of symptoms that accompany CAUTI or symptomatic bacteriuria can include leukocytosis, fever, hypotension, metabolic abnormalities, suprapubic and flank pain. CAASB, where patients have bladder colonization without manifestations of clinical infection, is highly prevalent and is rarely associated with subsequent bacteremia or infectious complications. Recent single center studies have found that less than 1% of cases of catheter-associated bacteriuria were associated with bacteremia, and these did not note mortality [4, 5, 6].
Acute abdomen in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Nicole Fearing, William L. Holcomb
The physiologic leukocytosis (as high as 15,000/mm3) during pregnancy and the wide range of normal values limit the usefulness of the leukocyte count for the diagnosis of appendicitis (21). Severe disease may be present when the leukocyte count is normal (20). Greater than 80% polymorphonuclear leukocytes are often present when appendicitis complicates pregnancy (21,25). Again, however, the test is not sufficiently sensitive to rule out disease and it discriminates poorly between those patients with and those without appendicitis. Ten to twenty percent of pregnant patients with appendicitis have an abnormal urinalysis, usually showing pyuria alone (25,27). Bacteriuria indicates a urinary tract infection. Asymptomatic bacteriuria is common enough in pregnancy that it may well occur coincidentally with appendicitis (31). Ultrasound may be the initial radiologic evaluation tool for diagnosis of appendicitis. However, it may be variable in its results due to operator performance, the gravid uterus, or a retrocecal appendix. MRI and CT are gaining popularity as evaluation tools. A recent systematic review from 2009 showed good sensitivity and specificity of both when ultrasound was normal or inconclusive (18).
Clinical Features of Endogenous Endophthalmitis Secondary to Minimally Invasive Upper Urinary Tract Calculus Removal
Published in Ocular Immunology and Inflammation, 2022
Bingsheng Lou, Yi Sun, Jialiu Lin, Zhaohui Yuan, Liwen He, Chongde Long, Xiaofeng Lin
ESWL, URL and MPCNL are the minimally invasive procedures to manage urinary calculi. However, complications such as bacteriuria, bacteremia, urinary tract infection, urosepsis, endocarditis and EE still can occur.14,15 The plausible reasons for the EE complication are listed as follows. First, predisposing conditions are important in evaluating patients’ risk. Among the predisposing medical condition assessed in our study, diabetes mellitus, which was found in 7 patients (58%), was the most common condition associated with EE. A number of studies have reported similar findings.16–18 A possible explanation is the dysfunction of blood-retinal barrier permeability caused by diabetes, especially for those with poorly controlled glucose levels. Moreover, elevated urine glucose levels also contribute to the growth of microorganisms. Diabetes has also been reported to be an underlying disease in patients with urinary tract infection due to C. albicans,19 which may probably lead to EE. Second, before crushing stones, occult lower urinary tract latent infections may exist in some patients. Mechanical trauma to the ureter during urological procedures may also be encountered. The regressive ureteral catheter will transfer the microorganisms into the upper urinary tract, and the elevated pressure in the renal pelvis is likely to cause sepsis.10 Third, the double-J stent, which is indwelled postoperatively to drain urine and prevent ureterostenosis for 2 to 4 weeks, may be also a potential risk factor because the procedure and subsequent stent removal may damage urinary mucosa.
Association of acute pyelonephritis with double-J ureteral stenting: a nationwide population-based case control study
Published in Scandinavian Journal of Urology, 2021
Szu-Ju Chen, Chi-Ping Huang, Kun-Yuan Chiu, Huey-Yi Chen, Yung-Hsiang Chen, Wen-Chi Chen
Junuzovic et al. [8] conducted a prospective study on safety involving a total of 208 patients who underwent endourological surgeries. Postoperative bacteriuria was significantly more present in patients who had experienced a preoperative catheterization. A longer duration of catheterization resulted in a higher chance of bacteriuria. The occurrence of postoperative bacteriuria did not relate to antibiotic prophylaxis. In our study, a significantly higher chance of APN in endourological surgery was during PCNL, which was greater than in other surgeries. This may be due to PCNL treating a higher stone burden, while also indicating a high infection stone rate. Therefore, this is reasonable in terms of a high chance of APN. However, our data also indicates that nearly all patients who received antibiotic treatment did not experience a prevention in the occurrence of APN.
MiRNA Expression is Associated with Clinical Variables Related to Vascular Remodeling in the Kidney and the Brain in Type 2 Diabetes Mellitus Patients
Published in Endocrine Research, 2020
Ligia Petrica, Agneta-Maria Pusztai, Mihaela Vlad, Adrian Vlad, Florica Gadalean, Victor Dumitrascu, Daliborca Vlad, Silvia Velciov, Cristina Gluhovschi, Flaviu Bob, Sorin Ursoniu, Maxim Petrica, Petru Matusz, Octavian Cretu, Daniela Radu, Oana Milas, Alina Secara, Anca Simulescu, Roxana Popescu, Dragos Catalin Jianu
All patients were assessed concerning: nephrin, podocalyxin, and synaptopodin as biomarkers of podocyte damage; urinary N-acetyl-β-D-glucosaminidase (NAG) and urinary kidney injury molecule-1 (KIM-1) as biomarkers of PT dysfunction; UACR, and serum cystatin C. Serum and urinary biomarkers were determined in specimens frozen at -80°C and thawed before assay. Urinary biomarkers were assessed on aliquots from the same first morning urine sample (midstream urine).26,27 In practice, untimed urine samples can be used to rule out the necessity for 24 hour collections. An early morning, ‘first pass’ sample is preferred since it correlates well with 24 hour protein excretion, has relatively low intra-individual variability and is required to exclude the diagnosis of orthostatic proteinuria.28 The same applies when biomarkers of podocyte injury and of PT dysfunction are referred to as per urinary creatinine ratio. Urine cultures were negative for bacteriuria in all patients. CKD was defined according to the KDIGO Guideline for the Evaluation and Management of Chronic Kidney Disease.28