New Modalities of Management for Urinary Tract Problems in Pregnancy
Mohamed Gamal Al Sadik El Banna;
Abstract
Normalpregnancyischaracterizedbyprofoundchangesinalmosteveryorgansysteminordertoaccommodatethedemandsofthefetoplacentalunit.Ureteraldilatation(hydronephrosisandhydroureter)iscommonduringpregnancy,asresultsfromhormonaleffects,externalcompression,andintrinsicchangesintheureteralwall.Kidneysizealsoincreasesduetoincreasedrenalbloodflow.
Glomerularfiltrationrate(GFR)andrenalbloodflowrisemarkedlyduringpregnancy,resultinginaphysiologicfallintheserumcreatinineconcentration.WhethertheGFRischangingorisstableisbestdeterminedbymonitoringchangesintheserumcreatinineconcentration.
Levelsofcalcium,oxalate,uricacid,andsodiumareallincreasedinurine.Thisriseinlithogenicfactorsisjoinedbyariseinlevelsofurinarycitrate,nephrocalcin,magnesium,glyscosaminoglycans,anduromodulin,allofwhichactasinhibitorsofstoneformation.However,althoughcitrateisaninhibitorofstoneformation,italsocausesariseinurinarypH,whichcanalterthesuper-saturationpointofcalciumphosphatecrystallization,increasingtheriskofcalciumphosphatekidneystones.
TheidealvoidedurinespecimenforevaluationofaUTIisaclean-catch,midstreamsampleofthefirstmicturitionoftheday,withcleaningoftheurethralmeatus,atthetimeofclinicalevaluationlikelyproducesareasonablespecimenforanalysis.
Dipsticks,whichdetectthepresenceofleukocyteesteraseandnitriteintheurine,canbeusedasascreeningtoolandaregenerallyperformedwheneverUTIissuspected.Apositivenitritetestisareliableindexofsignificantbacteriuria,althoughanegativetestdoesnotexcludebacteriuria.AnegativenitriteandleukocyteesteraseonthedipstickinapatientwithsymptomsofUTImayrepresentfalsenegativeresults.
Intrulyinfectedpatients,asignificantnumberofleukocytes(>10/microL)shouldgenerallybepresent.Giventheveryhighassociationbetweeninfectionandpyuria,microscopicassessmentforpyuriacanbehelpfulindistinguishingbetweencolonizationandinfectionwhenthereisbacteriuriaandcompatiblesymptoms.
Whereastrueinfectionwithoutpyuriaisunusual,pyuriacanoccurintheabsenceofapparentbacterialinfection,particularlyinpatientswhohavealreadytakenantimicrobials.orcontaminationfromvaginalsecretionsandothercausesofuroepithelialinflammation.Whenthemorecommoncausesofsterilepyuriahavebeeneliminated,patientswithdysuriaandfrequencyshouldbeevaluatedforatypicalorganisms,suchasChlamydia,Ureaplasmaurealyticum,ortuberculosis.
Cultureofaclean-
Glomerularfiltrationrate(GFR)andrenalbloodflowrisemarkedlyduringpregnancy,resultinginaphysiologicfallintheserumcreatinineconcentration.WhethertheGFRischangingorisstableisbestdeterminedbymonitoringchangesintheserumcreatinineconcentration.
Levelsofcalcium,oxalate,uricacid,andsodiumareallincreasedinurine.Thisriseinlithogenicfactorsisjoinedbyariseinlevelsofurinarycitrate,nephrocalcin,magnesium,glyscosaminoglycans,anduromodulin,allofwhichactasinhibitorsofstoneformation.However,althoughcitrateisaninhibitorofstoneformation,italsocausesariseinurinarypH,whichcanalterthesuper-saturationpointofcalciumphosphatecrystallization,increasingtheriskofcalciumphosphatekidneystones.
TheidealvoidedurinespecimenforevaluationofaUTIisaclean-catch,midstreamsampleofthefirstmicturitionoftheday,withcleaningoftheurethralmeatus,atthetimeofclinicalevaluationlikelyproducesareasonablespecimenforanalysis.
Dipsticks,whichdetectthepresenceofleukocyteesteraseandnitriteintheurine,canbeusedasascreeningtoolandaregenerallyperformedwheneverUTIissuspected.Apositivenitritetestisareliableindexofsignificantbacteriuria,althoughanegativetestdoesnotexcludebacteriuria.AnegativenitriteandleukocyteesteraseonthedipstickinapatientwithsymptomsofUTImayrepresentfalsenegativeresults.
Intrulyinfectedpatients,asignificantnumberofleukocytes(>10/microL)shouldgenerallybepresent.Giventheveryhighassociationbetweeninfectionandpyuria,microscopicassessmentforpyuriacanbehelpfulindistinguishingbetweencolonizationandinfectionwhenthereisbacteriuriaandcompatiblesymptoms.
Whereastrueinfectionwithoutpyuriaisunusual,pyuriacanoccurintheabsenceofapparentbacterialinfection,particularlyinpatientswhohavealreadytakenantimicrobials.orcontaminationfromvaginalsecretionsandothercausesofuroepithelialinflammation.Whenthemorecommoncausesofsterilepyuriahavebeeneliminated,patientswithdysuriaandfrequencyshouldbeevaluatedforatypicalorganisms,suchasChlamydia,Ureaplasmaurealyticum,ortuberculosis.
Cultureofaclean-
Other data
| Title | New Modalities of Management for Urinary Tract Problems in Pregnancy | Other Titles | طرق التشخيص و العلاج الحديثة لامراض المسالك البولية اثناء فترة الحمل | Authors | Mohamed Gamal Al Sadik El Banna | Issue Date | 2016 |
Attached Files
| File | Size | Format | |
|---|---|---|---|
| G11163.pdf | 395.8 kB | Adobe PDF | View/Open |
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