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 bacteriuria do 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 vesicoureteral reflux, and those with infected kidney stones are more likely to be given antibiotics. Giving antibiotics to persons who have longterm 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 RBCs/hpf; kidney dz False hematuria = urine appears bloody, but dipstick results are neg. for blood and no RBCs on micro

Free

hgb, myoglobin, porphyrins

1.Physologicalmenstruation 2. InfectionPyelonephriitis , 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, radiatinal inflammation 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.Generaldrugs 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 RBCs/hpf) Can screen with dipstick but false negs/pos may result Abnormal RBC morphologic characteristics, RBC casts & proteinuria suggest glomerular source If normal RBCs then infection probable Imaging (IVP, CT, renal US)

When haematuria(micro / Macro ) is noted Nephrologists 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