Urinary Tract
Diagnostic Procedures
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Urinary tract disorders often can be diagnosed through blood and urine tests. Blood tests can show when the kidneys are failing to adequately remove waste products. Urine tests (urinalysis) can show whether there is bleeding in the urinary tract, whether bacteria have infected the urinary tract, or whether the kidneys are functioning properly. A small sample of urine can be quickly tested for the presence of protein, sugar, blood, and other substances using a dipstick (a strip of paper coated with test chemicals that can be dipped into the urine and checked immediately for results). The relative amount of acid in the urine (pH) can be determined in the same way. Other urine tests require a person to collect all the urine he or she produces over a 24-hour period. Special imaging procedures also may be needed to examine the structure of the kidneys, ureters, bladder, and urethra. The following are the most common tests for diagnosing urinary tract disorders:
• Serum creatinine. This blood test measures the amount of creatinine, a waste product that results from eating meat and from muscle repair. High levels of creatinine in the blood indicate that the kidneys are not working properly.
• Blood urea nitrogen (BUN). Urea nitrogen is another by-product of protein digestion. As with serum creatinine, high BUN levels on a blood test indicate reduced kidney function.
• Creatinine clearance. A creatinine clearance test compares the amount of creatinine present in a 24-hour urine sample with creatinine levels in blood to determine how much blood the kidneys have filtered over a 24-hour period.
• Specific gravity. This urine test measures the extent to which the kidneys can concentrate the urine they produce. If the specific gravity is lower than normal, it suggests that the kidneys are not functioning efficiently.
• Urinary sediment. Normal urine contains a small number of cells and other materials shed during passage through the urinary tract. Examining the number and type of these substances can help identify specific disorders. For example, the presence of white blood cells and bacteria indicates infection. The presence of white blood cells also may indicate a tumor. Crystals appear when the urine is not acidic enough to dissolve them or when the concentration of crystals in the urine is abnormally high. Casts (cylindrical clumps of material that form in and come from the tubules in the kidney) distinguish kidney problems from disorders of the ureter, bladder, and urethra and help identify the diseased area of the kidney.
• Intravenous urography. This series of contrast medium-enhanced X rays allows doctors to view the interior structures of the urinary tract. This test sometimes is called an intravenous pyelogram, or IVP. The contrast medium is injected into a vein, and X rays are taken as it reaches the kidneys and is filtered out. When the contrast medium has filled your bladder, you will be asked to urinate, and X rays will be taken to see if any of the contrast medium remains in your bladder. This procedure is most often performed to look for stones in the kidney or the bladder, cysts in the kidney, tumors, an enlarged prostate, or other possible sources of blockage.
• Cystoscopy. For this test, a thin, rigid or flexible tube (with or without a video camera attached) is passed through the urethra into the bladder. This procedure is required to rule out a possible bladder tumor.
• Retrograde pyelogram. This procedure usually is performed during a cystoscopy and is used when poor kidney function limits the value of intravenous urography. For this test, contrast medium is injected directly from the bladder into the ureters through the cystoscope. The contrast medium allows the doctor to check for blockages or tumors.
• Ultrasound scanning. Ultrasound scanning (also called ultrasonography or a “sonogram”) is an imaging technique that allows doctors to see the outline and the interior of the kidneys and, to a lesser extent, the bladder. This procedure offers a noninvasive method of distinguishing between cysts and tumors of the kidney, checking for urinary tract obstruction, detecting inflammation and fluid collection around the kidneys, and identifying the best location for a planned biopsy.
• Computed tomography (CT) scanning. CT scanning is a diagnostic technique that uses a computer and low-dose X rays to produce detailed cross-sectional images of body tissues that are displayed on a video monitor. This technique is performed with or without a contrast medium (a dye) to detect stones and tumors in the urinary tract.
• Magnetic resonance imaging (MRI). MRI is a diagnostic technique that uses a computer, a powerful magnetic field, and radio waves to produce detailed two and three-dimensional images of body tissues that are displayed on a video monitor. This technique is used to detect tumors in the kidneys and bladder.
Categories : Urinary Tract
Other Urinary Tract Disorders
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Other possible disorders of the urinary tract include the following:
• Polycystic kidney disease. Polycystic kidney disease (PKD) is a genetic disorder in which numerous fluid-filled cysts (abnormal lumps or swellings) grow in the kidneys. These cysts can slowly displace much of the functional tissue of the kidneys, reducing kidney function and leading to kidney failure. People with PKD can have the disease for decades without developing symptoms. The most common symptoms are pain in the back and the sides (between the ribs and the hips) and headaches. People with PKD also may develop urinary tract infections, hematuria, cysts in other organs, high blood pressure, and kidney stones. Doctors use ultrasound scanning to look for cysts in the kidneys, especially in people who have a family history of PKD. Although there is no cure for PKD, treatment can ease the symptoms and prolong life.
• Acquired cystic kidney disease. People who have a long history of kidney disease (especially if they require dialysis) are likely to develop cystic kidney disease similar to PKD (above). The cysts may bleed. People with acquired cystic kidney disease are twice as likely to develop renal cell cancer.
• IgA nephropathy. This kidney disorder is caused by deposits of the protein immunoglobulin A (IgA) inside the filtering mechanisms (glomeruli) within the kidney. The IgA protein blocks the normal filtering process, which causes blood and protein to remain in the urine and also causes swelling in the hands and feet. IgA nephropathy is a chronic glomerular disease that may progress over a period of 10 to 20 years.
• Analgesic nephropathy. This kidney disease results from long-term use of analgesics (painkillers) and gradually leads to end-stage renal disease. Single analgesics such as aspirin have not been found to cause kidney damage. However, medications that combine two or more painkillers (such as aspirin and acetaminophen) with caffeine or codeine are most likely to damage the kidneys. People who already have kidney disease must use caution when taking any painkiller.
Categories : Urinary Tract
Disorders of the Bladder and Urethra
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The lower urinary tract consists of the bladder and urethra. If left untreated, disorders of the bladder or urethra can interfere with normal functioning of the urinary tract and lead to kidney damage.
Urethral Stricture
Urethral Stricture
Urethral stricture is a condition in which the
urethra (the tube that carries urine out of the
bladder) is narrowed, potentially interfering
with the flow of urine and with ejaculation.
The urethra can become narrowed when scar
tissue forms after some medical procedures
(such as placement of a catheter), surgery,
injury, or recurring infections.
The urethra can become narrowed by scar tissue following catheter placement, surgery, injury, or repeated episodes of urethritis. This condition, called urethral stricture, is a common problem following long-term catheter placement. Urethral stricture can interfere with urination and ejaculation. It also can damage the kidneys by causing back pressure (buildup of fluid) in the urinary tract. Urethral stricture also may be a factor in the development of urinary tract infections.
Urethral stricture can be treated in the doctor’s office by widening the urethra from within with a thin, flexible instrument called a dilator. Sometimes the scar tissue must be removed surgically using a cystoscope, or a portion of the urethra must be removed surgically. Laser therapy also may be used to remove the scar tissue. Depending on where the stricture is located, a urethral stent (a tiny springlike device that holds the urethra open) can be inserted to keep the passageway open. However, if the stricture is too close to the sphincter muscle (which prevents leakage of urine from the bladder), a stent cannot be used. In some cases the affected segment of the urethra may be surgically reconstructed using tissue taken from another part of the body.
Bladder Cancer
Bladder cancer is the fourth most common type of cancer in men. Transitional cell carcinoma, which develops from the cells that line the bladder walls, is the most common type of bladder cancer. This type of cancer also can occur in the kidneys, the ureters, and the portion of the urethra nearest the bladder.
Transitional cell carcinoma that remains confined to the surface of the bladder lining is called superficial bladder cancer. Superficial bladder cancer is the most common type of transitional cell carcinoma (75 to 80 percent of new cases) and is easy to treat, but it tends to recur. In some cases the cancer spreads beyond the bladder lining and invades the muscular wall of the bladder. This is called invasive bladder cancer. The tumor may continue to grow through the bladder wall and spread to nearby organs. Bladder cancer cells also can spread to surrounding lymph nodes and to distant organs such as the lungs or the bones.
Symptoms of bladder cancer can be the same as those for a bladder infection or other urinary tract disorder. Therefore you should talk to your doctor as soon as possible if you experience any symptoms. The most common symptoms of bladder cancer include blood in the urine, painful urination, frequent urination (without an increase in fluid intake), and an urge to urinate with little urine output. If your doctor thinks you may have bladder cancer, he or she will examine the inside of the bladder with a viewing tube called a cystoscope and use other imaging techniques to determine whether the cancer has spread.
Surgery is the most common treatment for bladder cancer. Superficial bladder cancer can be treated with transurethral resection, in which the tumor is surgically removed through a cystoscope. With invasive bladder cancer, all or part of the bladder is removed using a surgical procedure called cystectomy. Often, surrounding lymph nodes, the prostate gland, and the seminal vesicles also are removed. Additional treatment may include radiation therapy, chemotherapy (treatment with powerful anticancer drugs), or immunotherapy (treatment in which the body’s immune system is stimulated to destroy cancer cells), depending on where the cancer has spread and how advanced it is.
When the bladder must be removed, the doctor creates an alternative method for storing and passing urine. The doctor often will use an isolated piece of the person’s small intestine to create a new channel between the ureters and an opening in the wall of the abdomen (called a stoma) through which urine can pass. A flat bag is attached to the stoma to collect urine, and the person empties the bag as needed. A portion of small intestine also can be used to create a storage pouch inside the body (instead of an external bag), which the person drains by inserting a catheter through the stoma. The storage pouch also can be attached to the remaining portion of the urethra to allow the person to urinate through the urethra.
Until recently, nearly all men experienced erectile dysfunction after bladder removal surgery, but surgical improvements have reduced the likelihood of this side effect. However, men who have had their prostate gland and seminal vesicles removed no longer produce semen, so they do not ejaculate when they have an orgasm, and they are infertile.
Categories : Urinary Tract
Dialysis
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With kidney failure, when the kidneys can no longer remove waste and excess water and acid from the blood and maintain the body’s chemical balance, a person must undergo kidney dialysis. In this procedure, blood from an artery in the person’s arm or leg flows through a tube and into a machine called a dialysis unit that works as an artificial kidney. The blood is filtered and cleansed in the dialysis unit and returned through another tube inserted into a vein in the same arm or leg. Usually dialysis is performed at a dialysis center (although it can be done at home) three times per week. The person can sleep, read, write, talk, or watch television during the 3 to 4 hours of each treatment.
In another type of dialysis (called peritoneal dialysis), a cleansing fluid (called dialysate) is placed in the abdomen through a permanently implanted catheter (tube) to filter and cleanse the blood. To begin treatment, the person attaches a bag containing dialysate to the catheter and allows the fluid to drip into his or her abdominal cavity. The dialysate is left inside the abdomen for several hours while it pulls out waste, excess water, sodium, potassium, and other chemicals from the blood vessels that line the abdominal cavity. The fluid and waste are then drained from the abdomen through the catheter and back into the bag. The procedure is repeated four or five times per day. This method is called continuous ambulatory peritoneal dialysis and can be performed at home. Peritoneal dialysis also can be performed using a machine that fills and drains the abdominal cavity throughout the night while the person sleeps. This method is called continuous cycling peritoneal dialysis.
Categories : Urinary Tract
Hematuria
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Hematuria refers to excess red blood cells in the urine. In some cases of hematuria, the urine looks normal and the blood is visible only under a microscope; this is called microscopic hematuria. In other cases, the blood is visible to the naked eye and the urine looks red or cola-colored; this is called gross hematuria. (Note that some foods and food dyes also can cause the urine to look red or brown.) Usually the causes of hematuria are not serious, but all cases should be evaluated so the doctor can determine the cause and treat it appropriately. Symptoms such as pain or fever also can provide clues to the cause of hematuria, as does the timing of the blood’s appearance in the urine (at the beginning, end, or throughout urination). Possible causes of hematuria include the following:
• urinary tract infection or obstruction
• enlarged prostate
• kidney stones or bladder stones
• kidney cancer or bladder cancer
• injury to the urinary tract
• overexercising
• sickle-cell disease
• certain medications (including painkillers, blood-thinning drugs, and antibiotics)
• IgA nephropathy
Categories : Urinary Tract
Warning Signs of Kidney Stones
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Some kidney stones do not cause symptoms. Others may cause sudden, severe pain when they move into the ureter and cause an obstruction. As the stone moves toward the bladder, you may feel a strong urge to urinate, or you may feel a burning sensation. Fever and chills in addition to these symptoms may indicate a urinary tract infection. Contact your doctor immediately if you experience these symptoms:
• sudden, severe pain in your back or lower side
• fever and chills
• weakness
• nausea and vomiting
• cloudy or foul-smelling urine
• blood in your urine
• a frequent need to urinate in small amounts
• a burning sensation during urination
• an inability to urinate although your bladder feels full
Categories : Urinary Tract
Disorders of the Kidney
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Your kidneys have tremendous excess capacity to do their job. In fact, you can lose more than 50 percent of your renal (kidney) function and remain healthy. However, serious health problems occur when renal function drops to 20 percent, and either a kidney transplant or dialysis is required if renal function drops below 10 to 15 percent. Once nephrons (the filtering units of the kidneys) have been destroyed, either suddenly through injury or poisoning or gradually after years of kidney disease, they can never be regenerated or repaired.
Diabetes and hypertension (high blood pressure) are the two leading causes of kidney disease. In diabetes, blood flow through the kidneys increases, causing the kidneys to enlarge, and the excess sugar in the blood damages the glomeruli (tiny blood vessels that are part of the nephrons). High blood pressure can cause kidney disease by damaging the small blood vessels needed for filtering and reabsorption of fluids. Conversely, hypertension can result from kidney disease if blood flow through the kidneys is obstructed or slowed, resulting in the release of hormones that cause blood pressure to rise.
Kidney Stones
A healthy kidney removes extra electrolytes and other minerals from the blood. Normally the chemical composition of urine and prompt urination prevent these electrolytes and minerals from forming crystals and building up on the inner surfaces of the kidney. Some crystals that form may pass through the urinary tract unnoticed. However, others may accumulate until they have formed kidney stones.
Why kidney stones form in some people and not in others remains unknown. Men, especially white men, develop kidney stones more frequently than women. Kidney stones usually develop between ages 20 and 40, and once one stone has been diagnosed, more are likely to develop. A family history of kidney stones increases the risk, as do certain disorders of the kidney and recurrent kidney infections. Other diseases (such as gout and chronic inflammatory disorders) and certain medications (such as diuretics and calcium-based antacids) also can cause kidney stones.
The warning signs of kidney stones are unmistakable. Stones that are not causing symptoms may be found by chance on an X-ray or ultrasound image. Most kidney stones can be passed through the urinary system by drinking plenty of water (2 to 3 quarts per day), and taking over-the-counter pain medication as needed. If you ever pass a kidney stone, be sure to save it for testing: knowing the composition of the stone will help your doctor determine the appropriate treatment and recommend steps to prevent future stones.
Surgery is rarely needed to remove or to break up kidney stones. However, if a stone does not pass through the ureter and blocks urine flow, or if a stone causes ongoing urinary tract infection, medical treatment will be required. Extracorporeal shockwave lithotripsy (ESWL) passes shock waves through the body until they strike the stones and reduce them to the consistency of sand so they can be excreted in the urine. Lithotripsy usually is done on an outpatient basis. The procedure is performed using either intravenous sedation or epidural (spinal) anesthesia. Some lithotripsy devices require the patient to be in a water bath during the procedure, while others require that the patient lie on a soft cushion or pad.
A procedure called percutaneous nephrolithotomy may be performed when stones are especially large or when they are in tissues that make lithotripsy ineffective. In this procedure the surgeon makes a tiny incision in the patient’s back and inserts a nephroscope (a special type of viewing tube) to locate and remove the stone. For stones that are lower in the ureter, a thin, flexible viewing tube (called a ureteroscope) is passed up through the urethra and the bladder to the stone; the stone is then either removed or shattered. Both of these procedures are performed using general or epidural anesthesia, and both require either a short hospital stay or are done on an outpatient basis.
Additional kidney stones are likely to develop unless preventive measures are taken. The chemical composition of the first stone must be analyzed so the doctor can determine appropriate dietary changes and prescribe appropriate medications. Often the person is asked to collect a couple of 24-hour urine samples for analysis. The doctor also will advise the person to drink plenty of fluids (at least eight 8-ounce glasses per day), especially water. Additional treatment will be required if an underlying cause for the stones is diagnosed. Regular urinalysis will be important for monitoring the effectiveness of preventive measures and treatment.
Glomerular Diseases
Blood enters the kidneys through arteries that branch off inside the kidneys into tiny clusters of looping blood vessels called glomeruli. The glomerulus is part of the nephron, the basic filtering unit of the kidney. When the glomeruli are damaged, protein and, in some cases, red blood cells leak into the urine. When a certain type of protein called albumin is lost in the urine, the body is less able to remove excess fluid; the excess fluid causes edema (swelling) in the face, hands, feet, or ankles. Diseases that affect kidney function by damaging these filtering clusters of blood vessels are called glomerular diseases. When the attached renal tubules are affected, a condition known as nephrotic syndrome develops.
In glomerulonephritis, the membranous tissue in the kidney that serves as a filter becomes inflamed. In glomerulosclerosis, the tiny blood vessels that form the clusters become hardened or scarred. Signs of a glomerular disease include facial puffiness, hematuria (blood in the urine), or foamy urine caused by excretion of extra protein. Nephrotic syndrome is marked by very high levels of protein in the urine, low levels of protein in the blood, swelling (usually of the face, hands, or feet), and high levels of cholesterol in the blood. Blood tests, urinalysis, and other specialized tests can determine the type and the location of damage.
Glomerular diseases also can result from infection in other parts of the body, such as “strep” throat, endocarditis (inflammation of the lining of the heart), and human immunodeficiency virus (HIV) infection. Treatment varies according to the underlying cause and the tissues affected.
Kidney Failure
During acute renal failure, the kidneys may suddenly lose their ability to remove wastes, concentrate urine, and conserve water and essential nutrients. Urine production decreases or stops completely. Often there is blood in the urine. Protein waste products quickly accumulate in the blood, damaging tissues and reducing organ function throughout the body. This condition, known as uremia, can be fatal if kidney function is not restored promptly and if the blood is not filtered and cleansed. Symptoms of this toxic reaction include drowsiness, confusion, loss of appetite, nausea and vomiting, and seizures. The onset of symptoms is rapid, often occurring within days, but the condition can be reversed if diagnosed and treated quickly.
Disorders of the kidney itself also can lead to acute renal failure. These disorders include direct injury to the kidney, a urinary tract infection such as acute pyelonephritis, kidney stones, renal cell cancer, and any obstruction of the urinary tract. Acute renal failure also can be caused by reduced blood flow, which can occur after an injury, during complicated surgery, when there is uncontrolled bleeding elsewhere in the body, following severe burns, or as a result of another serious illness. Exposure to poisons, solvents, certain medications, or a blood transfusion can cause injury to the kidney tubules and, in turn, acute renal failure. Severe infections, autoimmune diseases, and uncontrolled high blood pressure are other possible causes of renal failure.
Both kidney failure and its underlying cause must be treated promptly. Dialysis may be required to cleanse the blood mechanically and prevent complications such as congestive heart failure. If you experience acute kidney failure, you will be placed on a diet that is low in protein, potassium, and sodium, and your fluid intake will be closely matched to your fluid output. You may recover adequate kidney function within 2 months, although your kidneys will not return to full normal function for much longer, perhaps a year.
In chronic renal failure, the kidneys lose the same amount of function as in acute renal failure, but the loss occurs slowly over many years. The loss of kidney function is continuous and progressive and may eventually lead to end-stage renal disease. In the early stages of chronic renal failure, there are no symptoms because of the excess capacity of the kidneys to do their job. When symptoms finally appear, the damage already done is irreversible, so treatment focuses on preventing additional damage to the kidneys and slowing the progression of the disease.
Diabetes and high blood pressure are major causes of chronic renal failure. Polycystic kidney disease, sickle-cell disease, glomerular diseases, obstructive disorders, kidney stones, the urinary tract infection pyelonephritis, and analgesic nephropathy all can lead to chronic renal failure.
In addition to treating the underlying cause of chronic renal failure, the doctor will take steps to prevent or treat complications that may result from limited kidney function. You may be given erythropoietin (epoetin alfa), a hormone that stimulates bone marrow to produce more red blood cells. You will be placed on a diet that is low in protein, phosphorus, potassium, sodium, and fluids to reduce the strain on your kidneys. If you continue to lose kidney function and progress to end-stage renal disease, you and your doctor will discuss your treatment options so you can make an informed decision.
End-Stage Renal Disease
People in end-stage renal disease (ESRD) have limited options. Because their kidneys have stopped working, they must have their blood cleansed by some means or they will die. They can undergo either hemodialysis or peritoneal dialysis, or they can have a kidney transplant. Many people who have the choice will opt for transplantation because it offers a better quality of life over the long term.
Kidney transplantation succeeds in most cases. Unless they are causing high blood pressure or are frequently infected, your own kidneys usually are left in place and the new kidney is placed between them and your bladder. The surgeon connects the artery and vein of the transplanted kidney to one of your arteries and one of your veins and connects the new kidney’s ureter to your bladder. The transplanted kidney may start working right away, or it may take up to a few weeks to produce urine.
The donated kidney must match your blood type and be very similar to your kidneys’ tissue type. Often a blood relative (a parent, sibling, or child) can supply a kidney for transplantation. Sometimes a spouse or a friend can provide a close match. Otherwise you will need to wait for a donation from someone who has recently died but who has healthy kidneys that match yours.
The surgery will take 3 to 6 hours, and you will stay in the hospital for up to 2 weeks afterward. Your doctor will give you immunosuppressant drugs to reduce the chance of your body rejecting the new kidney. You will take these drugs for the rest of your life. If your body does not accept the new kidney, you will need to continue using dialysis until another donor kidney can be found.
Kidney Cancer
Kidney cancer is the eighth most common type of cancer among men. Twice as many men as women develop kidney cancer. The cause of this type of cancer remains unknown. Possible risk factors include smoking (which doubles the risk of kidney cancer), exposure to asbestos or cadmium, a family history of kidney cancer, eating a high-fat diet, being overweight, and undergoing long-term dialysis.
Different types of cancer can occur in the kidneys. The most common form of kidney cancer in adults is called renal cell cancer. As renal cell cancer grows, it may invade nearby organs, such as the liver, colon, or pancreas, or it may spread via the blood or the lymphatic system to other parts of the body, such as the lungs or the bones. A less common type of cancer, transitional cell cancer, can occur in the kidneys, but occurs more often in the bladder.
Initially renal cell cancer does not cause symptoms. As the tumor grows, however, symptoms may develop, including blood in the urine, a lump near the affected kidney, fatigue, loss of appetite, weight loss, recurrent fevers, pain in the side, and a vague feeling of being ill. If you have any of these symptoms— which could point to many of the urinary tract disorders your doctor will perform tests to identify the cause of the problem. The earlier cancer is diagnosed and treated, the better the chances for recovery.
Once cancer is detected, your doctor will want to determine whether it has spread. This will influence your treatment options. Often, all or part of the cancerous kidney is removed surgically, along with the adrenal gland and any nearby lymph nodes. If the tumor cannot be removed, the doctor may try to block blood flow to the tumor by clogging the renal artery that supplies blood to the diseased kidney; this will starve the tumor of the blood it needs. In either case, the remaining healthy kidney will do the work of both kidneys.
Radiation therapy, while not a cure, may be used to shrink large tumors or to treat metastases (cancer that has spread to other parts of the body) in the bones. Immunotherapy (treatment in which the body’s immune system is stimulated to destroy cancer cells), chemotherapy (treatment with powerful anticancer drugs), and hormone therapy (treatment involving hormones that affect the growth of cancer cells) all attack the cancer at the systemic level. This means that the entire body is treated at the same time. Treating cancer at the systemic level may cause more unpleasant side effects (including nausea, vomiting, and hair loss) than other forms of treatment.
Categories : Urinary Tract
Urinary Tract Infections: Urethritis, Cystitis, and Pyelonephritis
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The structure of the urinary tract reduces the likelihood of infection by preventing urine from flowing backward toward the kidneys and by washing bacteria out of the body with the normal flow of urine. In men, the prostate gland also produces secretions that slow bacterial growth. Urine is normally sterile.
However, urinary tract infections are common, especially among women. An obstruction of the urinary tract (such as a kidney stone or an enlarged prostate gland) also increases the risk of infection. People with diabetes, immune disorders, or conditions that require regular use of a urinary catheter (a tube inserted through the urethra into the bladder to drain urine from the body) also are at greater risk.
An infection can begin when microorganisms, usually bacteria from the digestive tract (such as Escherichia coli, also called E coli), accumulate at the opening of the urethra. An infection that affects only the urethra is called urethritis. From the urethra, bacteria often move up to the bladder, causing a bladder infection (cystitis). Sexually transmitted microorganisms, such as those that cause gonorrhea and chlamydia, also can infect the urinary tract.
If a bladder infection is not treated promptly, bacteria may move up the ureters, causing a kidney infection (pyelonephritis), which can be serious. Kidney infections also can occur when bacteria or other microorganisms are carried to the kidneys through the bloodstream. When this happens, an obstruction in a ureter can trap infectious agents in the kidneys.
Urinary tract infections do not always cause symptoms. However, most men with a urinary tract infection will experience at least one or two of the following symptoms, especially upon waking in the morning:
• frequent urination
• painful urination
• reduced volume during urination
• fatigue
• fever
• a feeling of fullness in the rectum
• milky or cloudy urine
• reddish or brownish urine
• discharge from the penis
• itching around the urethral opening
A high fever may indicate that the infection has spread to the kidneys. Other symptoms of a kidney infection include pain in the back or side below the ribs, nausea, and vomiting.
A urinary tract infection is diagnosed through a urinalysis and a urine culture. First you provide a “clean catch” urine sample by washing the urethral opening with a disinfecting wipe and collecting a midstream sample (urinate for several seconds before collecting the sample of urine) in a sterile container. The sample is examined under a microscope for blood cells and bacteria. The bacteria will then be grown as a culture to confirm that an infection is present and to identify the bacteria and determine the best antibiotic to kill them. Some bacteria, especially those that are sexually transmitted, can be detected only by using special bacterial cultures.
For pyelonephritis, antibiotic treatment may last up to 6 weeks. If the infection does not improve within 3 days of starting treatment, you will need to undergo additional tests to determine whether an obstruction is present or whether an abscess (a cavity filled with pus) has developed. If kidney infections recur frequently, you may develop chronic pyelonephritis, a condition in which a kidney that has been infected several times or damaged by other disease becomes scarred, shrunken, and misshapen.
If the prescribed antibiotics do not eliminate the infection, your doctor probably will perform additional tests, such as intravenous urography or a computed tomography (CT) scan (see “Diagnostic Procedures,” Post) to check for another disorder or an anatomical abnormality.
If you are diagnosed with urethritis caused by a sexually transmitted microorganism, you will need to take measures to protect your sexual partner from infection. Your sexual partner also should be tested and, if necessary, treated for urethritis or any other urinary tract infection that is present. Otherwise you will risk passing the same infection back and forth between you or causing a worse and longer-lasting infection in your partner. You will need to continue using preventive measures such as latex condoms until the infection has been eliminated, not just until the symptoms disappear. Your doctor will tell you when the infection has completely cleared up.
Categories : Urinary Tract
Warning Signs of Urinary Tract Disease
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Many symptoms of urinary tract disease are vague—fever, weight loss, a vague feeling of being ill, fatigue, and vomiting—but others clearly indicate problems with the urinary tract. If you experience any of these symptoms, talk to your doctor:
• Frequent urination. If you are not drinking more fluids than usual but are urinating more, this could indicate that your kidneys or bladder are not working efficiently.
• Painful urination. A burning sensation while urinating suggests inflammation, infection, or obstruction of the urinary tract.
• Hesitancy or straining during urination. Any change in the force and diameter of the stream of urine, especially in men, suggests an obstruction of the urethra.
• Unusual appearance of urine. Urine is normally clear and ranges from colorless to deep yellow. Urine that appears red, brown, milky, or cloudy may indicate a urinary tract disorder.
• Pain. Pain in the side or the back between the rib cage and the hip can be a sign of inflammation, infection, or obstruction of the kidney.
• Fluid retention. When the kidneys are not functioning efficiently they do not maintain a good balance of water and sodium in the body, which can lead to fluid retention. This usually appears as facial puffiness but can progress until fluid collects in the lungs, the abdominal cavity, and elsewhere in the body.
Categories : Urinary Tract
