kidney infection

Urinary Tract Infections: An Introduction


A urinary tract infection (UTI) is an infection in any part of your system responsible for making and passing urine — your kidneys, ureters, bladder and urethra. In men the prostate may be involved in urinary tract infections. Most infections involve the lower urinary tract — the bladder and the urethra.

Urinary-tract-anatomy

Women are at greater risk of developing a UTI than are men. Infection limited to your bladder can be painful and annoying. However, serious consequences can occur if a UTI spreads to your kidneys.

Symptoms

Urinary tract infections don’t always cause signs and symptoms, but when they do they may include:

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • Passing frequent, small amounts of urine
  • Urine that appears cloudy
  • Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
  • Strong-smelling urine
  • Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone
  • Pelvic pain, in men when the prostate is involved.

UTIs may be overlooked or mistaken for other conditions in older adults. Sometimes especially in the elderly the beginning of a UTI can present as confusion and decreased appetite.

Types of urinary tract infection

Each type of UTI may result in more-specific signs and symptoms, depending on which part of your urinary tract is infected.

Part of urinary tract affected Signs and symptoms
Kidneys (also called pyelonephritis) ·       Upper back and side (flank) pain

·       High fever

·       Shaking and chills

·       Nausea

·       Vomiting

Bladder (cystitis) ·       Pelvic pressure

·       Lower abdomen discomfort

·       Frequent, painful urination

·       Blood in urine

Urethra (urethritis) ·       Burning with urination

·       Discharge

When to see a doctor

Contact your doctor if you have signs and symptoms of a UTI. It may be really serious  with complications or it might be a sign of something else that needs medical attention

Causes

Urinary tract infections can be caused by bacteria, parasites, viruses or fungi. The most common infections are causes by bacteria which are typically treated with antibiotics. If you have a UTI causes by other organisms such as viruses, parasites or fungi, other special medication or anti-microbials will be necessary to treat the infection and may take a longer time to cure. You can take steps to reduce your chances of getting a UTI in the first place.

UTI’s typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract. On the other hand infections of the urinary tract may occur from a blood infection that settles directly in the kidneys. In men, an infection of the prostate can start when bacteria in urine leak into your prostate. Antibiotics are used to treat the infection. If they don’t eliminate the bacteria, prostatitis (prostate infection) might recur or be difficult to treat

The most common UTIs occur mainly in women and affect the bladder and urethra.

  • Infection of the bladder (cystitis).This type of UTI is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible.

Sexual intercourse may lead to cystitis, but you don’t have to be sexually active to develop it. All women are at risk of cystitis because of their anatomy — specifically, the short distance from the urethra to the anus and the urethral opening to the bladder.

  • Infection of the urethra (urethritis).This type of UTI can occur when intestinal bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.

Risk factors

Urinary tract infections are common in women, and many women experience more than one infection during their lifetimes. Risk factors specific to women for UTIs include:

  • Female anatomy.A woman has a shorter urethra than a man does, which shortens the distance that bacteria must travel to reach the bladder.
  • Sexual activity.Sexually active women tend to have more UTIs than do women who aren’t sexually active. Having a new sexual partner also increases your risk.
  • Certain types of birth control.Women who use diaphragms for birth control may be at higher risk, as well as women who use spermicidal agents.
  • After menopause, a decline in circulating estrogen causes changes in the urinary tract that make you more vulnerable to infection.

Other risk factors for UTIs include:

  • Urinary tract abnormalities.Babies born with urinary tract abnormalities that don’t allow urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTIs.
  • Blockages in the urinary tract.Kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of UTIs.
  • A suppressed immune system.Diabetes and other diseases that impair the immune system — the body’s defense against germs — can increase the risk of UTIs.
  • Catheter use.People who can’t urinate on their own and use a tube (catheter) to urinate have an increased risk of UTIs. This may include people who are hospitalized, people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed.
  • A recent urinary tract procedure.Urinary surgery or an examination of your urinary tract that involves medical instruments can both increase your risk of developing a urinary tract infection.

Complications

When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left untreated, a urinary tract infection can have serious consequences.

Complications of a UTI may include:

  • Recurrent infections, especially in women who experience two or more UTIs in a six-month period or four or more within a year.
  • Permanent kidney damage leading to kidney disease or even kidney failure from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.
  • Increased risk in pregnant women of delivering low birth weight or premature infants.
  • Urethral narrowing (stricture) in men from recurrent urethritis, previously seen with gonococcal urethritis.
  • Sepsis, a potentially life-threatening complication of an infection, especially if the infection works its way up your urinary tract to your kidneys.

Prevention

You can take these steps to reduce your risk of urinary tract infections:

  • Drink plenty of liquids, especially water.Drinking water helps dilute your urine and ensures that you’ll urinate more frequently — allowing bacteria to be flushed from your urinary tract before an infection can begin.
  • Drink cranberry juice.Although studies are not conclusive that cranberry juice prevents UTIs, it is likely not harmful.
  • Wipe from front to back.Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
  • Empty your bladder soon after intercourse.Also, drink a full glass of water to help flush bacteria.
  • Avoid potentially irritating feminine products.Using deodorant sprays or other feminine products, such as douches and powders, in the genital area can irritate the urethra.
  • Change your birth control method.Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth.

Diagnosis

Tests and procedures used to diagnose urinary tract infections include:

  • Analyzing a urine sample.Your doctor may ask for a urine sample for lab analysis to look for white blood cells, red blood cells or bacteria. To avoid potential contamination of the sample, you may be instructed to first wipe your genital area with an antiseptic pad and to collect the urine midstream.
  • Growing urinary tract bacteria in a lab.Lab analysis of the urine is sometimes followed by a urine culture. This test tells your doctor what bacteria are causing your infection and which medications will be most effective.
  • Creating images of your urinary tract.If you are having frequent infections that your doctor thinks may be caused by an abnormality in your urinary tract, you may have an ultrasound, a computerized tomography (CT) scan or magnetic resonance imaging (MRI). Your doctor may also use a contrast dye to highlight structures in your urinary tract.
  • Using a scope to see inside your bladder and urinary tract.If you have recurrent UTIs, your doctor may perform a cystoscopy, using a long, thin tube with a lens (cystoscope) to see inside your urethra and bladder. The cystoscope is inserted in your urethra and passed through to your bladder.

Treatment

Antibiotics usually are the first line treatment for urinary tract infections. Which drugs are prescribed and for how long depend on your health condition and the type of bacteria found in your urine.

Simple infection

Drugs commonly recommended for simple UTIs include:

  • Trimethoprim/sulfamethoxazole (Bactrim, Septra)
  • Fosfomycin (Monurol)
  • Nitrofurantoin (Macrodantin, Macrobid)
  • Cephalexin (Keflex)
  • Ceftriaxone

GET IN TOUCH WITH YOUR DOCTOR BEFORE STARTING ANY ANTIBIOTICS. YOU MAY NEED TESTS DONE BEFORE STARTING TREATMENT. THE DOCTOR WILL HELP YOU SELECT THE SAFE AND APPROPRIATE OPTION FOR YOUR SITUATION.

The group of antibiotic medicines known as fluoroquinolones — such as ciprofloxacin (Cipro), levofloxacin (Levaquin) and others — isn’t commonly recommended for simple UTIs, as the risks of these medicines generally outweigh the benefits for treating uncomplicated UTIs. In some cases, such as a complicated UTI or kidney infection, your doctor might prescribe a fluoroquinolone medicine if no other treatment options exist.

Often, symptoms clear up within a few days of treatment. But you may need to continue antibiotics for a week or more. Take the entire course of antibiotics as prescribed.

For an uncomplicated UTI that occurs when you’re otherwise healthy, your doctor may recommend a shorter course of treatment, such as taking an antibiotic for one to three days. But whether this short course of treatment is enough to treat your infection depends on your particular symptoms and medical history.

Your doctor may also prescribe a pain medication (analgesic) that numbs your bladder and urethra to relieve burning while urinating, but pain usually is relieved soon after starting an antibiotic.

Frequent infections

If you have frequent UTIs, your doctor may make certain treatment recommendations, such as:

  • Low-dose antibiotics, initially for six months but sometimes longer
  • Self-diagnosis and treatment, if you stay in touch with your doctor
  • A single dose of antibiotic after sexual intercourse if your infections are related to sexual activity
  • Vaginal estrogen therapy if you’re postmenopausal

 

Severe infection

For a severe UTI, you may need special tests to determine the cause of the infection and treatment with intravenous antibiotics in a hospital.

 

Viral infections in kidney disease and dialysis patients in Nigeria- Truths, myths and what to do


Kidney failure interferes with the ability of the body to fight infections therefore making it easier to acquire infections. In addition, kidney patients may need to undergo important and life saving treatments such as dialysis catheter placement, blood transfusion or dialysis treatment and during such treatments, patients are at risk of acquiring a number of infections.

An important challenge in the care of patients with kidney disease and especially those on dialysis is the prevention and management of infections. The more common infections important to dialysis patients for instance involve infections of the dialysis access such as the dialysis catheter, graft or fistula. However, viral infections involving the HIV, Hepatitis B and Hepatitis C viruses are also quite important as they can cause serious medical problems.

© Copyright 2011 CorbisCorporation

If you are a dialysis patient, make sure you ask your doctor questions about how they reduce the risk of infection that can be acquired during dialysis. Even if you are not a dialysis patient, you need to ask questions about the safety of blood you might be receiving. It is always better to get blood from a known family member.

The first steps to understanding the risk of viral infection in Nigeria and protecting oneself is to know the risk of blood transfusion related and dialysis procedure related infections in Nigeria.

In a study from a major teaching hospital in mid western Nigeria, the risk of blood transfusion related syphilis infection was estimated at about 384 cases per year1. In another study from western Nigeria, the estimated prevalence of Hepatitis B, HIV, Hepatitis C and syphilis was found to be 18.6%, 3.1%, 6% and 1.1% respectively2 meaning that if 5000 transfusions were provided from such a blood pool in a year, approximately 900 cases of blood transfusion related Hepatitis B, 150 cases of HIV, 300 cases of Hepatitis C and 50 cases of syphilis could have been potentially created. In northern, south western and eastern Nigeria, the situation is just as concerning where the prevalence of donors with such infections is just as high3-9. Depending on the age of the donor, the risk of these infections could be even higher as the prevalence of infected donors that look healthy could be as high as 60%9.

It is however important to understand the main reasons for the high prevalence of such infections among persons donating blood.

– Window period for testing: The platform for all currently available blood donor screening testing in Nigeria and most other countries is not based on detection of the actual virus but based on the detection of antibody against the virus in the blood of the possible donor. Antibody is a substance produced by the body to fight infection and sometimes might be able to cure the infection and sometimes it cant. Depending on the infection in question, there is an incubation period during which the person could infect others with live virus without yet producing antibody in their blood to the organism they are infected with. This period during which they are infectious, without symptoms of disease and without antibody in their blood that can be picked up by these antibody based tests is called the “window period”. For HIV, the window period is 3-6 months, for hepatitis B and C it is about 1-3 months

Paid blood donors vs family blood donors: It is estimated that well over 90% of all blood donors in Nigeria are paid or commercial blood donors that receive compensation for their donation as opposed to non-commercial voluntary blood donors such as family members who are not paid. Paid donors are less likely to be truthful about their medical history and risk and still donate blood while knowing they may be infected. However, the medical status of family members is usually know and family or volunteer donors who are unpaid are much less likely to donate when they know they may have a transmissible infection.

Blood-donation--bag--supply---21363159

Haiti Earthquake 2010

Donating blood can save life. However, there is a risk of serious infection if you receive blood from an infected donor. Always try to get blood from a known family member without medical problems, Or ask your doctor where you can get safe blood for transfusion. You can also ask your doctor for alternatives to blood transfusion such as EPO injections. The Nigerian national blood transfusion service helps many hospitals provide safe blood

 

Inadequate blood testing: because of the high demand for blood, many private establishments may not have the appropriately trained staff to screen blood properly. There may also be expired or fake viral testing kits as well as the temptation by hospitals to accept infected blood and proceed to sell the blood as uninfected blood.

The seriousness of the infections in Nigeria is reflected in the high number of people newly infected with these viruses or already living with these infections [See below]

Kaiser Found- HIV prevalence rate

Over 1 million people in Nigeria are living with HIV infection or AIDS. Source: Kaiser Family Foundation

Medscape- Hep B prevalence

Almost 1 out of every 10 Nigerian adults has Hepatitis B infection. Soucre- US Centers for Disease Control-

 

 

Hemodialysis patients are at high risk for infection because the process of hemodialysis requires access to the blood for prolonged periods. In an environment where many patients receive dialysis at the same time, repeated opportunities exist for person-to-person transmission of infectious agents, directly or indirectly via contaminated devices, equipment and supplies, environmental surfaces, shared medications or hands of personnel.

Hep c prevalence

The number of people living with hepatitis C in Nigeria as well as other parts of Africa is not well documented (grey areas) except in Egypt which questionably has among the highest hepatitis C infection rates in the world. Source US Centers for Disease Control. However, based on sparse local data, it is estimated that somewhere between 1-3 in every 100 persons is infected with hepatitis C and the number is increasing.

 

To learn more about the nature of blood donation and transfusion services in Nigeria, click here.

The risk of dialysis related viral infection transmission has not been studied systematically in Nigeria. The only information available on the risk of transmission of such infections by dialysis treatment itself comes from studies performed in other countries. For instance in 1993 before the application of stringent prevention strategies, in Egypt and Columbia, there was an outbreak of HIV due to currently unacceptable dialysis practices10-11. With these observations, a number of safeguards were recommended by a number of professional bodies to reduce the transmission of such infections. In the US where there is very strict monitoring of such infections and application of processes to reduce the risk of infection transmission, the risk of dialysis treatment related infection is as low as 1%.

Listening to Patient's Heartbeat with Stethoscope

Ask your doctor or nurse how infections are controlled in the medical center where you get your care. They should be prepared to tell you and you should be prepared to follow their advice as well.

To learn more about Hepatitis B virus infection, click here.

To learn more about Hepatitis C infection, click here.

To learn more about HIV infection, click here.

Solutions to the problem of viral infections in kidney disease and dialysis patients.

  1. Avoid unnecessary blood transfusion. Ask your doctor how you might be able to avoid transfusion if possible. There are medicines that have been available for up to 30 years that can help avoid blood transfusion. To learn more about treatment of  low blood levels such as anemia in patients with kidney disease, click here.
  2. If you must get a blood transfusion, please ensure the supply is safe.  Get a healthy family member to donate for you.
  3. Medical centers need to sterilize dialysis machines and other durable equipment in between treatments.
  4. There should be single patient use of consumables and medications given during dialysis – all consumables should be used on one patient only. Do not allow a nurse or doctor use any needles, guide wires or equipment that touches blood on you if they have been used on someone else already.
  5. Observation of universal precautions in interactions between staff and patients. Handwashing and changing gloves is important.
  6. Repeat screening and testing for these viruses every couple of months. It might seem like a waste of money but especially if you are a dialysis patient. If you do become infected at some point, finding out early will be of benefit to direct proper and timely treatment.
  7. Vaccination of dialysis patients and staff against hepatitis B. Ask you kidney or dialysis doctor to give you a hepatitis B vaccine if you have never received one. Unfortunately, there is no vaccine for HIV or Hepatitis C yet.
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If you are a kidney disease or dialysis patient, ask you doctor about getting the hepatitis vaccine. It will protect you from Hepatitis B infection and might even save your life.

 

References for further reading

  1. AO Adegoke, O Akanni, J Dirisu. Risk of transfusion-transmitted syphilis in a tertiary hospital in Nigeria. N Am J Sci. Feb 2011; 3(2):78-81
  2. FI Buseri, MA Muhibi, ZA Jeremiah. Sero-epidemiology of transfusion-transmissible infectious diseases among blood donors in Osogbo, south-west Nigeria. Blood Transfus. Oct 2009; 7(4):293-299
  3. E Nwankwo, I Momodu, I Umar, B Musa, S Adeleke. Seroprevalence of major blood-borne infections among blood donors in Kano, Nigeria. Turk J Med Sci. 2012;42(2):337-341
  4. Uneke CJ, Ogbu O, Inyama PU, Anyanwu GI, Njoku MO, Idoko JH. Prevalence of hepatitis-B surface antigen among blood donors and human immunodefi ciency virus-infected patients in Jos, Nigeria. Mem Inst Oswaldo Cruz 2005; 100: 13-6.
  5. Egah DZ, Mandong BM, Iya D, Gomwalk NE, Audu ES, Banwat EB et al. Hepatitis C virus antibodies among blood donors in Jos, Nigeria. Annals of African Medicine 2004; 3: 35-7.
  6. Muktar HM, Suleiman AM, Jones M. Safety of blood transfusion: prevalence of Hepatitis B surface antigen in blood donors in Zaria, Northern Nigeria. Nigerian Journal of Surgical Research 2005; 7: 290-2.
  7. Ayolabi CL, Taiwo MA, Omilabu SA, Abebisi AO, Fatoba OM. Sero-prevalence of hepatitis C virus among donors in Lagos, Nigeria. African Journal of Biotechnology 2006; 5: 1944-6
  8. Chikwem JO, Mohammed I, Okwara GC, Ukwandu NC, Ola TO. Prevalence of transmissible blood infections among blood donors at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. East African Medical Journal 1997; 74: 213-6.
  9. Ejele O, Erhabor O, Nwauche C. Trends in the prevalence of some transfusion-transmissible infections among blood donors in Port Harcourt, Nigeria. Haema 2005; 8: 273-7.
  10. El Sayed NM, Gomatos PJ, Beck-Sagué CM, Dietrich U, von Briesen H, Osmanov S, Esparza J, Arthur RR, Wahdan MH, Jarvis WR. Epidemic transmission of human immunodeficiency virus in renal dialysis centers in Egypt. J Infect Dis. 2000 Jan;181(1):91-7.
  11. Velandia M, Fridkin SK, Cárdenas V, Boshell J, Ramirez G, Bland L, Iglesias A, Jarvis W. Transmission of HIV in dialysis centre. Lancet. 1995 Jun 3;345(8962):1417-22.