Its a condition resulting from glomerular injury and inflammation as a result of an immune response (usually to a streptococcal Infection).

Causes of Acute Glomerulonephritis

• Follows an immunologic injury (such as deposition of antigen anti-body complexes from the bloodstream in the glomeruli)
• Presene of conditions such as Hematuria, Edema (Dropsy), Hypertension, Proteinuria.
• Characterized by diffuse inflammatory changes in the glomeruli and clinically by the abrupt onset of Hematuria with RBC casts and mild Proteinuria 1–2 weeks after a streptococcal Infection
• Range of latent period (from onset of Infection to onset of nephritis) is 7–21 days

Risk Factors

• More common in children (peak ages 2–6 years)
• Most common in children is recent Group A beta hemolytic streptococcal Infection (such as Pharyngitis or Impetigo – only a few Strains cause this kidney problem [type 12 and type 49])

Prevention

• Early and aggressive treatment of streptococcal Infections.

Its a condition resulting from compromised renal function shown by a decrease in glomerular filtration rate (GFR) and characterized by elevated BUN and creatinine, and greatly diminished capacity for dealing with Water solute Fluctuations.
Chronic renal insufficiency occurs when serum creatinine is between 1.5–3.0 mg/dL, while chronic renal failure occurs when serum creatinine is greater than 3.0 mg/dL.

Causes of Renal Insufficiency and Failure

• Diabetes, Hypertension, glomerulonephritis, polycystic renal disease, obstructive uropathy, amyloidosis.
• Congenital anomalies, Infection, Collagen vascular disease, nephrotoxins, ischemia, acute renal failure.
• Deterioration may continue after initial insult resolves

Symptoms of Renal Insufficiency and Failure

• First sign is often simply an abnormal urinalysis (Proteinuria, Hematuria, pyuria, casts).
• Patient may be asymptomatic, but may have extra-renal symptoms of Edema (Dropsy), Hypertension, or signs of uremia

Risk Factors

• Poorly controlled chronic conditions mentioned above, especially Hypertension, Diabetes
• Chronic NSAID use, especially in patients with Hypertension
• Aging

Prevention

• Early treatment of above-mentioned conditions.
• ACE inhibitors decrease progression to renal failure in both diabetic and non-diabetic patients.
• Protein restriction may reduce progression of chronic renal disease.
• Blood pressure control in crucial.

Significant bacterial counts in urine of a patient who has no other symptoms.
Its more common with female gender, aging, perimenopausal status, Pregnancy, structural abnormalities in tract, prostatic hypertrophy, asymptomatic calculi, indwelling urinary catheter.

Causes of Asymptomatic Bacteriuria

• Most commonly caused by Gram-negative bacteria such as E. coli

Risk Factors

• Indwelling catheters
• Pregnancy
• Diabetes Mellitus
• Spinal cord injury

Prevention

• Screen, culture, and treat asymptomatic bacteriuria in pregnant women, before TURP and other urologic procedures with mucosal bleeding, and to improve urinary incontinence in the Elderly
• Increase fluids to Flush Urinary Tract System
• Empty bladder fully and frequently to avoid stasis

The presence of red blood cells (RBCs) in the urine in microscopic (>3 RBCs/high-power field) or gross (visible to naked Eye) form.

Causes of Hematuria

• Infection: Proximal (renal) or distal (urethral) in location.
• Renal calculi, tumors, Trauma, polycystic renal disease, neoplasms in persons over 50, hydroNephrosis, renal vascular diseases.
• Most commonly seen in inflammation or Infection of Prostate or bladder, stones, and in older patients with malignancy or benign prostatic hypertrophy (BPH).
• Medications (anticoagulants-heparin, warfarin, aspirin).
• Benign prostatic hypertrophy, Prostatitis, epididymitis
• Coagulopathies, sickle cell disease
• Strenuous exercise
• Vascular glomerular abnormalities, familial nephritis (Alport syndrome)
• Granulomatous diseases (Tuberculosis)
• Connective tissue diseases (Lupus)
• Trauma

Risk Factors

• UTIs
• Renal calculi
• Environmental exposure to elements that can cause bladder Cancer

UTI is Infection of one or more of the Urinary Tract System structures but most commonly is used to refer to Cystitis (inflammation or Infection of the bladder). If acute, usually one organism is identified; if chronic, two or more organisms may be found.

Causes of Urinary Tract System Infection

• Most commonly caused by E. coli (80%–90%), other Gram-negative bacteria from gastro-intestinal tract (E. coli, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter sp.).
• A Gram-positive organism (Staphylococcus saprophyticus) is common in sexually active young women but an uncommon cause of Infection in men. If found in men it is truly a urinary pathogen.
• Symptomatic women with pyuria but without significant bacteriuria (sterile pyuria) may have Infection with Chlamydia trachomatis.
• Viruses may be associated with hemorrhagic Cystitis.
• Most UTIs (>95%) are caused by ascending Infections from urethra.

Risk Factors

• Female; sexual activity; history of prior UTI; Diabetes Mellitus or other immuno-compromised state; Pregnancy; use of spermicides, diaphragm, or oral Contraceptives
• Structural Urinary Tract System abnormalities (strictures, stones, tumors, neuropathic bladder)
• Procedures such as catheterization or recent surgery
• Aging issues: Relaxation of pelvic supporting structures, BPH or Prostatitis, incontinence of urine/stool, cognitively impaired
• Dysfunctional voiding pattern or infrequent voiding
• Chronic Constipation in children

Prevention

• In women who experience three or more UTIs, voiding immediately after intercourse and avoiding use of a diaphragm may be helpful
• Drinking Cranberry juice or taking Cranberry pills to reduce pyuria and bacteriuria
• Education of parents and children regarding hygiene, tips on toilet training; education of adolescents regarding sexual intercourse
• Low-dose oral antimicrobial prophylaxis can be considered for recurrent Infections
• Post-coital treatment with a single-dose antibiotic is an option
• In post-menopausal women, systemic or topical estrogen therapy markedly reduces the incidence of recurrent UTI

Acute bacterial Infection of soft tissue of the renal parenchyma and pelvis, or other portion of upper Urinary Tract System, typically producing signs and symptoms of systemic toxicity.

Causes of Acute Pyelonephritis

• E. coli organism (75%)
• Other Gram-negatives (10%–15%, P. mirabilis, K. pneumoniae, Enterobacter)
• S. aureus or saprophyticus (10%–15%)
• Most common route of Infection is ascension from bladder

Risk Factors

• Urinary Tract System abnormalities or instrumentation, stones, catheters, Diabetes or other immuno-compromised states, recent pyelonephritis, BPH, Pregnancy, fecal incontinence.
• Recent lower UTI

Prevention

• Hygiene, hydration, voiding after coitus
• Prophylactic antibiotics if infected recurrently or frequently
• Screening pregnant women for asymptomatic bacteriuria

Its a general term used to describe the involuntary loss of urine based upon Infections or other diseases (5%) or fecal incontinence (10–25%)

Causes of Urinary Incontinence (UI)

• Urge incontinence – Involuntary loss of large amount urine preceded by strong, unexpected urge may be due to aging, Parkinson’s, Stroke
• Stress incontinence – Involuntary loss of small amounts of urine associated with activities that increase intra-abdominal pressure (including Coughing, sneezing, lifting, and certain exercises), may be due to aging, pelvic floor muscle weakness (e.g., cystocele, rectocele), perineal Trauma, Prostatitis/pelvic surgery, and estrogen deficiency in women
• Overflow incontinence from chronic urine retention resulting from the chronically distended bladder receiving an additional increment of urine to exceed intravesical pressure and release small amount of urine, may be due to prostatic enlargement, anti-Cholinergics, tricyclic anti-depressants, diabetic neuropathy, outflow obstruction, Multiple Sclerosis
• Functional incontinence – Physical or cognitive disability, sedating medications that make it difficult to use the bathroom.
• Total incontinence – Loss of urine at all times in all positions, due to sphincteric inefficiency from surgery, nerve damage, tumor infiltration, or Fistula formation.
• Transient incontinence may be due to delirium, Infection, atrophic vaginitis, urethritis, or drugs (Sedatives, Hypnotics, Diuretics, opioids, Calcium channel blockers, anti-Cholinergics, anti-depressants, anti-histamines, decongestants, and other less common causes including Diabetes Mellitus or insipidus, restricted mobility, stool impaction, Depression.

Risk Factors

• Elderly, estrogen deficiency, prostatic hypertrophy, multiparity, Dementia, Diabetes, Parkinson’s, myelodysplasia, Multiple Sclerosis (MS), Spinal cord injury or lesion, Stroke, immobility, Pregnancy, use of Diuretics

Prevention
• Kegel exercises, regular pelvic examination to detect pathology early
• Avoid Constipation
• Regular rectal exam for detection of BPH and initiation of therapy before symptom presents

Persistent involuntary loss of urine in girls (older than 5) and boys (older than 6 years) most commonly occuring during sleep.
• Primary Enuresis occurs in a child who has never achieved night-time continence.
• Secondary Enuresis occurs as a return of involuntary urination after night-time continence has been achieved.

Causes of Enuresis

• Usually multifactorial appears to run in families. Has been linked to specific genetic markers (e.g., chromosome 8, 12, 13, 22, and ENUR 1 gene on chromosome 13). 77% risk if both parents had Enuresis, 44% for one parent, and 15% if neither.
• Children with night-time incontinence also have daytime problems (20%).
• Primary Enuresis may be due to food Allergies, disorders of the urinary or Nervous Systems, psychological factors, reduced bladder capacity, lack of normal increase in nocturnal antiDiuretic Hormone (ADH) secretion.
• Primary nocturnal Enuresis (PNE) is primarily an arousal disorder with failure of the CNS to recognize bladder fullness or contraction and/or failure to inhibit bladder contraction or sphincter relaxation, detrussor instability.
• Secondary Enuresis may be due to bacteriuria, UTI, inability to concentrate urine secondary to insufficient ADH or a renal tubular defect, a pelvic mass or Spinal cord malformation, meatal stenosis, ectopic ureter, glycosuria as in Diabetes Mellitus or Diabetes insipidus, possible sleep disorder.

Risk Factors

• Males > females; First born
• Family history in at least one parent

Urolithiasis are stones that occur within the Urinary Tract System, while nephrolithiasis are stones that occur within the kidney
Stones are initially formed in the proximal Urinary Tract System and then pass distally, usually arrested in the ureter and cause pain, Infection, and obstruction
Stones are mostly composed of Calcium (80%), uric acid (5%), cystine (2%), or struvite.

Causes of Urolithiasis/Nephrolithiasis

• Supersaturation of urine with stone-forming salts
• In many instances, may be a manifestation of systemic disease (e.g., Bone diseases, immobilization, Hyperthyroidism, primary hyperparaThyroidism, hypervitaminosis D, renal tubular acidosis, mild-alkali syndrome, Gout, others), but idiopathic hypercalciuria responsible for about 50% in adults.
• Up to 98% of stones <0.5 cm in diameter will pass spontaneously, especially in the distal ureter
• Calcium stones are the most common. When they cause obstruction it tends to be acute and intermittent, producing no long-term effects on renal function
• Cystine and struvite stones are more likely to be associated with renal damage
• Struvite stones form in alkaline urine; may be seen with chronic proteus species Infections

Risk Factors

• Cystinuria, genetic defects, renal tubular acidosis, low Water intake, high-Protein diet, excessive oxalate intake, sedentary lifestyle
• Middle age, Whites, family history, Obesity, Diabetes Mellitus, chronic Diarrhea, malabsorption, history of bowel or barriatric surgery, pathologic skeletal fractures, Gout, Paget’s
• Certain medications: Vitamins A, C, D, loop Diuretics, ammonium Chloride, acetazolamide, alkali, antacids

Prevention

• Adequate fluid intake
• If prone to Calcium stones, restrict Protein, Sodium, Dairy products and other oxalate rich foods
• If prone to uric acid stones, alkalinization of urine may prevent formation