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NEPHROLOGY (KIDNEY)CONDITIONS IN INDIA

Neurology is the medical specialty encompassing diseases, conditions, and infections of the nervous system, which includes the brain, spinal cord, and peripheral nerves. Examples of neurological diseases and conditions include multiple sclerosis, Alzheimer’s, Parkinson’s, seizures, brain tumors, dementia, stroke, TIA (transient ischemic attack, or “mini-stroke”), headaches, migraine, nerve disorders, spinal cord injuries, chronic pain conditions, neuropathic pain conditions, head trauma (concussion), brain aneurysm, facial nerve problems, and trigeminal neuralgia.

The urinary tract includes the kidneys (which filter urine), bladder (which stores urine), and urethra (the tube that carries urine out of the bladder) Bacteria do not normally live in these areas. When bacteria enter the urinary tract and begin to multiply they cause Urinary tract infection (UTI). UTI is one of the most common infections, causing symptoms of burning with urination and needing to void frequently. A UTI can be an infection of the bladder (cystitis) or a more serious infection  of the kidney (pyelonephritis). Most people with UTI have an uncomplicated bladder infection that is easily treated with a short course of antibiotics.

UTI occurs more frequently in women since women have a short urethra and a small distance between the urethral opening and the anus (where bacteria commonly live). Both factors make it easy for bacteria to enter the bladder.Most UTIs are caused by the bacterium Escherichia coli (E. coli), which is commonly found in feces. The bacteria can move from the anus to the urethra and into the bladder (and less commonly into the kidney), causing infection.

A person who does not have symptoms of a UTI but has bacteria in the urine is said to have asymptomatic bacteriuria. This is especially common in elderly men and women. Treatment is not always needed for asymptomatic bacteriuria except in selected circumstances such as during pregnancy.

Risk Factors

Men, women, and children with underlying health problems such as use of a bladder

catheter, a recent procedure or surgery involving the urinary tract, an anatomic abnormality or blockage of the urinary tract, the inability to empty the bladder completely, pregnancy, diabetes, or age =65 years has higher risk for developing a UTI

Symptoms in India

The typical symptoms of acute cystitis are:

• Pain or burning when urinating
• Frequent need to urinate
• Urgent need to urinate
• Blood in the urine
• Discomfort in the middle of the lower abdomen (suprapubic pain)

Burning with urination can also occur in people with vaginitis (eg, yeast infection) or urethritis (inflammation of the urethra). The presence of blood in the urine is common in cystitis, but not in vaginitis or urethritis. Vaginal discharge, odor, itching, or pain with sexual intercourse are typical features of vaginitis. Urethritis is possible if the patient has a new sexual partner, has a partner with urethritis, or gradually develops symptoms over several weeks.

Pyelonephritis : Symptoms of pyelonephritis (an infection of the kidney) almost always include fever, which is defined as a temperature greater than 100.4º F (38º C). Pyelonephritis can also cause pain in the flank (side of lower back), nausea, and vomiting. Burning or pain on urination,frequent urination, urgency, and suprapubic pain may also occur in people with pyelonephritis.

Treatment in India

Bladder infection : In young, healthy adolescents and adults with simple cystitis, the usual treatment includes a three to seven day course of antibiotics. The typical drugs chosen are: trimethoprim-sulfamethoxazole (Bactrim®), nitrofurantoin (Macrobid®), ciprofloxacin (Cipro®) or levofloxacin (Levaquin®).Symptoms generally resolve one to three days after starting treatment.

It is important to take the full course of antibiotics to completely eliminate the infection.If needed, a prescription analgesic medication that numbs the bladder and urethra (phenazopyridine [Pyridium®]) can be taken to reduce the burning pain of some UTIs.It causes the urine to appear discolored (usually blue or orange) and can interfere with laboratory testing. The analgesic should not be used for more than 48 hours due to the risk of side effects. Analgesics do not eliminate the infection and must be taken along with an antibiotic. If urinary symptoms persist for more than two or three days, talk to a healthcare provider.

Some providers recommend increasing fluid intake to help flush bacteria from the bladder. Others believe that increasing fluids may dilute the antibiotic in the bladder and makes the medication less effective. No studies  have been performed to address this issue.  Kidney infection The optimal treatment for pyelonephritis depends upon the person’s underlying medical conditions and the severity of the  infection.Some people will require a one to two week course of oral antibiotics at home while others will need to be hospitalized and given intravenous (IV) antibiotics and fluids.

Treatment in pregnancy in India :

Pregnant women with a UTI or asymptomatic bacteriuria (a UTI without symptoms) need to be treated to reduce the risk of pyelonephritis and pregnancy-related complications. In pregnant women, the urine is sent for culture to identify the  specific bacteria causing the problem, and antibiotic treatment is given for three to seven days. Follow-up care — Follow-up testing is not needed in healthy, young women with simple cystitis if symptoms resolve. Pregnant women are usually asked to have a repeat urine culture two weeks after treatment has ended.

Recurrent Urinary Tract Infections

UTI versus other causes :

Some adults, especially women, develop urinary tract infections frequently. In this case, it is important to confirm that symptoms of a UTI (eg, pain or burning, frequency, and urgency) are caused by an infection. The best way to confirm the  presence of infection is to have a urine culture and sensitivity . If a urine culture is negative for infection, other causes of pain, burning, and frequency should be investigated. There is no benefit of antibiotic treatment if the urine culture is negative.

Need for further testing :

Young healthy women with UTI whose symptoms improve with antibiotics do not usually require further testing. However, testing may be recommended for some people with recurrent urinary tract infections, especially if there is any possibility of an abnormality in the kidneys, ureter, bladder, or urethra , or if there is concern about other factors that increase the risk  of a urinary tract infection (eg, kidney stone).

Tests for these conditions may include a computed tomography (CT) scan, ultrasound, or cystoscopy (looking inside the bladder with a thin, lighted telescope-like instrument).Anyone who continues to have blood in the urine after a urinary tract infection has  cleared should have further testing.

Preventing recurrent UTIs :

Young women with recurrent urinary tract infections may be advised to take steps to prevent UTIs, including one or more of the following:

Changes in contraception :

Women who develop frequent UTIs and use spermicides, particularly those who also use a contraceptive diaphragm, may be encouraged to use an alternate method of birth control.

Cranberry products :

Several small studies have suggested that there may be some benefit to consuming cranberry products to prevent recurrent UTIs, although this has not been proven. In the laboratory, cranberry extracts appear to decrease the ability of E. coli to stick to the cells lining the urinary tract. More definitive studies are needed before cranberry juice or supplements are routinely recommended for the prevention of UTIs.

Increasing fluid intake and urinating after intercourse — Although clinical studies have not proven that increasing fluid intake or urinating soon after intercourse can prevent infection, healthcare providers frequently recommend these measures since they are not harmful.

Postmenopausal women :

Postmenopausal women who develop recurrent UTIs may benefit from the use of a vaginal estrogen.

Antibiotics

A preventive antibiotic treatment may be considered for people who repeatedly develop UTIs despite use of other preventive measures. Antibiotics are highly effective in preventing recurrent UTIs and can be given in several different ways.

• Preventive antibiotic : A low dose of an antibiotic may be taken daily or three times per week for six months to several years.

• Antibiotics following intercourse : In women who develop urinary tract infections after sexual intercourse, a single low dose antibiotic after intercourse is often effective in preventing infection.

• Self-treatment : A plan to begin antibiotics at the first sign of a UTI may be recommended in some situations. Before this is started, it is important that previous UTIs have been tested (cultured) to be sure that there is an infection; some women have symptoms of a UTI but do not actually have an infection.

• Chronic Kidney Disease
• End-stage renal disease (ESRD)
• Hematuria
• Kidney Cancer
• Kidney stones
• Prostate Disease
• Urinary Incontinence
• Carotid Endarterectomy
• Carpal tunnel release
• Craniotomy
• CSF Shunt procedures
• Renal Failure Treatment
• Glomerulonephritis Treatment
• Lupus Nephritis Treatment
• Amyloidosis Treatment
• Renal Insufficiency Treatment
• Nephrotic Syndrome Treatment
• Polycystic Kidney Disorder Treatment
• Renal Hypertension Treatment
• Electrolyte Disorders Treatment
• Bladder Outlet Incision Surgery
• Nephrectomy -Kidney Removal Surgery
• Nephrolithotomy-Removal Of Kidney Stone Surgery
• Retrograde Pyelogram Surgery
• Ureterolithotomy -Dormia Basket Surgery
• Urethroscopy Surgery

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