URINARY TRACT INFECTION (UTI) Definition

complications - Obesity, hypertriglyceridemia and diabetes following glucose loading from dialysis fluid, protein and amino acid losses. Advantages - Can be performed at home without any specific equipment, lower cost than hemodialysis, continuous fluid removal with better hemodynamic stability. Disadvantages - Complications as stated above, high failure rate, psychological problems related to indwelling catheter, fatigue from continuous treatment. 2. INTERMITTENT (PERIODIC) DIALYSIS - 8-12 hrs of dialysis with 12-16 hrs of interdialytic phase 3 CONTINUOUS CYCLIC PERITONEAL DIALYSIS - A single day of exchange, plus 4-6 exchanges during the night using automatic equipment. Renal transplantation - is the treatment of choice for ESRD, as it enables the patient to resume a normal life, with no restrictions in diet and fluid intake. Types of renal transplantation - (a) LIVING DONOR TRANSPLANTATION - Renal transplantation between identical twins is the only situation where immunosuppression is not required , following grafting First degree blood relatives may be suitable donors but most transplant units require the donor to be both ABO compatible and to have close matching particularly of HLA class II loci. (b) CADAVERIC TRANSPLANTATION. Contraindications - (a) Old age. (b) Associated conditions that might deteriorate with immunosuppression e.g. bronchiectasis or severe cardiovascular disease. (c) Presence of high litres of cytotoxic antibodies to transplant antigens Immunosuppression - Cyclosporin is the drug of choice. Immunosuppression with cyclosporine can be achieved without long-term steroid treatment. Many immunosuppressive drugs produce side-effects. Complications of transplantation - (1) Rejection - Identification of rejection - (a) Serum creatinine is the most common marker. (b) Renal biopsy - may also be used to detect rejection and to assist in determining presence of cyclosporin toxicity. Cl. Fs. - (i) Acute cellular or vascular rejection occurring in first 3 months may be reversible by short-term high-dose corticosteroids. Additional regimens such as ant i lymphocyte immunoglobulin and plasmapheresis may be necessary. (ii) Chronic vascular rejection is usually unresponsive to treatment and may lead to progressive graft deterioration. (2) Complications of immunosuppression - Side-effects associated with immunosuppressive drugs - (i) General - Susceptibility to infection, increased risk of neoplasia (ii) Corticosteroids - Hyperglycemia, Gl bleeding, cataracts, avascular necrosis of bone, Cushings habitus (Complications now reduced with low dose regimens). (iii) Azathioprine - Generalised or selective marrow hypoplasia, jaundice (iv) Cyclosporin - Nephrotoxicity, hirsutism, gingival hyperplasia, tremor, CNS effects. These are dose-dependent. 6. URINARY TRACT INFECTION (UTI) Definition - UTI is the presence of micro-organisms in the tract: the presence of a least 105 colony forming units (cfu) per millilitre of freshly passed urine is regarded as evidence of likely UTI. Significant bacteriuria describes urine that yields on culture a pure growth of organisms greater than 105 colony forming units (CFU)/ml.). Significant pyuria occurs when there are more than 10 neutrophils/high power field (equivalent to approximately 10 neutrophils/mm3). Recurrent UTIs are divided into - (a) Relapsing infection with recurrence of bacteriuria with the same organism within 2 weeks of completing treatment, which during treatment rendered the urine sterile. It is usually seen in association with renal scars, cystic disease, stones or prostatitis. (b) Reinfection is defined as eradication of bacteriuria by