1. Asymptomatic Bacteriuria

2. Defination
 When a bacterial count of same species over
10^5 per ml in mild stream clean catch
specimen of urine on two occasion is
detected without the symptom of urinary
infection it is called asymptomatic
bacteriuria

3.  Causes
 Asymptomatic bacteriuria occurs in a small
number of healthy individuals. It more often
affects women than men. The reasons for the
lack of symptoms are not well understood.
 Most patients with asymptomatic bacteriuria
do not need treatment because the bacteria are
not causing any harm. Persons who have
urinary catheters often will have
bacteriuria, but most will not have symptoms.

4.  The following increases your risk:
 Diabetes
 Infected kidney stones
 Kidney transplant
 Older age
 Pregnancy -- up to 40% of pregnant women
with untreated asymptomatic bacteriuria will
develop a kidney infection
 Vesicoureteral reflux in young children

5. Symptoms
 By definition, asymptomatic bacteriuria
causes no symptoms. The symptoms of a
urinary tract infection include burning
during urination, an increased urgency to
urinate, and increased frequency of
urination.

6. Exams and Tests
 Asymptomatic bacteriuria is detected by the
discovery of significant bacterial growth in
a urine culture taken from a urine sample.

7. Treatment
 Pregnant women, kidney transplant
recipients, children with vesicoureteral
reflux, and those with infected kidney stones
are more likely to be given antibiotics.
 Giving antibiotics to persons who have long-
term urinary catheters in place may cause
additional problems. The bacteria may be more
difficult to treat and the patients may develop a
yeast infection.

8.  If asymptomatic bacteriuria is found before
a urinary tract procedure, it should be
treated to prevent complications. The course
of treatment in these cases depends on the
person's risk factors.

9. Possible Complications
 Untreated, asymptomatic bacteriuria can
lead to a kidney infection in high-risk
individuals

10. When to Contact a Medical
Professional
 Call your health care provider if the
following symptoms occur:
 Difficulty emptying your bladder
 Fever
 Flank or back pain
 Pain with urination

11. PROTEINURIA
INPREGNANCY
 When 2+protein in deepstick test it is
called proteinuria
 CAUSES
 Pre-eclampsia and eclampsia
 Urinary tract infection
 Chronic Renal disease :Nephritis and
Nephrotic Syndrome

12.  Essential hypertension
 Orthostatic- Due to increased lumbar
lordosis there is increased pressure on the
inferior Venacava by the uterus or left renal
vein

13.  Is compressed by the aorta this leads to
congestion of one or both kidney leading to
proteinuria.
 In late pregnancy,the enlarged gravid
utrerus may compress es the left renal vein
when the patient is lying on supine position
.lying down on lateral position relieves the
pressure and congestion and makes the
urine free of protein

14.  Investigations (microscopic examination of
Pus cells RBCs Cast cells)
 Management depends upon etiology

15. Hematuria in Pregnancy
 Painful - infection
 Painless – neoplastic, hyperplastic, vascular
 Gross – urine appears ―RED‖; lower tract
prob.
 Microscopic – > 5 RBC’s/hpf; kidney dz
 False hematuria = urine appears bloody, but
dipstick results are neg. for blood and no
RBC’s on micro
Free hgb, myoglobin, porphyrins

16. 1.Physological—menstruation
2. Infection—Pyelonephriitis , cystitis ,
urethritis , Tuberculosis of kidney and
bladder
3. Trauma– Renal injury, Foreign body in
bladder and urethra including catheter.
4.Inflammatory / autoimmune—
Glomerulonephritis , Polyarteritis nodosa ,
Ch. Interstitial nephritis, radiatinal
inflammation of renal tract.

17. 5.Accidental haemorrhage
6.Rupture uterus
7. Obstructed labour
8 .DIC
9. Traumatic PPH

18. 10.Heparine therapy for DVT
11.Eclampsia
12. HellP syndrome
13. Mismatched blood transfusion
14.Pregnancy associated with hematological
diseases
15.Drug induced
16. Instrumental delivery
17.Traumatic VVF

19. 5.Stones– renal , ureteric , bladder and
urethra.
6 .Tumors– benign /malignant of renal tract.
7.General—drugs including anticoagulants
Bleeding disorders , caruncle and prolapse
of urethral mucosa.

20.  Diagnosis:
 H & P
 Clean catch midstream urine for U/A
 Cath urine if woman has vag. d/c, menstrual or vag.
Bleeding (cath urine will rarely exceed 3
RBC’s/hpf)
 Can screen with dipstick but false negs/pos may
result
 Abnormal RBC morphologic characteristics, RBC
casts & proteinuria suggest glomerular source
 If normal RBC’s then infection probable
 Imaging (IVP, CT, renal US)

21.  When haematuria(micro / Macro ) is noted
Nephrologist’s consultation should be
shout.
 Clinical Assessment
 Check the catheter, clinical examination of
renal tract , genital tract any other bleeding
sites

22.  Investigations:
 Complete urine examination, CBC, platelet
count , bleeding – clotting factor
profile, liver enzyme study should be
immediately ordered.

23. MANAGEMENT
 It depends upon the causes of hematuria