Faculty Opinions recommendation of Impact of urinary tract infection on inpatient healthcare for congenital obstructive uropathy.

Hyperammonemia is mainly caused by diseases related to liver failure. However, there are also non-hepatic causes of hyperammonemia, such as urinary tract infection (UTI) due to urease-producing organisms. Urease production by these bacteria induces a hydrolysis of urinary urea into ammonia that can cross the urothelial cell membrane and diffuse into blood vessels, leading to hyperammonemia. Delayed diagnosis and treatment of hyperammonemia can lead to lethal encephalopathy that can cause brain damage and life-threatening conditions. In the presence of obstructive uropathy, UTI by urease-producing bacteria can lead to more severe hyperammonemia due to enhanced resorption of ammonia into the systemic circulation. In this report, we present a case of acute severe hyperammonemic encephalopathy leading to brain death due to accumulation of ammonia in blood caused by Morganella morganii UTI in a 10-year-old girl with cloacal anomaly, causing obstructive uropathy even after multiple corrections.

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Pattern of infection in children presented with obstructive uropathy: A hospital-based study

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v7i1.29146 ◽

2016 ◽

Vol 7 (1) ◽

pp. 44

Author(s):

Md. Habibur Rahman ◽

Kamrul Laila ◽

Golam Muinuddin

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Obstructive Uropathy ◽

Pediatric Nephrology ◽

Posterior Urethral Valve ◽

Laboratory Evaluation ◽

Stage Renal Disease ◽

End Stage ◽

Medical University

Background: Obstructive uropathy refers to the structural impedance to the flow of urine anywhere along the urinary tract which may result from congenital (anatomic) lesions or can be caused by trauma, neoplasia, calculi, inflatnmatory process or surgical procedure. It is responsible for about 4% of end-stage renal disease. Obstructive uropathy is invariably associated with some co-morbid conditions specially infection.Objecctive: This study was conducted in the department of pediatric nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh with an objective to identify different pattern of infections in children with obstructive uropathy. Methods: A total of 55 patients of obstructive uropathy were enrolled. Thorough clinical and laboratory evaluation including hematological, biochemical, radiological and radio nucleotide imaging were done along with blood and urine culture. Result: Out of 55 cases, 42.27% of obstructive uropathy was detected between I to 5 years and 89.27% was infected. Among obstructive uropathy cases, majority had posterior urethral valve (PUV) (42.27%). Urinary tract infection was the commonest (60%) type of infections followed by septicemia and respiratory tract infection. Conclusion: Age between 1 to 5 years was the commonest age of children for hospital admission due to obstructive uropathy. Among various manifestations of obstructive uropatby, infections, mostly urinary tract infection was the commonest one.

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Profile and Outcome of Pelviureteric Junction Obstruction

The Open Urology & Nephrology Journal ◽

10.2174/1874303x01407010067 ◽

2014 ◽

Vol 7 (1) ◽

pp. 67-70 ◽

Cited By ~ 1

Author(s):

Prabha Senguttuvan ◽

Joseph Jigy

Keyword(s):

Renal Failure ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Obstructive Uropathy ◽

Cystic Kidney Disease ◽

Cystic Kidney ◽

E Coli ◽

Pediatric Populations

Obstructive uropathy represents one of the largest fractions of identifiable causes of renal failure in pediatric populations. This is one of the largest series of PUJ obstructions reported in children. PUJ obstruction is a relatively common congenital anamolyes in neonates and children and a cause of ESRD in developing countries. This series expands our knowledge about the clinical presentation and course of this disease. Pelviureteric junction (PUJ) obstruction is a partial or total blockage of the flow of urine that occurs where the ureter enters the kidney and is the most common cause of significant dilatation of the collecting system in the fetal kidney. We retrospectively analyzed children diagnosed as PUJ obstruction between the periods of 2008-2010 who presented to our institute. Forty four children were diagnosed to have PUJ obstruction. The median age at presentation was 11 months, with range of 3 months to 11 years. Male children constituted 34 (77.3%) cases. Unilateral PUJ with left sided involvement was more common (52.3%). Antenatal diagnosis was made in 18 (40.9%) cases. The common clinical presentations were fever, urinary tract infection (UTI) and abdominal pain. Hypertension was present in five (11.3%) patients and renal failure at presentation was seen in eight (18.2%) patients. Associated urogenital anomalies were present in twelve (27.3%) patients, with medullary cystic kidney disease (MCKD) being the most commonassociated anomaly. Prophylactic antibiotics were not prescribed to patients. Urinary tract infection was present in fourteen (31.9%) patients with E. coli being the most common organism (75%). Conservative management with regular follow up was done for 32 patients and the remaining twelve patients underwent pyeloplastyin view of gross hydronephrosis, and four (33.3%)of these patients later underwent nephrectomy for a non-functioning kidney. Antenatal screening is mandatory to make an early diagnosis and for further management and close follow upof PUJ obstruction. Randomized control trials and longer follow up studies are needed for evidence to suggest the optimal management.

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