Chapter 13: Renal Disorders 171
includeviruses,parasites,andfungi.
3
Inmostcases,cysti-
tisiscausedbyorganismsreachingtheurinarytractby
the ascending route. Anatomic and mechanical factors
can contribute to thedevelopment of UTIs by promot-
ing urinarystasis,retention, and bacterialcolonization.
Cystitisismorecommoninwomenthaninmen.Infact,
nearly60percentofwomenwilldevelopcystitisatleast
once in their lifetime. In persons younger than age 11
years,cystitisismorefrequentingirlsthaninboys,with
acomparisonof5to1.5percent.
Thereareadditionalhigh-riskgroupsandriskfactors
forcystitis,includingsexuallyactiveyoungwomen,preg-
nant women, men with prostatic obstruction, diabetics,
those with catheters, those using barrier contraceptives
suchasdiaphragms,andengaginginsexualintercourse.
Signs, Symptoms, and Diagnosis
Themainsymptomsofcystitisarefever,frequency,dysuria,
urgency,hematuria,andsuprapubicdiscomfort.
3
Notallof
thesesymptomsareconsistentlypresent,andagemaybe
an important factor in determining which symptomsare
present.Forexample,inchildrentheremightbeasigni-
cantfeverconcomitantwithvomiting.Inelderlypatients
feverisabsent,gastrointestinalsymptomsaremoresigni-
cant,andattimestheelderlymayevenbeasymptomatic.
8
Children who cry on micturition, complain of vague
abdominalpains,orhaveafoul-smellingurineshouldbe
suspectedofhavingcystitis.Intheelderlypopulation,any
acuteonsetofmentalstatuschangeshouldalerttheclini-
ciantopossiblecystitis.
Other than clinical ndings, the most useful and cost-
effective means of diagnosing cystitis is urinalysis. Micro-
scopicexaminationoftheurinemayrevealpyuria,whichis
frequentlythecausativeagent.Proteinandglucosemaybe
present;however, otherconditions (e.g.,diabetesmellitus
andnephritis)mayalsoberesponsiblefortheseresults.It
isalsoimportanttonotethatgoodpatientinstructionisvital
forthecollectionofanuncontaminatedurinespecimen.
Management
Antibioticsarethemainstayoftherapyforcystitis(Table
13–5
).Signicantdehydrationmayalsooccur,especially
inchildrenandtheelderly,andmanyrequireintravenous
uidsupplementation.Theselectionofappropriateanti-
microbialshasbecomedifcultwiththeincreasingnum-
berofavailableagents,butthedecisionshouldbemade
based upon the responsible pathogen and patient toler-
ance.Fortunately,inmostcasesthereareseveralsatisfac-
toryagents,inwhichcasethemosteconomicalchoiceis
best.Thelengthoftherapyvariesdependingonthesever-
ity and length of the infection as well as the condition of
thepatient(e.g.,ifthepatientispregnant,elderly,orimmu-
nosuppressed,or if the infection is recurrent).A single-
doseregimenhasbeenprovensuccessfulinnonpregnant
womenwhoareatlowrisk.The3-dayantibioticregimen
ismorewidelyacceptedbypatientsandcliniciansandis
indicated for symptoms that have not been present for
morethan3days.A7-dayregimenisindicatedifsymp-
tomshavebeenpresentformorethan3days,duringpreg-
nancy,ifanunderlyingmedicalconditionexists,ifthere
isanunderlyingurologicabnormality,orifthereisahis-
toryofrecurrentcystitisorrenalcalculi.
Lifestyle Changes: Practical Tips for Your
Patients
Thereareseveralthingsthatcanbedonetohelpprevent
cystitis. For women who suffer from recurring cystitis
(morethanthreetimesin1year),prophylacticantibio-
tic therapy is usually done with the use of nitrofuran-
toin, cephalexin, or trimethoprim–sulfamethoxazole.
1
Topreventcystitis,individuals shoulddrink plentyof
uids—at least 6–8, 8-ounce glasses of uid daily.
Womenshouldmake suretheywipethemselvesfrom
thefronttothebackaftervoidingtoavoidcontamina-
tion of the urethral entrance with bacteria from the
bowel.Vaginaldeodorants,bubblebaths,andotherirri-
tatingsubstancesshouldbeavoided.Ifawomanusesa
diaphragm,sheshouldconsiderusingasmallersizeor
switchingtoanalternatemeansofbirthcontrol.Women
whohavefrequentcystitisshoulddrinkaglassofwater
priortointercourseandurinateimmediatelyafterinter-
course.Thishelpstoushoutanypathogensthatmay
haveenteredtheurethra.Drinkingcranberryjuicehas
beenrecommendedinconjunctionwithantibioticuse.
It is thought to be benecial because of the increased
acid content, which makes it difcult for bacteria to
adheretothebladdermucosa.
Urethritis
General Characteristics
Oneofthemostcommongenitourinaryinfectionsinboth
malesandfemalesisurethritis.Urethritisisaninfection
of the urethra and can be caused by viruses, bacteria, or
fungi. Bacteria is the most frequent causative agent and
Table 13–5
Selected Antibiotics for Cystitis
Antibiotic Duration
Cephalexin 250–500 mg every 6 hr 1–3 days
Ciprooxacin 250–500 mg every 12 hr 1–3 days
Nitrofurantoin (macrocrystals) 100 mg
every 12 hr
7 days
Ooxacin 200 mg every 12 hr 1–3 days
Trimethroprim–sulfamethoxazole
160/800 mg, two tablets
Single dose
Noroxacin 400 mg every 12 hr 1–3 days
Source: Adapted from McPhee SJ, Papadakis MA, eds. Current Medical
Diagnosis and Treatment. 48th ed. New York, NY: McGraw-Hill; 2009.

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