INFECTIOUS DISEASES AND INFECTIONS. 1. DIPHTHERIA Epidemiology - Age

used for long-term drainage, as it is less irritant. (iii) 'Three way' Foley catheters have an extra lumen to allow continuous bladder irrigation following urological surgery or trauma. (iv) Malecot's self-retaining catheter with a flower at its end which keeps the catheter in the bladder. Its use is limited to females. The flower can be collapsed during catheterization with an introducer The catheter preferred in females is a short simple open-ended catheter. 2. Catheters for urine sampling - Urine samples may be obtained by catheterization in patients (usually females) who are unable to produce adequate mid-stream urine. several weeks of treatment because of poor penetration of antibiotics into the prostate. 4. Obstruction - of long-term indwelling catheters by fibrous material and encrustations, hence the need for replacing the catheters at regular intervals. 5. Urethritis - and very occasionally, stricture formation may result from traumatic catheterization or failure to change catheters over a prolonged period. 6. Hematuria -from irritation of the bladder wall, usually microscopic, less commonly macroscopic. 7. Failure of balloon deflation - can be overcome by insertion of a ureteric catheter stylet into the balloon channel under fluoroscopic control. ADDENDUM 'Telescoped' urinary sediment - (Red cells, white cells, casts, tubular epithelial cells, fat globules) occur in collagen vascular disease especially SLE and PAN Hyperoxaluria - 1. Inherited (AR pyridoxine responsive) 2. Heal disease. 3. Toxic - Ethylene glycol ingestion, methoxyflurane. 4. Orotic - Sulphadiazine, nitrofurantoin, acyclovir, acetazolamide. Mechanism of kidney damage in diabetes mellitus- 1. Diffuse glomerulosclerosis, with in some cases nodular glomeurlosclerosis. 2. Pyelonephritis. 3. Necrotizing papillitis. 4. Atherosclerosis of renal vessels Hypercalciuria - Idiopathic Hyperparathyroidism Immobilization (esp. Paget's disease) Bone lysis Distal renal tubular acidosis. Sarcoidosis. Medullary sponge kidneys. Acromegaly, Cushing's syndrome. latrogenic - Corticosteroids, frusemide. Renal tubular acidosis (RTA) disorders - are due to abnormalities of renal tubular acidification Defects may be - 1. Quantitative - as in chronic renal failure (number of functioning nephrona too small for metabolic acid load) 2. Qualitative - (a) Proximal RTA - (i) Primary form rare with infant failing to thrive and grow. (ii) Secondary form e.g. as result of Fanconi syndrome and following renal transplantation. (b) Distal RTA - (i) Primary in early life with failure to thrive, polyuria, dehydration. (ii) Secondary due to vitamin D poisoning, idiopathic hypercalmia, amphotericin toxicity. Cystinuria - It is a disorder of proximal tubule in which there is failure to reabsorb four amnio acids - cystine, ornithin, arginine, lysine (COAL). Nephrotoxic antibiotics - With the exception of erythromycin, the antibiotics whose name ends in mycin are nephrotoxic. Renal failure with hemoptysis - I. Goodpasture's, Wegner's, HSP, PAN, SLE, cryoglobulinemia. 2. Renal vein thrombosis with pulmonary embolism. 3. Pulmonary oedema in ARF. 4. Right-sided infective endocarditis with septic pulmonary emboli and immune-complex nephritis. 5. Infection - TB, Legionnaire's disease Bleeding in uremia mechanisms. 1. Increased prostacyclin production by the endothelium and reduced biosynthesis of tromaxane. 2. Accumulation of waste products (urea and its metabolite guanidinosuccinic acid) in uremic plasma may lead to smaller platelet size, reduced platelet coagulant activity (platelet factor III), decreased platelet adhesion, defects in cytoplasmic calcium mobilization, decreased expression of fibrinogen receptors and impaired platelet aggregation, and consequently prolonged bleeding time. 3. Anemia may contribute to reduced platelet adhesion in vivo, and consequently, to the abnormal bleeding time. Renal disease with jaundice - 1 Hemolytic-uremic syndrome. 2. Hepatorenal failure. 3. Hepatitis B with nephrotic syndrome. 4. Alcoholic cirrhosis with IgA nephropathy or renal tubular acidosis. 5. Weil's disease (Leptospirosis) 8. Polycystic disease with congenital hepatic fibrosis. 7. Renal cell carcinoma with hepatic dysfunction e.g.cholestasis. 8. Toxic - CCI4, methoxyflurane Distinction between pre-renal and renal causes of ARF in an oliguric patient - Identifiable causes (shock, Pre-renal Renal hypovolemia) Yes No Plasmapheresis in renal disease -Indications - Anti-GBM nephritis Rapidly progressive GN Goodpasture's syndrome Polyarteritis nodosa and other vasculitides Systemic lupus erythematosus. Thrombotic thrombocytopenic purpura Hemolytic-uremic syndrome. Scleroderma Acute renal allograft rejection. 8. INFECTIOUS DISEASES AND INFECTIONS. 1. DIPHTHERIA Epidemiology - Age - Maximum incidence between 2-5 years Mode of spread - Droplet infection due to contact with person with active disease or more often with a carrier of virulent organisms. Chronic sinusitis and diseased tonsils important predisposing factors Sub types of C. diphtheriae - Three strains gravis, intermediate, and mitis usually related to the clinical severity of the disease, the other factors being host-resistance, site of infection and length of time elapsing before starting treatment. Incubation period - 2 to 6 days. Clinical types -1. RESPIRATORY GROUP - includes majority. Nasal diphtheria - Unilateral or bilateral nasal discharge, at first serous and often