to dated scarring. CT scanning - may hetp precise diagnose of a localized abnormality identified poorty by other-techniques

hrly. For perinephrlc abscess - Percutaneous drainage Co-extesing nephrolithlas is has to be treated. Cystit is - (I) High fluld Intake. (ii) Symptomatic ralial by alkalization of urine. (iii) 5-day course of AMA (tabla). Single dosa thsrapy with Trimethoprim 600mg. Co-trirnaxozole 1. 92g. Norfloxacin 800mg. Ciprofoxachin 500mg or Pefloxacin 800mg can be used in selected females (young. sexually active) who seek rrecfcal advice shortly afier becoming symptomatic Further investigations - INDICATIONS -(a) Relapsing Infection (b) Onset of first infection in chillhood (c) Male sex. (d) Urological symptoms. (e) Persistent hemalurla (f) Unusual organism (e.g. pseudomonas, proteus), Frequent relapses (6-week interval or less). INVESTIGATIONS - LHirasound-Estimatian of renal size. detection of cysts and to exclude obstruction. Bladder size and wall thickness may Intfcale oullei obstruction, and residual volume after micturion provides good asseasment of completeness of voiding Large renal scars may be seen. Radiography • Radio-opaque stones. PVU = may allow batter visualization of duplex kidneys and double ureters, small parenchymal scars, calyceal dubbing and parenchymal thinning. Abnormalities of ranal calyces may confirm papillary necrosis and pelvicalyceal Filling detects e.g. with radolucnnt stones. Micturating cystogram - In ctilldrsn to detect vesicureteric reflux Isolope scanning - to dated scarring. CT scanning - may hetp precise diagnose of a localized abnormality identified poorty by other-techniques. Complicated UTI Undertying abnormality must be corrected it possible (e.g. obstruction cafculus) Pcule pyelonephrtis - Therapy with one of the AMA drugs for 6 weeks with initial use of parenieral drugs as mentioned earfier Cystlls -For mild case to moderaie cases one of the AMA. drugs for 7-14 days. In severe cases upto. 3 weeks wiih Initial parental therapy. Special situations Asymplomatc bacleriuria (AB) - need nor be treated unless for. (i) Pregnant famales .(ii)children 4 years of age. (iii)CompllcaiedAB. (presence of urinary obstruction/reflux, diabetes, analgesic nephropathy. sickle cell diaease). In pregnancy urine cultures followad by (reament with non-toxic drug such as amonyclllin for 3 days Urethral syndro