- Provide a basis for the connection between urinary tract infections (UTI) and acute kidney disease (AKD).
Answer: The association of the urinary tract infection (UTI) and acute kidney disease (AKD) has no direct relationship in most cases. UTI is a common infection that affects urinary tract parts but is easily cured. However, a more frequent urinary tract infection can lead to inflammation in the kidney that affects the renal tissues and lead to kidney damage or acute kidney disease. A chronic or acute kidney disease causes progresses to kidney failure.
If the infection is in lower urinary tract it causes a bladder infection known as cystitis and the common symptoms will include urge to urinate, pain and burning feeling during urination and frequent urination. On the other hand, if the infection is in the upper part of the urinary tract it causes pyelonephritis, a kidney infection (Foxman, 2014).
The common symptoms of kidney infection includes flank pain and fever along with cloudy urine and bad odor, frequent urination, urge to urinate in empty bladder. John Gower, an elderly man is having urinary tract infection in the upper urinary tract as the symptoms observed are cloudy urine with offensive smell, flank pain and the patient has very high fever as temperature is 40 degree celsius. Moreover, the dark coloured urine of the patient is also an indicative of urinary tract infection and kidney/bladder infection (Ödev et al., 2013).
It is concluded that the urinary tract infection in the patient is likely to cause kidney disease as there is direct association between urinary tract infections and acute kidney disease in this case.
- Explain the clinical association or relationship between UTI and confusion in the elderly.
Answer: According to National Institutes of Health (NIH), the condition of urinary tract disorder is misjudged for early phase of dementia (gradual confusion) due to state of confusion in old patient (Agata et al., 2013). The state of mental condition with declining mental functioning due to some disturbances is known as delirium (sudden confusion).
It is a syndrome which is considered to be a consequence of urinary tract infection. The patient with this condition has a reduced response towards the environment and declining awareness. According to Woodford and George (2009), delirium and urinary tract infection are common condition in the individual at the age of 65 or older and there is a positive link with its occurrence in patient increases with age factor. The brain of elderly is more prone to stressors like medications, medical illness and dehydration. There is an increased risk for patients with UTI condition to develop a fast change in behavior or mental state (delirium).
The patient has dark colored urine due to infection and it is also associated with the dehydration. The less intake of water by elder patient at the age of 78 years is likely to void higher urine concentration which is dark in color. It can be noted that a sudden change in the patient cognitive state is not always associated with aging factor in elders. The sudden state of feeling confused in patient with UTI such as for time confusion can be expected which indicates illness and medical care.
Therefore, in the case of John Gower, there is seems to be a link between the UTI and state of sudden confusion for time while being conscious at the emergency department.
- Describe why John’s classical clinical signs have climbed now.
John’s classical clinical signs have scaled up as the patient is likely to suffer from acute pyelonephritis due to the UTI which comprises of symptoms of flank pain, high fever, nausea, vomiting, chills and shakes. The clinical signs of the patient show a temperature of 40 degree Celsius which indicates a very high fever due to infection and an abnormal respiratory rate and high pulse rate.
However, the blood pressure is 90/60 mmHg which is a sign that patient is likely to have a condition of low blood pressure or hypotension. The clinical signs of the John include high voiding, flank pain and cloudy urine along with symptoms of pyelonephritis. The presence of RBC detected in the urinalysis is a sign of infection or inflammation of the especially lower urinary tract and leucocytes in urine indicate infection or renal system inflammation (Perazella, 2015).
The albumin (protein) in the urine points to disease conditions and presence of nitrites directly specify UTI in John. However, ketones and glucose specifies for diabetic condition in John which require further analysis in this case. The specific gravity (1.025) reveals the high concentration of the patient urine which has altered the kidney function to remove metabolic waste and maintain the fluid volume due to disease.
The elevated signs show the risk of diabetes, narrowing of renal artery and dehydration condition. Thus, in the patient case the UTI and acute kidney infection is one of the main reasons of the high temperature and other clinical signs of the patient.
- What therapy is needed for John?
Answer: The therapy plan for John needs a full clinical assessment and vital signs for the diagnosis of upper and lower urinary tract infection along with blood test to identify kidney failure and imaging test. The therapy will include collection of blood cultures and urine specimen to test for disease sensitivity.
The management of UTI in John’s case can be effectively planned through antibiotic treatment when symptoms are present and adherence to good medication which will be useful to develop immune system. For the treatment of Upper UTI, the medication can be Co-amoxiclav for treatment of bacterial infections or Ciprofloxacin, an antibiotic to treat the infection due to UTI and help in rental function.
Ciprofloxacin in the patient case will be able to get filtered and secreted by the kidney due to its superior tissue penetration. Nitrofurantoin which is an antibacterial agent can be used for lower UTI to provide treatment of bladder infection and antibacterial medications can be followed for 7 to 14 days (Hooton, 2012).
The therapy for John needs to be optimal use of antimicrobials and apart from thus it will also include hydration as a goal of care for its dark urine which is also due to dehydration. The drinking of sufficient water by the patient will help to take away bacterium from the urinary tract and it will also lower the incidence of kidney failure.
Thus, it can be suggested that therapy for the patient with acute kidney disease will be majorly done through effective management of the urinary tract infection with the use of antibiotics with antibacterial action.
Agata, E. D., Loeb, M. B., & Mitchell, S. L. (2013). Challenges in assessing nursing home residents with advanced dementia for suspected urinary tract infections. Journal of the American Geriatrics Society, 61(1), 62-66.
Foxman, B. (2014). Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infectious disease clinics of North America, 28(1), 1-13.
Hooton, T. M. (2012). Uncomplicated urinary tract infection. New England Journal of Medicine, 366(11), 1028-1037.
Ödev, K., Turgut, A. T., & MacLennan, G. T. (2013). Inflammatory Conditions of the Kidney. In Genitourinary Radiology: Kidney, Bladder and Urethra (pp. 65-93). Springer London.
Perazella, M. A. (2015). The urine sediment as a biomarker of kidney disease. American Journal of Kidney Diseases, 66(5), 748-755.
Woodford, H. J., & George, J. (2009). Diagnosis and management of urinary tract infection in hospitalized older people. Journal of the American Geriatrics Society, 57(1), 107-114.