**10. References**


It has been well documented that bladder outlet obstruction by an enlarging prostate can lead to renal insufficiency. Relationship between symptoms severity and elevated serum creatinine in men with BPH have not been well defined. Recent data make us believe that combination of all these factors leading to chronic and progressive urinary retention, high bladder pressure, ureterohydronephrosis work together causing progressive renal injury. Obstructive process root cellular and physiological changes in bladder muscle and collagen, contribute to a high pressure bladder that perpetuates itself with worsening ability to empty

The advent of medical treatment has obviated the need for surgery in many patients with BPH. Men in acute urinary retention or those with urinary tract infection and other BPHcomplications, may benefit from more aggressive BPH treatment to prevent renal failure,

Other kidney risk factors such as diabetes mellitus, cardiovascular disease, hypertension, obesity and dyslipidemia may also be considered in the patient with BPH. Etiology of CKD is often multifactorial and BPH may accelerate the progression of CKD in other disease

Older men with BPH often tolerate and ignore lower urinary tract symptoms and may not present for medical consultation until they develop uremic syndrome. Thus, these patients should have prostatic obstruction considered during evaluation and treatment as this

We emphasize that CKD secondary to BPH is a preventable disease, and if early detected can prevent costs of CKD treatment (including hemodialysis) with considerable saves

Findings that we mentioned in this chapter suggest that progressive nephropathy caused by prostatic/bladder outflow obstruction – urinary outflow obstruction – might be averted by

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**22**

Suzanne Geerlings *Infectious Disease specialist,* 

*The Netherlands* 

*Academic Medical Center, Amsterdam* 

**Asymptomatic Bacteriuria (ASB), Renal Function and Hypertension** 

*Department of Internal Medicine, Division of Infectious Diseases,* 

*Tropical Medicine and AIDS Center for Infection and Immunity Amsterdam (CINIMA)* 

Chronic kidney disease is an increasing public health problem. In the United States, the prevalence is estimated to be approximately 11% of the adult population. Chronic kidney disease may progress to end-stage renal failure, a condition associated with high morbidity and mortality. Diabetes mellitus (DM) is one of the main causes of kidney disease and endstage renal failure. In the United States, DM is the primary diagnosis in 44% of all new cases of renal replacement therapy. Vascular complications are the most common cause of diabetic nephropathy, but it is possible that urinary tract infections (UTIs) also contribute to renal

The urinary tract is normally sterile. However, asymptomatic bacteriuria (ASB), which is defined as the presence of a positive urine culture with at least 10e5 cfu/ml collected from a patient without symptoms of a UTI, is a common phenomenon, especially in women. Different studies report a prevalence of approximately 1-5% among healthy young women, increasing to over 20% in the elderly and 12-26% in women with DM. A Swedish study among 1,462 adult women showed that women with bacteriuria at study entry had an increased risk of having bacteriuria six and twelve years later, compared to women without bacteriuria (Odds Ratio (OR) 6.9 and 3.1, after six and twelve years, respectively). Another Swedish study among 116 schoolgirls with ASB showed that at baseline renal parenchymal reduction was found in 10.3%, while reflux was found in 20.7%, but only 30% of the 116 patients had a history referable to an earlier UTI. A 3-year follow-up of these 116 schoolgirls with ASB (treated or untreated) showed that the risk of developing renal damage as a result of ASB in a schoolgirl with a roentgenographically normal urinary tract seemed to be small. *Escherichia coli* is the most prevalent causative microorganism in both symptomatic and asymptomatic bacteriuria, accounting for more than 80% of uncomplicated UTIs. Previous studies have demonstrated that patients with renal scarring due to pyelonephritis are at increased risk for the development of hypertension and chronic kidney disease. Results from previous in vitro and in vivo studies indicate that a UTI with *E. coli* can lead to renal damage, either by the microorganism itself or by the following host response. For instance, it has been shown that type 1 fimbriae (the adhesive organelles at the outer surface of the bacterial

**1. Introduction** 

insufficiency in patients with DM.

