URINARY TRACT STRUCTURE

&
INFECTION

 F 30y/o, fever, chills, nausea, right flank

pain for 2 days.
dd: acute pyelonephritis
Anamnesis:
Irritative symptoms,
what were her initial symptoms,
did she have similar episodes in the past
any preceding risk factors
Coitus, withholding urination, instrumentation,.

Dx: PE, Lab, imaging

Treatment and advise

Infection of the Urinary Tract

Asymptomatic bacteriuria,
presence of bacteria in UT, absence of symptoms,
colonization from female periurethral area
Significant bacteriuria = > 100.000 bct/ ml
in 2 voided specimens or 1 in-out catheter specimen in a
woman, or 1 voided specimen in a man
Treatment only when risk factors for potential
complicated UTI, eg pregnancy,

Acute UTI

Lower UTI : dysuria, frequency, urgency.

Upper UTI : infection involving the kidney
Complicated, uncomplicated
Clinical presentation in children more variable and frequently
nonspecific
Cystitis
Prostatitis, urethritis
Acute bacterial Pyelonephritis: bacterial invasion of the kidney,
clinical syndrome w/ chills and fever, flank pain,
constitutional symptoms
Chronic pyelonephritis, path ~ tubulointerstitial nephritis
caused by # of disorders: VUR, chronic obstructive uropathy,
drugs & toxins, renal medullary ds,
chronic / recurrent renal bacteriuria
Complicated infection :abnormal anatomy,
obstruction, dilatation & impaired drainage
risk of renal damage, abcess formation,septicemia

85%

50%

Urease

Proteus mirabilis, P vulgaris, S saprophyticus

Involved in tissue adherence
Splitting urea into into CO2 & Ammonia
Urinary alkalinization
Precipitation of Mg, NH4, PO4
Stone formation, struvite

Investigation of UTI
5

Dx: Microbiological: bacterial count >10 CFU /ml

Midstream urine collection
Women, introitus should be cleaned with NaCl,
midstream urine is collected with the labia spread apart
Suprapubic aspiration ( infants % children )
Urine can be stored at 4C for up to 48h before culture
Infection may be present CFU 10 2 - 10 5
Mixed culture w/ low colony counts in F ~ contamination
Urinalysis ~first line screen, nitrates, leucocytes
+ hematuria, proteinuria
Urine microscopy, white cell casts ~ renal parenchymal
infection

IVP
Obstructions
Prostate,
Urethral stricture

Congenital anomalies
Of urinary tract:
Reflux, urethral valves

Abscess

Displacement / lateral ectopia

Of the ureteric orifice,
Loss of valve like action

Treatment of UTI
Most cases, uncomplicated lower UTI, 3 day course of
antibiotics, no culture needed
Trimethoprim, cephalexin, amox/clavulanate, ciprofloxacin
Relapsing infections , 10 14 days
if persist / recurs, further investigation
Prophylactic low dose antibiotics for recurrent, >3x/y UTI
In patients w/ clear relation between infection and sexual
activity, single dose after intercourse may be effective
Acute pyelonephritis ~ Rx in Hospital, IV fluids &
antibiotics started before culture results
Antibiotics IV oral , 2 weeks
If no improvement in 48H, review AB, further investigation
(obstruction, abscess?)