Description
Urinary tract infections are common bacterial infections that can affect any part of the urinary system, including the bladder, urethra, and kidneys. If left untreated, a UTI can progress to kidney involvement, a condition known as pyelonephritis. Pyelonephritis typically presents with symptoms such as high fever, chills, flank pain, and nausea, in addition to the usual UTI symptoms like frequent urination and a burning sensation during urination. Kidney involvement in UTIs is a serious condition and requires prompt medical attention.Diagnosis involves urine tests, blood tests, and imaging (such as ultrasound or CT scan) to confirm kidney involvement. Treatment for kidney involvement often includes antibiotics to clear the infection and medications to manage pain and fever. Severe cases of pyelonephritis may require hospitalization for intravenous antibiotics and supportive care. After recovery, it's essential to follow up with a healthcare provider to prevent future UTIs and kidney involvement through lifestyle changes and sometimes prophylactic antibiotics.
Summary Listen
- Urinary tract infections (UTIs) are defined as microbial infiltration of the sterile urinary tract, commonly caused by ascending bacterial infections or bacteremia. Uncomplicated UTIs, often seen in women due to anatomical factors, are mainly caused by uropathogenic E. coli (UPEC) and other pathogens like Klebsiella species and Proteus mirabilis. Symptoms include dysuria, increased frequency, and hematuria for cystitis, while pyelonephritis presents with fever, nausea, vomiting, and flank pain. Diagnosis involves urine examination, culture, and sometimes imaging.
- Treatment for uncomplicated cystitis includes nitrofurantoin, trimethoprim-sulfamethoxazole (cotrimoxazole), or fosfomycin, while acute uncomplicated pyelonephritis requires empiric therapy with third-generation cephalosporins, extended-spectrum penicillins, or aminoglycosides. Symptomatic relief for cystitis can be achieved with phenazopyridine. Recurrent UTIs in women are defined as two infections in six months or three in a year, caused by intracellular bacterial complexes and poor host defenses. Management involves low-dose antibiotic prophylaxis and postcoital antibiotic prophylaxis.
- Complicated UTIs are associated with structural or functional abnormalities of the genitourinary tract or underlying diseases. Common causes include indwelling catheters, postvoid residue, obstructive nephropathy, and conditions like diabetes and immunodeficiency. Special forms include pyonephrosis, emphysematous pyelonephritis, xanthogranulomatous pyelonephritis, and malacoplakia. Asymptomatic bacteriuria does not require treatment except in pregnant women and those undergoing urological procedures.
- Sterile pyuria, indicated by significant pyuria with no bacterial growth, may point to tuberculosis or allergic interstitial nephritis. Tuberculosis presents with acidic urine and granulomas in the kidney, while allergic interstitial nephritis is characterized by eosinophils. Treatment of complicated UTIs involves addressing the underlying cause and using appropriate antibiotics, while the duration of antibiotic therapy for pyelonephritis depends on the severity and presence of complications.
- Renal stones, especially struvite stones, can act as a nidus for infection, requiring complete stone removal under antibiotic cover. Catheter-associated UTIs are best prevented through aseptic catheter insertion techniques, and the choice of catheter material does not significantly affect infection risk. Stenting is used for pyonephrosis, papillary necrosis and to relieve obstruction. Cranberry and D-mannose may provide some benefit in recurrent UTIs, but are not treatment.
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About the Speakers
Dr. Prashant Rajput
Consultant Nephrologist & Transplant Physician,Global Hospital & Transplant Center,Mumbai
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