Download Pyelonephritis

Urinary tract infection
Dr.Nariman Fahmi
Objectives
• Define Urinary Tract Infection (UTI)
• Diagnosis of UTI
• treatment for UTI
Relationship of the Kidneys to
Vertebra and Ribs
They are retroperitoneal
and are located in the
abdominal cavity.
They are at the level of T12
to L3, so they are at the
costal margin, and the ribs
protect them a little.
Even though they are
protected by thoracic ribs,
they are NOT in the thoracic
cavity because they are
below the diaphragm.
4
Figure 23.1b
Case history
• A 9 year old girl with a 2 days history of loin pain ,fever
and vomiting, clinically she appears ill.
• a full blood count shows a Hb 12 mg/dl,
• WBC of 14x10( cells/L
• You send of a midstream urine sample for culture.
• prescribed paracetol and ask the patient came next
day. The next day you find that she has been reported
urine culture of more than 100 000colonies of E-Coli.
• What is the most probable diagnosis ??
• Which part of renal tract is most likely infected
and why??
• What choice of antibiotics??
• investigations that are needed
Urinary Tract Infections
Yes, it is a bacteriuria
Female
Male
Definition of UTI
A UTI can happen anywhere along the urinary tract.
UTI have different names, depending on what part of the
urinary tract is infected.
Bladder -- an infection in the bladder is
also called cystitis or a bladder infection
Kidneys -- an infection of one or both
kidneys is called pyelonephritis or a
kidney infection
Terminology
 Bacteriuria
Presence of bacteria in the urine
 Dysuria
Pain or difficulty in urinating
 Pyuria
Presence of/increased numbers of white blood cells in
the urine
• Most UTIs are from ascending bacteria
– E. coli (60-80%), Proteus, Klebsiella,
Enterococcus, and coag. neg. staph.
forms of UTI are
1-pyelonephritis
2-Cystitis
3- urithritis
4- prostitis
Cystitis (bladder involvement )
clinical fatures
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•
•
•
•
•
•
dysuria,
urgency,
frequency,
suprapubic pain,
incontinence,
malodorous urine.
Cystitis does not cause fever and does not result
in renal injury s
General urine exam
Microscopical exam
Pus cells in urine
DIAGNOSIS
urine culture
Imaging of the Renal tract
The goal of imaging studies in UTI is to identify
Anatomic abnormalities that predispose to infection and
identify scarring
* Renal U/S
* KUB
* DMSA
* IVU
* Cystogram
•VCUG/RNC
Reflux Seen on
Voiding
Cystourethrogram
(VCUG) using
transurethral
contrast
Urinary Tract Infection
• Upper urinary tract Infections:
– Pyelonephritis
• Lower urinary tract infections
– Cystitis (“traditional” UTI)
– Urethritis (often sexually-transmitted)
– Prostatitis
Symptoms of pyelonephritis
•
•
•
•
Hematuria
Fever
Nausea/Vomiting (pyelonephritis)
Flank pain (pyelonephritis)
Findings on Exam in UTI
• Physical Exam:
–
–
–
–
Costo Vertebral Angle tenderness (pyelonephritis)
Urethral discharge (urethritis)
Tender prostate on PRE (prostatitis)
Suprapubic tenderness (cystitis)
• Labs: Urinalysis
 Positive + WBCs
 Positive + RBCs
Culture in UTI
• Positive Urine Culture = >105 CFU/mL
• Most common pathogen for cystitis, prostatitis,
pyelonephritis:
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–
–
–
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Escherichia coli
Staphylococcus saprophyticus
Proteus mirabilis
Klebsiella
Enterococcus
• Most common pathogen for urethritis
• Chlamydia trachomatis
• Neisseria Gonorrhea
Pyelonephritis
• Infection of the kidney
• Associated with constitutional symptoms – fever,
nausea, vomiting, headache
• Diagnosis:
• Urinalysis, urine culture, CBC, Chemistry
• Treatment:
• 2-weeks of Trimethroprim/sulfamethoxazole
or fluoroquinolone ,cephalosporins
• Hospitalization and Intravenous antibiotics if
patient unable to take orally .
Question
• A 24-year old woman presents with fever,
chills, nausea, vomiting, flank pain and
tenderness. Her temperature is 40°C, pulse
rate is 120/min., and blood pressure is 100/60
mm Hg.
Question
• What further studies do you want in this
patient?
• How would you treat this patient?
• What might you do if she does not improve
after 3-4 days?