Balaji Medical and Educational Trust
| Chronic Kidney Failure is one of the Deadliest disease. Yet, it is least understood. |
 |
| Dr.Rajan Ravichandran MD,MNAMS,FRCP(Edin),FACP(USA) Nephrologist |
|
URINARY TRACT INFECTION
Urinary tract infection is a common problem. There is a 50% chance of a woman getting it in her
life-time. It can be very disturbing and occasionally life-threatening. Urinary tract infection is more
common in females because of the short urinary passage (Urethra) and the injury that can happen
during sexual act. There are several misconceptions regarding urinary tract infection both among lay
people and many doctors. Colonisation of the urinary tract by organisms is called urinary tract
infection. The urinary tract consists of a collecting system in kidney, ureter (tube from the kidney to
the bladder), bladder and lastly the urethra. The kidneys and the ureter constitute the upper urinary
tract. Bladder and urethra constitute the lower urinary tract. The urinary tract is devoid of any
organisms till the terminal portion where it is exposed to the atmosphere. Infections occur once the
organisms ascend to the bladder and the kidneys. Males get urinary tract infections either in the first
year of life due to abnormalities in the urinary tract from birth or after the age of sixty when the
prostate gland blocks the urinary tract. Otherwise during the sexually active period, it is
predominantly a disease of the females.
Causes of the Urinary Infection:
Urinary infection can be community-acquired or acquired in the hospital due to instrumentation of the
urinary tract (bladder catheterisation). Community-acquired infections are bacterial in origin and the
commonest organism is called E.Coli. Hospital- acquired infections can be caused in addition to
multiple bacteria by fungi.
Symptoms of Urinary Tract Infection:
Classical symptoms of urinary infections are painful urination (dysuria) and increased frequency of
urination. This results from an irritation of the bladder and urethra. Urinary infections normally should
not be diagnosed in the absence of these symptoms. Discolouration and passing of blood in urine in
isolation (i.e) without dysuria do not indicate urinary infections. Fever, lower abdominal pain, and
backache occur in upper urinary tract infection in the absence of symptoms if organism grow in the
urine on checking in the laboratory, it is called asymptomatic bacteriuria. This is a laboratory test and
does not require treatment except in rare situations. Dysuria or painful micturation can happen in the
absence of urinary infection due to inflamation or injury to urethra (urethral syndrome). Thus
differentiation between upper and lower urinary tract infection and urethral syndrome is important to
decide the line of treatment.
Diagnosis:
It is essentially by history, sudden onset of dysuria with increased frequency is almost diagnostic of
urinary infection. Laboratory test only confirms it and helps to decide the choice of drug.
Interpretation of urine reports:
Presence of pus cells in the urine indicates an inflamation of the urinary tract. The commonest cause
of this is infection. However, stones, tumours, nephritis can all produce pus cells in the urine.
Presence of albumin is not a feature of uncomplicated urinary tract infection. It indicates usually a
disease of the kidneys. Presence of the epithelial cells indicates contamination during collection of
urine sample. The ideal way to collect is to clean the private part with water, the initial few ml in urine
should be discarded and subsequently urine should be collected in a clean/sterilized container. It is
called a mid stream sample or clean catch specimen. It should be transported to the laboratory
immediately.
Urine Culture :
This test is fraught with errors due to poor collection. It is absolutely essential to mention the colony
count while giving the result of culture. Colony counts > 10-5 are only considered significant. Beware
of urine culture reports without colony counts. Apart from the type of bacteria, culture report should
contain the list of drugs with antibacterial sensitivity. This will help to decide the drug to be given for
treatment. The drug with least toxicity, narrow spectrum of action and with good tissue penetration
should be chosen.
Other investigations :
Detailed investigation like ultrasound, x-rays, Cystoscopies are required in certain situations
mentioned below.
Treatment of urinary tract infection:
This depends upon whether it is community-acquired or hospital-acquired, upper or lower urinary
tract infection. Lower urinary tract infections acquired in the community can be treated with simple
drugs including single-dose antibiotics. Other infections require longer period of antibiotics.
Prevention of urinary infection in sexually active females :
Role of water in Urinary Tract Infection:
Consumption of large quality of water can reduce urinary tract irritation. However it can also dilute the
antibiotic administered.
Role of alkaline mixture:
Alkaline mixture can also symptomatically relieve urinary irritation. How-ever it cannot eradicate
infections.
Diet:
High animal protein in the diet leads to a highly acidic urine. This can increase urinary irritation.
Vegetables reduce the acidity in urine and make it alkaline.
Highlights:
References
1. Madras Institute Of Nephrology, Chennai, India
2. www.kidneytransplant.org
Urinary tract infection is a common problem. There is a 50% chance of a woman getting it in her
life-time. It can be very disturbing and occasionally life-threatening. Urinary tract infection is more
common in females because of the short urinary passage (Urethra) and the injury that can happen
during sexual act. There are several misconceptions regarding urinary tract infection both among lay
people and many doctors. Colonisation of the urinary tract by organisms is called urinary tract
infection. The urinary tract consists of a collecting system in kidney, ureter (tube from the kidney to
the bladder), bladder and lastly the urethra. The kidneys and the ureter constitute the upper urinary
tract. Bladder and urethra constitute the lower urinary tract. The urinary tract is devoid of any
organisms till the terminal portion where it is exposed to the atmosphere. Infections occur once the
organisms ascend to the bladder and the kidneys. Males get urinary tract infections either in the first
year of life due to abnormalities in the urinary tract from birth or after the age of sixty when the
prostate gland blocks the urinary tract. Otherwise during the sexually active period, it is
predominantly a disease of the females.
Causes of the Urinary Infection:
Urinary infection can be community-acquired or acquired in the hospital due to instrumentation of the
urinary tract (bladder catheterisation). Community-acquired infections are bacterial in origin and the
commonest organism is called E.Coli. Hospital- acquired infections can be caused in addition to
multiple bacteria by fungi.
Symptoms of Urinary Tract Infection:
Classical symptoms of urinary infections are painful urination (dysuria) and increased frequency of
urination. This results from an irritation of the bladder and urethra. Urinary infections normally should
not be diagnosed in the absence of these symptoms. Discolouration and passing of blood in urine in
isolation (i.e) without dysuria do not indicate urinary infections. Fever, lower abdominal pain, and
backache occur in upper urinary tract infection in the absence of symptoms if organism grow in the
urine on checking in the laboratory, it is called asymptomatic bacteriuria. This is a laboratory test and
does not require treatment except in rare situations. Dysuria or painful micturation can happen in the
absence of urinary infection due to inflamation or injury to urethra (urethral syndrome). Thus
differentiation between upper and lower urinary tract infection and urethral syndrome is important to
decide the line of treatment.
Diagnosis:
It is essentially by history, sudden onset of dysuria with increased frequency is almost diagnostic of
urinary infection. Laboratory test only confirms it and helps to decide the choice of drug.
Interpretation of urine reports:
Presence of pus cells in the urine indicates an inflamation of the urinary tract. The commonest cause
of this is infection. However, stones, tumours, nephritis can all produce pus cells in the urine.
Presence of albumin is not a feature of uncomplicated urinary tract infection. It indicates usually a
disease of the kidneys. Presence of the epithelial cells indicates contamination during collection of
urine sample. The ideal way to collect is to clean the private part with water, the initial few ml in urine
should be discarded and subsequently urine should be collected in a clean/sterilized container. It is
called a mid stream sample or clean catch specimen. It should be transported to the laboratory
immediately.
Urine Culture :
This test is fraught with errors due to poor collection. It is absolutely essential to mention the colony
count while giving the result of culture. Colony counts > 10-5 are only considered significant. Beware
of urine culture reports without colony counts. Apart from the type of bacteria, culture report should
contain the list of drugs with antibacterial sensitivity. This will help to decide the drug to be given for
treatment. The drug with least toxicity, narrow spectrum of action and with good tissue penetration
should be chosen.
Other investigations :
Detailed investigation like ultrasound, x-rays, Cystoscopies are required in certain situations
mentioned below.
- All males with urinary tract infection.
- Females in childhood or above the age of sixty.
- Sexually active females if there are recurrent of repeated urinary tract infections.
Treatment of urinary tract infection:
This depends upon whether it is community-acquired or hospital-acquired, upper or lower urinary
tract infection. Lower urinary tract infections acquired in the community can be treated with simple
drugs including single-dose antibiotics. Other infections require longer period of antibiotics.
Prevention of urinary infection in sexually active females :
- Good personal hygiene and passing of urine after sexual act.
- Low-dose antibiotic after sexual act.
- Pro-longed night time low-dose antibiotic.
Role of water in Urinary Tract Infection:
Consumption of large quality of water can reduce urinary tract irritation. However it can also dilute the
antibiotic administered.
Role of alkaline mixture:
Alkaline mixture can also symptomatically relieve urinary irritation. How-ever it cannot eradicate
infections.
Diet:
High animal protein in the diet leads to a highly acidic urine. This can increase urinary irritation.
Vegetables reduce the acidity in urine and make it alkaline.
Highlights:
- Urinary infection is a CLINICAL DIAGNOSIS. The laboratory is used for only confirmation. In the
absence of symptoms do not treat urinary infection except is special situations. - Laboratory examination is fraught with errors.
- Differentiate upper and lower urinary tract infections.
- Investigate persons who are not vulnerable (other than sexually active females).
- Prevent urinary infections by simple measures.
References
1. Madras Institute Of Nephrology, Chennai, India
2. www.kidneytransplant.org