??????(lower urinary tract infections)??????????????????,???????(upper urinary tract infections)????????????????????????(hematogenous)??

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• ???????????,?????????????????????????????????????
  ??????????????????
• ?????(????)???50????????????,?????????????(???????
  ??)???
• ??????(lower urinary tract infections)????????????
  ??????,???????(upper urinary tract
  infections)????????????????????????(hematogenous)?
  ?

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Definitions (??)

• Bacteriuria(???)- bacteria in urine
• Pyuria(???)- WBCs in urine
• Uncomplicated- healthy patient with a
  structurally and functionally normal urinary
  tract.
• Complicated- obstruction, anatomic or functional
  disorder, calculi, instrumentation, incontinence,
  pregnancy.
• Unresolved bacteriuria- resistence, multiple
  organisms, rapid reinfection, azotemia, papillary
  necrosis, infected stones or foreign body,
  patient noncompliance
• Recurrent infection- persistence or reinfection

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Pathogenesis(1)

• Ascending infection
• - most common
• Hematogenous spread
• - immunocompromised and neonates
• - uncommon except Staphylococcus, Candida and
  TB
• Lymphatogenous spread
• - little evidence,
• iatrogenic?
• Direct extension
• - intraperitoneal abscess, vesicointestinal or
  V-V fistula

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Pathogenesis(2)

• Host factor
• - Anatomic or functional abnormalities
• - Secretion of IL-8 from renal cells may
  participate in the
• initiation and maintenance of renal
  inflammation.
• - Increase adherence due to more receptors
• - Change of pH or estrogen levels, Zn
• Bacterial factors
• - Uropathogenic E.coli(O,K,H) have
  pili(type1, P) and
• hemolysin, resistant to serum
  bactericidal activity

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Pathogenesis(3)

• Causative pathogens
• - aerobic
• ? Escherichia coli(80), Proteus
  mirabilis, Klebsiella
• ? Staphylococci, Pseudomonas(nosocomial)
• - anaerobic bacteria (suppurative infections)
• ? Bacteroides fragilis, Clostridium
  perfringens
• Diabetes more likely caused by Klebsiella, group
  B streptococci
• S. saprophyticus causing approximately 10 of
  symptomatic lower UTIs in young, sexually active
  females

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???????

• ??(urinary urgency)
• ??(urinary frequency),?????????????????(urinate)
• ??(nocturia)????????
• ???(urethritis)?????????????,??????????
• ????(dysuria)
• ??(pyuria)?????????
• ??????
• ??????
• ??????
• ????(urinary incontinence)

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???????

• ??
• ??
• ??(back pain)???(flank pain)??????(groin pain)
• ??(Abdominal pain)
• Knocking pain at CV angle
• Shaking chills and high spiking fever
• ?????
• ????

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Diagnosis

• Urine Collection
• midstream urine collection
• urethral catheterization
• suprapubic aspiration
• Localization study
• Urinalysis
• Pyuria- gt5WBC/HPF(M), gt20WBC/HPF(F)
• Pyuria may be present in the absence of UTI(25)
• Sterile pyuria- antibiotic effect, atypical
  organisms, tumor, stones
• Dipstick tests for bacteriuria (nitrite) or
  pyuria (leukocyte esterase) less sensitive
• Urine culture-- gt105 CFU/ml

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E.Coli in urine analysis
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Kidney infection

• Acute pyelonephritis inflammation of kidney and
  renal pelvis, diagnosis made clinically
• Presentations-- chills, fever, and costovertebral
  angle tenderness
• CT scan perfusion defects (segmental, multifocal
  or diffuse), renal enlargement
• Tx parenteral antibiotics for 7-10 days then
  oral antibiotics for 10-14 days

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Kidney infection

• Chronic Pyelonephritis
• Repeat renal infection-gt renal scarring, atrophy
  and renal insufficiency.
• Refers to radiologic findings of the small,
  contracted, atrophic kidney, focal coarse
• Correct underlying problems, prophylactic
  antibiotics
• Removal if hypertension or nonfunction with stone
  burden

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Kidney infection

• Emphysematous Pyelonephritis
• acute necrotizing infection caused by gas-forming
  uropathogens(E.coli, Klebsiella)
• 80-90 have DM
• KUB and CT gas presentation
• Poor prognosis CRE?, Platelet?, renal/perirenal
  fluid in association with a bubble/loculated gas,
  gas in collecting system
• Tx Drainage combination with medical treatment

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Kidney infection

• Renal Abscess
• Renal/ Perinephric / Paranephric abscess
• Most hematogenous spread before but now E.coli
  more common
• Ultrasonography echo-free or lowecho-density
  space-occupying lesion
• CT hypodnesity-gt fluid collection with rim
  enhancement
• Tx empiric therapy plus aminoglycoside or
  3rd-generation cephalosporin
• Percutaneous drainage is indicated if treatment
  failure

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Kidney infection

• Xanthogranulomatous Pyelonephritis????????
• rare, severe, chronic infection ?diffuse renal
  destruction.
• Lipid laden macrophages, mistaken for RCC
• Most unilateral, nonfunctioning, enlarged kidney
  associated with obstructive uropathy secondary to
  nephrolithiasis.
• CT large heterogenous, reniform mass with
  central calcification
• Nephrectomy

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• ???(1600-2000ml/day),????,
• ?????????,
• ??????????,????????? (cranberry supplements),
  ??(berry)???
• ???????????????C,?????????

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