Urinary tract infections: Pathology review
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Urinary tract infections: Pathology review
Renal system
Renal and ureteral disorders
Renal agenesis
Horseshoe kidney
Potter sequence
Hyperphosphatemia
Hypophosphatemia
Hypernatremia
Hyponatremia
Hypermagnesemia
Hypomagnesemia
Hyperkalemia
Hypokalemia
Hypercalcemia
Hypocalcemia
Renal tubular acidosis
Minimal change disease
Diabetic nephropathy
Focal segmental glomerulosclerosis (NORD)
Amyloidosis
Membranous nephropathy
Lupus nephritis
Membranoproliferative glomerulonephritis
Poststreptococcal glomerulonephritis
Goodpasture syndrome
Rapidly progressive glomerulonephritis
IgA nephropathy (NORD)
Lupus nephritis
Alport syndrome
Kidney stones
Hydronephrosis
Acute pyelonephritis
Chronic pyelonephritis
Prerenal azotemia
Renal azotemia
Acute tubular necrosis
Postrenal azotemia
Renal papillary necrosis
Renal cortical necrosis
Chronic kidney disease
Polycystic kidney disease
Multicystic dysplastic kidney
Medullary cystic kidney disease
Medullary sponge kidney
Renal artery stenosis
Renal cell carcinoma
Angiomyolipoma
Nephroblastoma (Wilms tumor)
WAGR syndrome
Beckwith-Wiedemann syndrome
Bladder and urethral disorders
Posterior urethral valves
Hypospadias and epispadias
Vesicoureteral reflux
Bladder exstrophy
Urinary incontinence
Neurogenic bladder
Lower urinary tract infection
Transitional cell carcinoma
Non-urothelial bladder cancers
Renal system pathology review
Congenital renal disorders: Pathology review
Renal tubular defects: Pathology review
Renal tubular acidosis: Pathology review
Acid-base disturbances: Pathology review
Electrolyte disturbances: Pathology review
Renal failure: Pathology review
Nephrotic syndromes: Pathology review
Nephritic syndromes: Pathology review
Urinary incontinence: Pathology review
Urinary tract infections: Pathology review
Kidney stones: Pathology review
Renal and urinary tract masses: Pathology review
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Urinary tract infections: Pathology review
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Contributors
Ursula Florjanczyk, MScBMC
Anca-Elena Stefan, MD
Kaylee Neff
Tanner Marshall, MS
Two people came to the Nephrology ward.
The first one is 25 year old Carmen who recently returned from her honeymoon and now complains of suprapubic pain, dysuria and urinary frequency.
The other one is 35 year old Pamela who has had dysuria, fever, nausea and flank pain for the past 2 days.
On physical exam, she has costovertebral angle tenderness.
CBC and urinalysis were done for both people.
They showed that Carmen had a normal white blood cell count, but on the dipstick test, leukocyte esterase and nitrites were both positive.
For Pamela, the white blood count was high, the dipstick test showed positive leukocyte esterase and nitrites, and on microscopy, there’s white blood cell casts in the urine.
Both Pamela and Carmen have urinary tract infections, or UTIs.
This includes the lower portion of the tract like the bladder and urethra, and the upper portion of the tract like the kidneys and ureters.
UTIs are almost always caused by an ascending infection, where bacteria moves from the rectal area to the urethra and then migrate up the urethra and into the bladder.
Normally, bacteria would be washed away with urination, but in some cases, like with E. Coli, that doesn’t happen.
Instead, E. Coli uses little thread-like extensions called fimbriae to bind the uroepithelial cells and colonize the bladder mucosa, causing cystitis.
From the bladder, the infection can go up the ureter and into the kidney, where they attract neutrophils into the renal interstitium, causing pyelonephritis.
Summary
Urinary tract infections (UTIs) are common bacterial infections that can occur in any part of the urinary tract, including the kidneys, bladder, ureters, and urethra. They are most commonly caused by bacteria, such as E.coli, Klebsiella pneumoniae, Proteus mirabilis, and Staphylococcus saprophyticus.
Symptoms include pain or burning sensation when urinating, frequent urge to urinate, cloudy or strong-smelling urine, pain or pressure in the lower abdomen or back, and in more severe cases, fever or chills.
Risk factors for UTIs include female gender, sex, diabetes mellitus, indwelling catheters, pregnancy, and kidney stones. Complications of untreated or recurrent UTIs can include cystitis, pyelonephritis, and sepsis. Treatment typically involves a course of antibiotics and plenty of fluids to help flush out the bacteria.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Practical Renal Pathology, A Diagnostic Approach E-Book" Elsevier Health Sciences (2012)
- "Diagnosis and management of urinary infections in older people" Clinical Medicine (2011)
- "Urinary tract infections in women" European Journal of Obstetrics & Gynecology and Reproductive Biology (2011)
- "Uncomplicated Urinary Tract Infection in Adults Including Uncomplicated Pyelonephritis" Urologic Clinics of North America (2008)
- "Risk Factors Associated with Acute Pyelonephritis in Healthy Women" Annals of Internal Medicine (2005)
- "Diagnosis and Management of Acute Ureterolithiasis" American Journal of Roentgenology (2000)
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