The urinary tract is divided into two parts:

• Upper
  • Kidneys
  • Ureters
• Lower
  • Bladder
  • Urethra

Uncomplicated UTIs occur when there isn’t a functional or anatomical abnormality. Females are the main target.

Complicated UTIs occur when there’s a functional or anatomical abnormality, such as bladder issues, kidney stones or diabetes mellitus.

In both forms, the most common bacterial cause of UTIs is Pee coli. That is, E. coli. Multidrug-resistant strains are emerging.

Acute pyelonephritis

Pyelonephritis means inflammation of the renal pelvis. Causes include:

• Ascending UTI, where bacteria march up the urinary tract
• Vesicoureteral reflux, which is where urine goes the wrong way up the urinary tract, due to an anatomical abnormality or blockage

Symptoms include:

• Fever and chills
• Flank pain
• Nausea and vomiting

Investigations can show leukocytes in the urine and blood, plus other generic markers of infection.

For treatment, collect urine samples before administering antibiotics. For mild cases, oral antibiotics are sufficient. For severe cases, IV antibiotics are warranted.

Acute cystitis

Cystitis means inflammation of the bladder.

Empirical treatment can be started in non-pregnant females with uncomplicated cystitis. In other cases, collect urine samples before administering antibiotics.

References

1. Urinary tract infections [revised 2015 Oct]. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited (eTG November 2017 edition); 2017 Nov.
2. Manski, D. (2017). Acute Pyelonephritis: Definition and Causes. [online] Urology Textbook. Available at: http://www.urology-textbook.com/acute-pyelonephritis.html [Accessed 29 Dec. 2017].
3. Shah, V. and Gaillard, F. (2017). Acute pyelonephritis. [online] Radiopaedia. Available at: https://radiopaedia.org/articles/acute-pyelonephritis-1 [Accessed 29 Dec. 2017].
4. Better Health Channel. (2017). Cystitis. [online] Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cystitis [Accessed 29 Dec. 2017].
5. Mayo Clinic. (2017). Vesicoureteral reflux. [online] Available at: https://www.mayoclinic.org/diseases-conditions/vesicoureteral-reflux/symptoms-causes/syc-20378819 [Accessed 29 Dec. 2017].
6. Healthline. (2017). Pyelonephritis | Definition & Patient Education. [online] Available at: https://www.healthline.com/health/pyelonephritis#risk-factors [Accessed 29 Dec. 2017].
7. Colgan, R., Williams, M. and Johnson, J. R. (2011). Diagnosis and Treatment of Acute Pyelonephritis in Women. [online] American Family Physician. Available at: https://www.aafp.org/afp/2011/0901/p519.html [Accessed 29 Dec. 2017].
8. Harding, M. (2016). Pyelonephritis. [online] Patient. Available at: https://patient.info/doctor/pyelonephritis [Accessed 29 Dec. 2017].