{"id":8311,"date":"2021-11-22T18:18:26","date_gmt":"2021-11-22T16:18:26","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/nephrology\/internal-aspects-of-urinary-tract-infection-and-stones\/"},"modified":"2022-01-08T13:53:34","modified_gmt":"2022-01-08T11:53:34","slug":"internal-aspects-of-urinary-tract-infection-and-stones","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/internal-aspects-of-urinary-tract-infection-and-stones\/","title":{"rendered":"Internal aspects of urinary tract infection and stones"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h2 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Urinary tract infections<\/h2>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">UTIs are typically spread as an ascending infection, but they can also be spread hematogenously, or directly (tissue destruction or through a penetrating injury).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Females are at a greater risk for UTIs. Certain drugs such as SGLT2 inhibitors can increase the risk for UTIs.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Classification<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">Urinary tract infections are generally classified based on the presentation, location, risk factors, and source of infection.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Presentation<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Asymptomatic<\/strong> (asymptomatic bacteruria)<\/li><li><strong>Symptomatic<\/strong><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Location<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Upper UTIs<\/strong><ul><li>Kidney (pyelonephritis)<\/li><\/ul><\/li><li><strong>Lower UTIs<\/strong><ul><li>Urinary bladder (cystitis)<\/li><li>Urethra<\/li><li>Prostate<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Risk factors<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Complicated UTI<\/strong><ul><li>Requiring catheterization<\/li><\/ul><ul><li>Secondary to structural abnormality, metabolic or neurological disorders<\/li><li>Immune-compromized<\/li><li>Pregnant<\/li><li>Diabetics<\/li><li>Renal transplants<\/li><li>Atypical microorganisms<\/li><\/ul><\/li><li><strong>Uncomplicated UTI<\/strong><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Source of infection<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Community-acquried<\/strong>. Due to bad hygiene and intercorse. <ul><li>Mostly E. coli, Staph. saprophiticus (in young women).<\/li><\/ul><\/li><li><strong>Hospital-acquired<\/strong>. Mostly catheter-associated. <ul><li>Mostly E. coli, Klebsiella, P. aeruginosa, Staph. epidermitis, Candida<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Symptoms<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\">Cystitis:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Polyuria<\/li><li>Painful urination<\/li><li>Hematuria<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Pyelonephritis:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Fever<\/li><li>Flank pain<\/li><li>Nausea and vomiting<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Complications<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<ul class=\"wp-block-list\"><li>Recurrent UTIs from incomplete treatment, or an infection from another agent<\/li><li>Permanent kidney damage, scarring and atrophy in chronic infections<\/li><li>Premature delivery and low birth weight in pregnancy<\/li><li>Urosepsis<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ul class=\"wp-block-list\"><li>Urinalysis<\/li><li>Culture and sensitivity analysis<\/li><li>Blood culture (when urosepsis is suspected)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_10\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_10\">\n\n\n<p class=\"wp-block-paragraph\">A culture and sensitivity analysis should be performed, and until the results are back, empirical treatment should be started.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>In patients without kidney impairment:<ul><li>Sulfamethoxazole-trimethoprime for 3 days<\/li><li>Fluoroquinolones (ciprofloxacin or levofloxacin, avoid in pregnancy)<\/li><\/ul><\/li><li>Ceftriaxone<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_11\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Prophylaxis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_11\">\n\n\n<ul class=\"wp-block-list\"><li>Proper wiping techniques (front to back)<\/li><li>Empty the bladder right after intercorse<\/li><li>Wear clean, well-fitting underwear<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_12\">\n<h2 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Urinary stones<\/h2>\n<\/span><span class=\"block-content\" id=\"contents_12\">\n\n\n<p class=\"wp-block-paragraph\">Urinary stones (calculi) can range from a microscopic collection of crystals to stones larger than a few centimeters.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Stones smaller than 5mm in diameter typically pass through the urinary system on their own, while stones larger than 5mm often get stuck and require intervention.<\/li><li><strong>Urolithiasis <\/strong>is the general term for urinary stones anywhere in the kidney, while <strong>nephrolithiasis <\/strong>describes urinary stones in the kidney.<\/li><li>Males are at a much higher risk for urinary stones (except for struvide calculi).<\/li><li>A lodged stone will induce inflammation and edema, further excrabating the situation.<\/li><li>Recurrence of stones is common.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_13\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Composition<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_13\">\n\n\n<p class=\"wp-block-paragraph\">Urinary stones usually have the composition of one of the above:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Calcium-oxalate (most common)<\/li><li>Calcium-phosphatre<\/li><li>Uric acid<\/li><li>Magnesium-ammonium-phosphate<\/li><li>Cystine (least common)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_14\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Calcium-oxalate and calcium-phosphate calculi<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_14\">\n\n\n<p class=\"wp-block-paragraph\">Calcium-containing calculi are usually present in conditions where urinary excretion of calcium is increased (<strong>hypercalciuria<\/strong>). They are the most common form of urinary calculi (with the vast majority of stones composed of calcium-oxalate).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Hypercalciuria may arise due to a hereditary condition (<strong>primary hypercalciuria<\/strong>), or due to secondary conditions such as:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Renal tubular acidosis type I<\/strong><\/li><li><strong>Primary hyperparathyroidism<\/strong><\/li><li>Sarcoidosis<\/li><li>Hyperthyroidism<\/li><li>Excess of vitamin D<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Hypocitriuria <\/strong>is present in a large portion of patients with calcium-containing stones, as citrate binds to calcium and helps eliminate it, and its decreased amounts in the urine will increase the tendency of calcium to crystalize.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_15\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Uric acid calculi<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_15\">\n\n\n<p class=\"wp-block-paragraph\">Uric acid calculi are typically the result of acidic urine (pH &lt;5.5) due to chronic dehydration and diarrhea, or more rarely, <strong>hyperuricosuria<\/strong>, caused by excessive intake of purines.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Uric acid calculi are radiolucent, meaning that they generally do not show up on x-ray or CT scans; they can be, however, visualized by using ultrasound.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_16\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Magnesium-ammonium-phosphate calculi<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_16\">\n\n\n<p class=\"wp-block-paragraph\">Magnesium-ammonium-phosphate calculi (also known as <strong>struvite <\/strong>or <strong>infection calculi<\/strong>) are the result of urate-splitting bacteria (such as Proteus or Klebsiella). <\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Struvites are much more common in females.<\/li><li>The stones often become lodged in the renal pelvis, and require manual removal adjacent to antibiotic therapy.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_17\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Cystine calculi<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_17\">\n\n\n<p class=\"wp-block-paragraph\">Cystine-containing calculi occur in patients with cystine transporter defects that cause <strong>cystinuria<\/strong>, and as a result, they are the rarest form of urinary calculi.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_18\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Symptoms<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_18\">\n\n\n<ul class=\"wp-block-list\"><li>Sudden and severe pain (flank or abdominal)<\/li><li>Nausea and vomiting<\/li><li>Hematuria<\/li><li>Sudden anuria (in occlusion of a single kidney\/urethra)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_19\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_19\">\n\n\n<ul class=\"wp-block-list\"><li>Urinalysis<\/li><li>US<\/li><li>CT<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_20\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_20\">\n\n\n<ul class=\"wp-block-list\"><li>Analgesics (NSAIDs, opiates with antiemetics)<\/li><li>Antispasmodics (alpha-blockers)<\/li><li>Antibiotics (in struvide calculi)<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Opiates (such as tramadol) also work by relaxing the smooth muscle, facilitating the expulsion of the stones.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Larger stones, stones that do not pass within several weeks, and struvides require manual removal, done using endoscopic methods (retrograde cysto\/urethroscopy), along with a urethral stent to help with the drainage, or percutaneously.<\/li><li>In case of obstruction, the pressure must be relieved as soon as possible to avoid hydronephrosis and permanent renal damage.<\/li><li>Alkalization of the urine (using potassium citrate) may help dissolve uric acid calculi (has no effect on other calculi).<\/li><li>Fluid loading does not speed up or improve the outcome of urinary stones.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_21\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Differential diagnosis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_21\">\n\n\n<ul class=\"wp-block-list\"><li>Appendicitis and peritonitis<\/li><li>Cholecystitis<\/li><li>Pancreatitis<\/li><li>Ileus<\/li><li>Herpes zoster<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Compared with appendicitis, where patients lie still to reduce pain, patients with urinary stones usually cannot stay still.<\/p>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h2 class=\"wp-block-heading\" class=\"wp-block-heading\">Urinary tract infections<\/h2><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Classification<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Presentation<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Location<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Risk factors<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Source of infection<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Symptoms<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Complications<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Prophylaxis<\/h3><h2 class=\"wp-block-heading\" class=\"wp-block-heading\">Urinary stones<\/h2><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Composition<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Calcium-oxalate and calcium-phosphate calculi<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Uric acid calculi<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Magnesium-ammonium-phosphate calculi<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Cystine calculi<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Symptoms<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Differential diagnosis<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>Urinary tract infections UTIs are typically spread as an ascending infection, but they can also be spread hematogenously, or directly (tissue destruction or through a penetrating injury). Females are at a greater risk for UTIs. Certain drugs such as SGLT2 inhibitors can increase the risk for UTIs. Classification Urinary tract infections are generally classified based [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":685,"menu_order":18,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8311","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Internal aspects of urinary tract infection and stones &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/internal-aspects-of-urinary-tract-infection-and-stones\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/nephrology\\\/internal-aspects-of-urinary-tract-infection-and-stones\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/nephrology\\\/internal-aspects-of-urinary-tract-infection-and-stones\\\/\",\"name\":\"Internal aspects of urinary tract infection and stones &#8211; 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