Bladder And Kidney Infections
BLADDER AND KIDNEY INFECTIONS
The terms cystitis and pyelonephritis refer respectively to infections of the urinary bladder and the kidney. Urinary tract infection (UTI) is a general term referring to both types of infections. The usual cause of such infections are bacteria which are normally found in the large intestine, the commonest of which is a bacterium called e. coli.
Probably because of anatomic factors involving the proximity of the urethra and bladder to the anal area, women are far more prone to UTI’s than are men. Furthermore, intercourse and various hygienic activities can exaggerate this mechanical- anatomic relationship. Thus when a woman gets an uncomplicated urinary infection it is usually not because of some other problem in the urinary tract; men, on the other hand, rarely get a UTI without some additional urinary disorder such as an enlarged prostate, a kidney stone, etc.
SYMPTOMS
Burning with urination, frequency and urgency, lower abdominal cramping pain, and occasionally bloody or cloudy urine all are common in bladder infections. The presence of a fever over 100 degrees, chills, back pain, or severe symptoms raise the suspicion of kidney involvement, which usually occurs from a bladder infection climbing up the ureters to the kidney.
DIAGNOSIS
The characteristic symptoms will lead to a microscopic evaluation of the urine in most cases. The presence of abnormal numbers of white blood cells, sometimes with red cells suggests infection. Infections of the urethra (tube from the bladder to the opening on the outside of the penis or upper vaginal area) can sometimes be difficult to distinguish from a true bladder infection in this way. Many physicians will culture the urine in a special material for a day or two to confirm the presence of abnormal numbers of bacteria, and to identify which strain is involved. Others, knowing that the odds are very high that the bacteria is one of a very few types, might proceed to treatment without further studies. Findings further suggesting that the kidneys may be involved include tenderness to firm clapping on the flank areas.
TREATMENT
A simple bladder infection ma be treated with 90% success using a simple single dose of any of several antibiotics including ampicillin, amoxicillin, Bactrim or Septra, sulfa, and others. In the 10 per cent of patients who fail to respond to this, the bacteria may be resistant to the drug, early kidney involvement may already be involved, or some other problem may be complicating the situation. Some doctors still treat immediately with a full 10 day course of medication. If urethritis (see above) is suspected, tetracycline and related drugs may be chosen since it would cover most of the germs common to both types of infection.
If kidney infection, or pyelonephritis, is likely, much more aggressive therapy and follow-up are used. Some patients who are able to drink readily and are not critically ill may be treated at home with oral medication, whereas many others may require hospitalization for intravenous fluid and medication. Cultures of urine and blood may be done, and treatment begun with ampicillin, sulfa or combination drugs, or some of the “-mycin” drugs. Blood poisoning and shock may occur, and careful observation is very important.
Some cases of recurrent, persistent, or unusual types of infection may require very long courses of therapy, up to 6 months or more. In selected cases, lifelong treatment with lower suppressive doses of an antibiotic may be the only way to control infections. Other preventive measures for some patients include ample fluid intake, acidifying of the urine with high doses of vitamin C under a doctor’s supervision, and prompt emptying of the bladder following intercourse.
Further diagnostic tests to exclude some of the predisposing conditions mentioned above include x-rays of the kidneys and cystoscopy of the bladder, where a viewing instrument is passed into the urethra under local or light general anesthesia. Some indications for doing one or both of these include infections in males, highly persistent or difficult to cure infections, frequent recurrences without other explanation, or abnormal kidney function.
INFECTION WITHOUT SYMPTOMS
From time to time a routine urine analysis will disclose a urinary infection in a patient with no symptoms. This may be the first clue to some unsuspected urinary abnormality, but more often represents a low- grade infection. Where there is no other complication present, these patients do not seem to suffer any serious permanent harm from this, although they are probably at increased risk for developing symptomatic episodes compared to those with no low-grade infection. One exception is pregnant women in whom the presence of bacteria without symptoms is associated with a 25% incidence of kidney infection later during pregnancy. Whether to treat the non-pregnant group is unclear at this time, but many physicians will do so if there are no contra-indications to doing so; in the chronic situation where multiple previous episodes have resisted or recurred after treatment, it may also be prudent to simply observe until such time that symptoms or kidney dysfunction occur.
SUMMARY
As the commonest of all bacterial infections, urinary infections are experienced by millions of people each year. Careful diagnosis, appropriate treatment, and adequate follow- up will result in total cure for most of these patients, and adequate symptomatic relief for almost all of the others.