RENAL AND GENITOURINARY
EMERGENCIESSYMPTOMS/EXAM
■ Urgency, dysuria, hematuria
■ Flank pain, back pain, suprapubic pain
■ FeverDIAGNOSIS
■ Pyuria:Significant at >2–5 WBC/hpf in women and >1–2 WBC/hpf in
men
■ Bacteriuria:Significant for any bacteriain an unspun urine sample or
>15/hpf on spun samples
■ Urine dipstick leukocyte esterase: Indicates presence of WBCs; negative
result does not rule out infection.
■ Urine dipstick nitrite: Indicates presence of Gram-negative bacteria; nega-
tive result does not rule out infection.
■ Urine culture: Definitive test; indicated for all complicated UTIs; positive
if >100 CFU/mL of known uropathogenDIFFERENTIAL
■ Nonbacterial cystitis: Due to inflammation (radiation, interstitial cystitis,
medications)
■ Urethritis:Clamydiais commonly implicated pathogen.
■ Prostatitis
■ VaginitisTREATMENT
■ Antibiotic therapy (see Table 18.8)
■ Criteria for admission:
■ Extremes of age
■ Systemic toxicity
■ Renal failure
■ Obstruction
■ Intractable vomiting or pain
■ Complicated UTI: Have lower threshold if questionable
■ Pregnancy: Treat asymptomatic bacteriuria as UTI.
■ Diabetes and sickle cell disease: Patients are at an increased risk of papillary
necrosis, abscess formation, and microvascular complications.
■ Indwelling catheters: Replacement of the catheter can eliminate bacteria
in many patients.COMPLICATIONS
■ Complications include perinephric abscess or obstruction; CT is preferred
method of evaluation.URETHRITISInflammation of the urethra, it is most commonly due to Chlamydia tra-
chomatisor Neisseria gonorrhoeae (GC), but other organisms include
Ureaplasma urealyticum,Trichomonas vaginalis, herpesvirus, or candida.The presence of anybacteria
in an unspun urine sample is
significant.The presence of nitrite on
urine dipstick indicates the
presence of Gram-negative
organisms.Urethritis or prostatitis is most
likely cause of dysuria or
pyuria in sexually active
young male, not UTI.Asymptomatic bacteriuria in
pregnancy should be treated
as a UTI.