Urinary tract infection

Introduction to urinary tract infection Urinarytraction infection (UTI) refers to the inflammation caused by pathogens in the urinary tract and invading the mucosa or tissues of the urinary tract. It is the most common infection in bacterial infections. Urinary tract infections are classified into upper urinary tract infections and lower urinary tract infections. Upper urinary tract infections refer to pyelonephritis, and lower urinary tract infections include urethritis and cystitis. Urinary tract infections can also be classified into complex urinary tract and non-complex urinary sensations depending on the presence or absence of underlying disease. Pyelonephritis is further divided into acute pyelonephritis and chronic pyelonephritis. Occurs in women. basic knowledge The proportion of illness: 1% Susceptible people: good for women Mode of infection: non-infectious Complications: cystitis

Causes of urinary tract infection

Escherichia coli (95%):

More than 95% of urinary tract infections are caused by a single bacterium. Among them, 90% of outpatients and about 50% of inpatients have Escherichia coli. The serotype of this bacterium can reach more than 140 types. Escherichia coli is the same type of Escherichia coli isolated from the stool of patients, and is more common in asymptomatic bacteriuria or uncomplicated urinary sensation.

Candida albicans (3%):

Cryptococcus neoformans infection is more common in patients with diabetes and glucocorticoids and immunosuppressive drugs, and after renal transplantation, Staphylococcus aureus is more common in skin trauma and bacteremia and sepsis caused by drug users. Viruses and mycoplasma infections are rare. In recent years, there has been an increasing trend. A variety of bacterial infections have been found in indwelling catheters, neurogenic bladders, stones, congenital malformations and vagina, intestines, and urethra.

Other pathogens (2%):

Proteus, Aerogen, Klebsiella pneumoniae, Pseudomonas aeruginosa, Streptococcus faecalis, etc. are found in reinfection, indwelling catheter, and urinary tract with complications.

Pathogenesis

1. Bacterial colonies spread around the intestines and urethra to the urethra.

2, through the urine reflux, bacteria retrograde in the urinary tract and combined with the corresponding receptors of the epithelial cells of the urinary tract, local reproduction, inflammation.

3. Through the turbulent flow of urine in the ureter, the bacteria ascend to the kidneys. If the inflammation is not controlled in time, the kidney tissue is damaged and fibrosis eventually occurs.

Urinary tract infection prevention

1. Urinating immediately after sex

Go to the bathroom immediately after sexual intercourse, even if the bacteria have entered the bladder, it can be excreted by urinating.

2, timely urination

When urinating, the urine washes away the bacteria in the urethra and vaginal opening, which has a natural cleaning effect.

3. Avoid pollution

The most common cause of infection is Escherichia coli. Under normal circumstances, it is parasitic in the intestines and does not cause illness. However, if the anus enters the urethra, it will cause inflammation of the urethra, so wipe it with clean toilet paper after stool. According to the order from the beginning to the end, in order to avoid contamination of the vaginal opening, if the toilet has flushing equipment, it is best to carefully rinse the anus.

4, vitamin C supplement

Vitamin C can increase the acidity of urine, making various bacteria that induce urinary tract infections difficult to survive. Therefore, drinking more vitamin-rich beverages such as orange juice, citric acid, and kiwi juice is beneficial for preventing urinary tract infections.

5. Consult a doctor

Sometimes even if you do all the things you should do, you will still get infected. If you have the above symptoms, ask your doctor as soon as possible. If you have frequent infections, like 4-5 times a year, don't ignore them. You must ask your doctor to develop a preventive or treatment plan and work with your doctor to find out what caused the repeated infection.

Urinary tract infection complications Complications cystitis

Complications of urinary tract infections are renal papillary necrosis, peri-renal inflammation and peri-renal abscess, infectious kidney stones and Gram-negative bacilli sepsis.

1, renal papillary necrosis

Kidney papillary necrosis can spread the entire cone, from the tip of the nipple to the junction of the renal cortex and medulla, a large piece of necrotic tissue is shed, small pieces of tissue can be excreted from the urine, and large pieces of tissue block the urinary tract, so pyelonephritis with renal nipple When necrosis, in addition to the symptoms of pyelonephritis, renal colic, hematuria, hyperthermia, rapid deterioration of renal function, and concurrent Gram-negative bacilli sepsis, such as acute renal papillary necrosis, may occur in patients. Oliguria or no urine, acute renal failure occurs, the diagnosis of this disease mainly depends on the cause of the disease and clinical manifestations, the diagnosis conditions are two: 1 found in the urine to fall off the renal papillary necrotic tissue, pathological examination confirmed. 2 Intravenous pyelography revealed a circular sign, and / or eclipse-like changes at the edge of the renal pelvis, which are helpful for diagnosis. Treatment should use effective antibiotics to control systemic and urinary tract infections, and use various supportive therapies to improve the patient's condition. Active treatment of diabetes, urinary tract obstruction and other primary diseases.

2, perirenal inflammation and perirenal abscess

Infectious inflammation of the adipose tissue between the renal capsule and the periorbital fascia is called peri-renal inflammation. If an abscess occurs, it is called perirenal abscess. This disease is directly spread by pyelonephritis (90%), a small part. (10%) is a blood-borne infection. The onset of this disease is insidious. After several weeks, obvious clinical symptoms appear. In addition to the worsening of pyelonephritis symptoms, patients often have unilateral obvious low back pain and tenderness. Individual patients may touch the mass in the abdomen. When the inflammation spreads across the sputum, the movement of the breathing and diaphragm muscles is restricted. There is often traction pain during breathing. X-ray chest fluoroscopy can be seen in the local sacral bulge. In the case of intrarenal lesions, there are many pus cells and pathogenic bacteria in the urine. The lesion only has a small amount of white blood cells around the kidney. The diagnosis of this disease depends mainly on clinical manifestations. X-ray examination, pyelography, ultrasound and CT can help to confirm the diagnosis. The treatment should use antibiotics as soon as possible to promote inflammation, and if the abscess is formed, it will be cut. drainage.

3. Infectious kidney stones

Infectious kidney stones are infected by a special type of stone, accounting for 15% to 20% of kidney stones. The main components are magnesium ammonium phosphate and phosphate apatite. Infectious kidney stones are difficult to treat and the recurrence rate High, if not properly treated, it will make pyelonephritis become chronic, and even lead to renal failure. In addition to the performance of common kidney stones, clinical manifestations also have its own characteristics. Infectious stones grow fast, often with large antlers. X-ray, on-line development, often accompanied by persistent or repeated history of urinary sensitization of pathogenic bacteria such as Proteus, the disease can be diagnosed according to medical history, physical examination, hematuria test and X-ray examination, patients often have deformation History of bacillary urinary tract infection, urine pH>7, urinary bacterial culture positive, treatment includes medical treatment, surgical treatment and other treatment methods, kidney stones below 0,7~1cm, smooth surface, available medical treatment, currently not satisfied For lytic drugs, it is usually necessary to use drugs sensitive to bacteria. Secondly, acidified urine can be treated with ammonium chloride. Surgical treatment is an important treatment. Patients should be advised to have surgery as soon as possible. Other treatment packages Drink lots of water, acidification of urine, diuretic and antispasmodic.

4. Gram-negative bacilli sepsis

In Gram-negative bacilli sepsis, 55% are caused by urinary tract infections. The main manifestations are that most patients may have chills, high fever, cold sweats, and other patients with mild general malaise and moderate fever. Later, the disease can become dangerous, the patient's blood pressure drops rapidly, and even obvious shock can occur, accompanied by clinical manifestations of heart, brain and kidney ischemia, such as oliguria, azotemia, acidosis and circulatory failure. Shock generally lasts for 3 to 6 days. In severe cases, it can die. The diagnosis of this disease depends on the positive culture of blood bacteria. Therefore, it is advisable to take blood for bacterial culture and drug sensitivity test before applying antibacterial drugs, and repeatedly culture in the course of disease. The mortality rate of Gram-negative bacilli sepsis is 20% to 40%. Removal of the source of infection is an important measure to deal with septic shock. Common measures are anti-infection, correcting water, electrolyte and acid-base balance disorders, using a large number of corticosteroids, Reduce the symptoms of venom, try heparin to prevent and treat DIC, and patency of the urinary tract.

Symptoms of urinary tract infections Common symptoms Urinary frequency urinary incontinence Blood urinary urgency Urinary urinary pain Proteinuria abscess

The disease occurs in women of childbearing age, and the ratio of male to female is about 1:8. Clinical manifestations include the following four groups.

First, cystitis:

That is usually referred to as lower urinary tract infection. The main manifestations of cystitis in adult women are urinary tract irritation, that is, frequent urination, urgency, dysuria, white blood cell urine, occasionally hematuria, and even gross hematuria. The bladder area may have discomfort. Generally no obvious symptoms of systemic infection, but a small number of patients may have low back pain, low fever (generally no more than 38 ° C), white blood cell count is often not increased. About 30% of cystitis is self-limiting and can heal itself within 7-10 days.

Second, acute pyelonephritis:

The performance includes the following two groups of symptoms: 1 urinary system symptoms: including frequent urination, urgency, dysuria and other bladder irritation, low back pain and/or lower abdominal pain. 2 symptoms of systemic infections: such as chills, fever, headache, nausea, vomiting, loss of appetite, etc., often accompanied by increased white blood cell count and increased erythrocyte sedimentation rate. Generally no hypertension and azotemia.

Third, chronic pyelonephritis:

The course of chronic pyelonephritis is very concealed. Clinical manifestations are divided into the following three categories: 1 urinary tract infection performance: only a small number of patients may intermittently develop symptomatic pyelonephritis, but more commonly manifested as intermittent asymptomatic bacterial urine, and (or) intermittent urgency, frequent urination, etc. Symptoms of lower urinary tract infection, waist and abdomen discomfort and/or intermittent low fever. 2 Chronic interstitial nephritis, such as hypertension, polyuria, nocturia increased, prone to dehydration. 3 related manifestations of chronic kidney disease.

Fourth, atypical urinary tract infections:

1 The main symptoms of systemic acute infection, and local symptoms of urinary tract are not obvious. 2 urinary tract symptoms are not obvious, but mainly manifested as acute abdominal pain and symptoms of gastrointestinal dysfunction. 3 with hematuria, mild fever and low back pain as the main performance. 4 no obvious urinary tract symptoms, only showing back pain or low back pain. 5 a small number of people with renal colic, hematuria. 6 completely no clinical symptoms, but quantitative culture of urinary bacteria, colony 105 / ml. The reason for the negative culture of urinary bacteria in the middle section has already partially explained the cause of acute urethral syndrome.

Among women with symptoms of urinary tract infection, 40% to 50% of patients are acute urethral syndrome, and women with this syndrome can be divided into two categories clinically:

1. (1) pyuria and true urinary tract infections: About 70% of women with acute urethral syndrome have pyuria and true urinary tract infections during urine tests. Most of these patients are Chlamydia trachomatis or common non-pathogenic bacteria such as the large intestine. Escherichia coli, Staphylococcus aureus infection, the number of bacteria is less than the number of significant bacteria (100 ~ 10,000 / ml), other patients are urethral tuberculosis, fungal urinary tract infection, or rare abdominal or pelvic abscess Adjacent to the inflammation of the urethra, the treatment can take doxycycline (doxycycline) 0, 1g, 2 times / d, 7 to 14 days of treatment, relapse for 6 weeks, and need to treat their spouse.

(2) There is no pyuria and pathogenic bacteria: the remaining 30% of women with acute urethral syndrome have acute urethral syndrome, but there is no pyuria and pathogenic bacteria. It is speculated that these symptoms may be caused by trauma, sexual intercourse injury, local Stimulation or allergies (such as topical contraceptives, organic fibers on the underwear, allergies such as dyes), or other undetermined factors, but need to clean the middle of the urine culture negative for 3 times, and exclude urinary tract tuberculosis, fungi, anaerobic Bacterial, chlamydia, gonococcal infection, the treatment of this disease should check and remove the above factors that may cause the disease, because most of the disease may be part of the symptoms of anxiety neurosis, can take stability 2, 5mg, 3 times /d, oryzanol 10mg, 3 times / d, to help alleviate the symptoms.

2, asymptomatic bacteriuria: asymptomatic bacteriuria (asymptomatic bacteriuria) refers to no urinary tract infection, only occasionally mild fever, fatigue, but multiple urine cultures are positive, and the number of colonies is more than 10,000 to 100,000 /ml.

The disease is more common in adult women, the incidence rate is about 2%. In the past, this was considered a benign process and no treatment was needed. It has been confirmed by a large number of studies that long-term asymptomatic bacteriuria can also impair kidney function, so treatment should be symptomatic. Urinary tract infections are the same, especially in children, because there is often bladder-ureteral reflux, asymptomatic bacteriuria can easily cause upper urinary tract infection, asymptomatic bacteriuria in pregnant women often develop acute pyelonephritis and lead to sepsis, so Prophylactic treatment should be started in the first trimester. After sexual intercourse, it should take 0,05g of furopyrazine or 0,25g of cefotaxime, which can effectively prevent urinary tract infection and has no effect on the mother and fetus.

3. Complex urinary tract infections: This concept includes a wide range of clinical syndromes such as asymptomatic bacteriuria, cystitis, pyelonephritis, dominant urinary sepsis, structural abnormalities in the urinary tract (urethra Or bladder neck obstruction, polycystic kidney disease, stone obstruction, presence of catheters and other foreign bodies), or dysfunction (spinal cord injury, neurogenic bladder caused by diabetes or multiple sclerosis), hereditary urinary tract kidney disease or some When the systemic disease process makes the patient highly susceptible to bacterial invasion, the patient often has a urinary tract infection. In the above situation, the pathogenic microorganisms that cause infection are more extensive than the simple urinary tract infection, and these bacteria The resistance to antibiotics is also much larger than that of the general population. Because the diagnosis and treatment of complex UTI is different from those of non-complex infections, it is important to treat them differently.

4. Giant kidney abscess and perirenal abscess: Two uncommon types of kidney infection are giant kidney abscess and perirenal abscess. In the past, most kidney abscesses were secondary to hematogenous infections of Staphylococcus aureus or less common. Group A streptococcal infection, the abscess is mainly located in the cortex of the kidney. At present, most abscesses are secondary to kidney stones, kidney or ureteral obstruction, caused by common Escherichia coli. Typical abscesses are located at the junction of the renal cortex and medulla, which is formed by the infection of the existing renal cyst. Kidney abscess is relatively rare, and renal abscesses caused by local spread of lesions such as the colon or lower rib abscess are rare, and the renal abscess can extend into the surrounding tissues of the kidney.

The clinical manifestations of renal and perirenal abscess are often hidden, with fever, weight loss, night sweats, anorexia, chronic inflammation associated with abdominal pain and back pain, and sometimes acute clinical manifestations associated with bacteremia due to obstruction, or It is characterized by specific urinary tract infection symptoms such as dysuria, hematuria and obvious urinary retention. Physical examination may reveal tenderness of the rib angle and may even touch the mass, but 30% to 50% of the patients may have normal physical examination, routine experiment Room examination can be found with elevated white blood cells, anemia, urinalysis with inflammatory changes such as pyuria, proteinuria or both, more than half of the patients in the urine can be cultured to the same bacteria in the presence of abscesses, to determine the diagnosis must rely on Excretory urography confirms the presence of mass in the kidney. Radionuclide scanning, ultrasound and CT examination can also detect intra-renal or perirenal inflammatory masses. If the abscess fails to receive timely drainage or antibiotic treatment, the abscess can be The abdominal cavity, chest or skin spread causes complications.

Urinary tract infection check

When the patient meets one of the following conditions, the diagnosis can be diagnosed as:

1, typical urinary tract infection symptoms + pyuria (peripheral urine microscopic examination of white blood cells > 5 / HP) + urine nitrite test positive.

2, clean the number of white blood cells in the middle of the centrifuge, or have symptoms of urinary tract infection > 10 / HP.

3, there are symptoms of urinary tract infection + regular morning cleaning mid-stage urinary bacteria quantitative culture, the number of colonies 105 / ml, and two consecutive urinary bacteria count 105 / ml, the same two bacteria and subtypes.

4, for bladder puncture urine culture, such as bacteria positive (regardless of the number of bacteria).

5, the typical symptoms of urinary tract infection, clean the middle of the morning before the treatment of urine urinary sediment urine gram staining to find bacteria, bacteria > 1 / oil mirror field of view.

Chronic pyelonephritis: X-ray venous pyelography (IVP) with focal, rough cortical epilepsy, accompanied by signs of expansion and dullness of the associated renal papilla contraction can be diagnosed.

Diagnostic identification of urinary tract infection

diagnosis

Due to the wide range of urinary tract infections, from dysuria-urinary frequency syndrome to paroxysmal pyelonephritis, from symptomatic bacteriuria to asymptomatic bacteriuria, it is not only clinically possible to make "urinary tract infections". Diagnosis, it is also necessary to conduct etiological diagnosis and localization diagnosis for UTI patients, so that patients can get correct and effective treatment and follow-up measures, thereby reducing the incidence of chronic renal damage after several years.

In fact, the clinician's accurate judgment of the cause of urinary tract infection and the location diagnosis ability of the affected part are limited. If the patient has obvious chills, high fever, severe low back pain, and obvious clinical manifestations such as Gram-negative sepsis signs, it is easy. Diagnosis of pyelonephritis is made, but without the above symptoms and signs, the possibility of kidney disease, such as occult pyelonephritis, cannot be ruled out. Therefore, in the diagnosis and treatment of patients with suspected UTI, the following comprehensive analysis should be made:

1, the principle of diagnosis

(1) Identify pathogenic bacteria that produce symptoms and choose the ideal antibiotic treatment.

(2) Identify the anatomical part of the infection, that is, whether the infection is invading the upper or lower urinary tract, or is limited to the lower urinary tract. For male patients, it should also be determined whether the infection affects the prostate or bladder.

(3) Determining whether there is abnormal structure or function of the urethra and selecting reasonable clinical treatment measures, such as cystoscopy, evacuation of bladder urethra, ultrasound, etc.

2, medical history and physical examination

Although there is no clear correlation between clinical symptoms and different parts of the urinary tract infection, useful information is usually obtained from the detailed medical history collected.

When examining a patient with an acute onset of UTI symptoms, first consider whether there are symptoms and signs suggesting systemic sepsis or impending sepsis, such as chills, fever, shortness of breath, abdominal cramps and Severe low back pain, etc., such patients need immediate hospitalization, if the patient does not have acute sepsis, you should pay attention to whether the patient has UTI, kidney disease, diabetes, multiple sclerosis, other neurological diseases, kidney stones, Or the presence of urogenital device operation, these conditions often lead to UTI, and affect the effect of treatment, in addition, careful neurological examination is particularly important for the presence of neurogenic bladder.

For patients with recurrent UTI, special attention should be paid to the history of sexual life, response to treatment, time to stop treatment and recurrence: female patients with UTI recurrence and sexual intercourse may be effective for antibiotic treatment after each sexual intercourse, by trachoma Female patients with acute urethral syndrome caused by chlamydial infection may be temporarily effective against chlamydia treatment, but they may re-infect from untreated sexual partners (so-called ping-pong infection), which can only be cured when both sides are treated at the same time. Judging female UTI Repeated episodes of recurrence or reinfection, can refer to the length of time between the end of the previous treatment and the next infection symptoms, the recurrence of most female infections occurred in 4 to 7 days, women re-infection, if there is no bladder dysfunction Or some other urinary tract dysfunction, there is usually a longer interval between the two episodes.

In male patients with persistent prostate infections, the infection can recur quickly after similar conventional treatment, in addition to actively looking for the presence of prostate obstruction on the flow of urine (eg, finer urine flow, Unsatisfactory urine, nocturia or urine.)

For patients with suspected chronic pyelonephritis and reflux nephropathy, care should be taken to determine if there is a history of UTI in children and during pregnancy, and if there are abnormalities in renal function, such as hypertension, proteinuria, polyuria, nocturia, and frequent urination. Wait.

The diagnosis of urinary sensation can not rely solely on clinical symptoms and signs, but rely on laboratory tests. Some people have reported the analysis of 297 patients with urinary sensation. The symptoms are only 66, 5%. Anyone with true bacteriuria has Should be diagnosed as urinary sensation, true bacterial urine refers to: bladder puncture urine qualitative culture has bacterial growth, catheterization of quantitative bacteria 100,000 / ml, clean mid-stage urine quantitative culture 100,000 / ml, and the same strain, in order to To be determined to be true bacterial urine, it must be pointed out that women with obvious urinary frequency and dysuria have more white blood cells in the urine. For example, the number of bacteria in the middle part of the urine is >100/ml, which can be diagnosed as urine, even while waiting for the culture report. It can also be diagnosed as a urine sensation.

Differential diagnosis

1, febrile illness

When the symptoms of systemic infection such as fever and urinary tract are more prominent, and the local symptoms of urinary tract are not obvious, it is easy to be confused with febrile diseases, such as influenza, malaria, sepsis, typhoid, etc., accounting for 40% of misdiagnosed cases, but if Detailed medical history, attention to local symptoms of urinary sensation, and urine sediment and bacteriological examination, identification is not difficult.

2, abdominal organ inflammation

Some cases may have no local symptoms of urinary sensation, but manifested as abdominal pain, nausea, vomiting, fever, increased white blood cell count, etc., easily misdiagnosed as acute gastroenteritis, appendicitis, female annexitis, etc., through detailed medical history, timely urine routine And urine bacteriological examination, can be identified.

3, urethral syndrome

Also known as aseptic urinary frequency, dysuria discomfort syndrome, Stamm et al pointed out that in women with lower urinary tract symptoms, that is, frequent urination, urgency, dysuria or urination discomfort, bladder pain, can be divided into two groups, About 70% of patients have pyuria and bacterial urine (only 100/ml), which is true urinary sensation, while about 30% of patients are not true urinary tract. Urethral syndrome means only urinary frequency. According to our experience, urethral syndrome is very common in clinical practice. It is often misdiagnosed as urinary sensation by primary doctors, while long-term use of antibiotics and urethral syndrome patients are indeed excluded. After urinary tract tuberculosis, fungi and anaerobic infection, the next step should be to determine the possibility of urinary tract infection, but these patients often have a history of unclean sexual intercourse and white blood cells in the urine, after taking 4 to 10 days of tetracycline The symptoms will disappear, and the diagnosis is not difficult. If the above possibility can be excluded in order, the patient can be diagnosed as a non-microbial urethral syndrome, which is more common in middle-aged women. The frequent urination is more prominent than the urination discomfort. Have a long The use of antibiotics and invalid medical history, the cause is still unknown, some people think that may be related to local urinary tract irritation or allergies, such as topical contraceptives or tools, bath liquid, deodorant spray, etc., some people think that may be urinary kinetics Abnormal dysfunction, especially the ataxia and sphincter ataxia, and some people believe that some non-infectious non-specific inflammatory diseases of the lower urinary tract can also be caused. According to our limited experience, most of these patients are caused by anxiety. Caused by sexual neurosis, they have obvious psychological factors. When attention is dispersed, the symptoms of frequent urination can be significantly alleviated. Long-term use of diazepam has a certain effect.

4, kidney tuberculosis

Some urinary sensations are mainly manifested by hematuria. The bladder irritation sign is obvious and it is easy to be misdiagnosed as renal tuberculosis. However, the tuberculosis of kidney tuberculosis is more prominent. The morning tuberculosis culture can be positive, while the common bacteria culture is negative, and the urine sediment can be found to be acid resistant. Bacillus, intravenous pyelography can be found in X-ray signs of renal tuberculosis, some patients may have lung, genital and other extra-renal tuberculosis lesions and anti-tuberculosis treatment can be identified, but it should be noted that kidney tuberculosis can often coexist with ordinary urine, so If the patient has active antibacterial treatment, there are still frequent urination, dysuria or abnormal urine sediment, should pay attention to the possibility of kidney tuberculosis, should be checked accordingly.

5, chronic glomerulonephritis

If there is edema, a large number of proteinuria is not difficult to identify, the urinary protein content of pyelonephritis is generally below 1 ~ 2g / d, if > 3g are mostly glomerular lesions, but this disease and occult nephritis are more difficult to identify, after There are more red blood cells in the urine routine, and pyelonephritis is mainly white blood cells. In addition, urine culture, long-term observation of patients with low fever, frequent urination and other symptoms can also help identify, when advanced glomerulonephritis secondary to urinary tract infection, It is difficult to identify. At this time, the medical history can be detailed and analyzed in combination with clinical characteristics.

6, prostatitis

Men over the age of 50, have prostate hyperplasia, hypertrophy, placement of catheters, cystoscopy, etc. are prone to this disease, often manifested as frequent urination, dysuria, urine examination with pus cells, easy to phase with acute cystitis Confusion, however, in addition to chills, fever, and increased total white blood cells, acute prostatitis may have lumbosacral and perineal pain, resulting in restlessness, chronic prostatitis, except for abnormal urine test, clinical symptoms are not obvious, prostate massage to obtain prostate The liquid was examined and the number of white blood cells was >10/HP. The prostate B-ultrasound was helpful for differential diagnosis.

7, tubulointerstitial nephritis

Various tubulointerstitial nephritis, such as reactive tubulointerstitial nephritis (ie tubulointerstitial nephritis caused by systemic infection), allergic tubulointerstitial nephritis (drug-associated acute tubulointerstitial nephritis), non Carcass anti-inflammatory drug-related nephropathy, heavy metal toxic nephropathy, radiation nephritis, reflux nephropathy, etc., can cause pyuria, but it is aseptic pyuria, bacterial culture is negative, acute infectious tubulointerstitial caused by blood infection Nephritis has recently increased. Our department treats more than 10 cases of acute infectious tubulointerstitial nephritis caused by drug-related systemic infections every year.

8, hypercalciuria

Hypercalciuria can cause frequent urination, urgency, and dysuria, but generally no pyuria, negative bacterial culture, urinary ca/Cr ratio and 24h urinary calcium increase.

9, hematuria

When a large amount of hematuria is caused by various reasons, it can cause frequent urination, urgency, and dysuria, but the white blood cells in the urine are significantly less than red blood cells. Further examination can often find the primary disease causing hematuria.

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