Complicated urinary tract infection

Introduction Complex urinary tract infections are: 1 urinary tract has organic or functional abnormalities, causing urinary tract obstruction, poor urine flow. 2 There are foreign bodies in the urinary tract, such as stones, indwelling catheters, etc. 3 There are obstructions in the kidney, such as urinary tract infections that occur on the basis of chronic renal parenchymal diseases, most of which are pyelonephritis, which can cause damage to kidney tissue. Long-term repeated infection or incomplete treatment can progress to chronic renal failure (CRF).

Cause

(1) Causes of the disease

More than 95% of urinary tract infections are caused by a single bacterium. Among them, 90% of outpatients and about 50% of inpatients, the pathogen is Escherichia coli, the serotype of the bacteria can reach more than 140, the urinary Escherichia coli and the large intestine isolated from the patient's feces The same type of bacteria is more common in asymptomatic bacteriuria or uncomplicated urinary sensation; Proteus, Aerobacter, Klebsiella pneumoniae, Pseudomonas aeruginosa, Streptococcus faecalis, etc. Catheter, urinary tract with complications; Candida albicans, Cryptococcus neoformans infection more common in diabetes and patients with glucocorticoids and immunosuppressive drugs and after kidney transplantation; Staphylococcus aureus is more common in skin trauma and drug users Caused by bacteremia and sepsis; although viral and mycoplasma infections are rare, there has been an increasing trend in recent years. A variety of bacterial infections are found in indwelling catheters, neurogenic bladder, stones, congenital malformations, and vaginal, intestinal, and urethral fistulas.

(two) pathogenesis

Urinary tract infection is caused by the invasion of pathogenic bacteria, and its pathogenesis is related to pathogen infection. The ways and ways of pathogen invasion and infection are roughly divided into the following.

Ascending infection

About 95% of urinary tract infections, the pathogens from the urethra through the bladder, ureter and up to the kidneys. Under normal circumstances, a small amount of bacteria is present at the upper end of the urethral opening 1 to 2 cm. Only when the body's resistance is reduced or the urethral mucosa is damaged, the bacteria can invade and multiply. Urine flushing, IgA in urine, lysozyme, organic acids, mucosal integrity, and mucosin secreted by the bladder transitional epithelium can resist the invasion of pathogens. In recent years, electron microscopy confirmed that there are many P-pilus on the surface of Escherichia coli, which can specifically recognize and bind to the corresponding receptors on the surface of urothelial cells, so that the cells adhere closely to the urothelial cells and avoid being Rinse off the urine. Escherichia coli has bacterial (O) antigen, flagellar (H) antigen, and capsular (K) antigen. The K antigen of polysaccharide can inhibit the bactericidal activity of phagocytic cells, which is directly related to its pathogenicity. Proteus has no P-pilus and K-antigen and is not easy to adhere to the transitional epithelium of the bladder, but can adhere to the squamous epithelial cells of the external genitalia. Indwelling catheter, urinary calculi, planing injury, tumor, prostatic hyperplasia, congenital urinary tract malformation (including ureteral ureter and sphincter dysplasia caused by sphincter dysplasia), neurogenic bladder, etc. are all ascending Risk factors for infection.

2. Hematogenous infection

Hematogenous infections account for only 3% of urinary tract infections. The blood flow of the kidney accounts for 20% to 25% of the cardiac output. When sepsis and bacteremia occur, the bacteria in the circulating blood easily reach the renal cortex. Diabetes, polycystic kidney disease, transplanted kidney, urinary tract obstruction, renal vascular stenosis, analgesics or the use of sulfonamides increase the vulnerability of kidney tissue. Common pathogens such as Staphylococcus aureus, Salmonella, Pseudomonas, and Candida albicans are rare, and lymphatic infection has not been confirmed.

3. Susceptibility factors

(1) urinary tract obstruction: urinary tract obstruction caused by various reasons, such as kidney and ureteral calculi, urethral stricture, urinary tract tumor, prostatic hypertrophy, etc. can cause urine retention, so that bacteria can easily breed and produce infection. Pregnancy uterus compression of the ureter, renal ptosis or hydronephrosis can cause poor urine excretion and cause the disease.

(2) urinary system malformations or dysfunction: such as renal hypoplasia, polycystic kidney disease, sponge kidney, hoof iron kidney, double renal pelvis or ureteral malformation and huge ureter, etc., are easy to reduce the resistance of local tissue to bacteria. Bladder ureteral reflux causes urine to flow back from the bladder to the renal pelvis, thus increasing the chance of illness. The urinary function of the neuronal bladder is dysfunctional, leading to urinary retention and bacterial infection.

(3) urethral intubation and device examination: catheterization, cystoscopy, urinary tract surgery can cause local mucosal damage, the pathogenic bacteria of the anterior urethra into the bladder or upper urinary tract and cause infection. According to statistics, the incidence of persistent bacteriuria after a catheterization is 1% to 2%; the indwelling catheterization for more than 4 days, the incidence of persistent bacteriuria is more than 90%, and severe pyelonephritis and Gram-negative bacteria The danger of sepsis.

(4) Female urinary tract anatomy and physiology characteristics: Female urethra length is only 3 ~ 5cm, straight and wide, urethral sphincter is weak, bacteria easily rise to the bladder along the urethra, and the urethral orifice is close to the anus, providing conditions for bacteria to invade the urethra. Local irritation around the urethra, menstrual period genital area is susceptible to bacterial contamination, vaginal diseases such as vaginitis and cervicitis, and changes in sex hormones during pregnancy, postpartum and sexual life can cause changes in vaginal and urethral mucosa and facilitate pathogen invasion. . Therefore, the incidence of urinary tract infection in adult women is 8 to 10 times higher than that in men.

(5) weakened body resistance: systemic diseases such as diabetes, high blood pressure, chronic kidney disease, chronic diarrhea, long-term use of adrenal cortex hormones, etc., reduce the body's resistance, and the incidence of urinary tract infections is significantly increased.

In summary, the occurrence of urinary tract infections is a fairly complex process that can be summarized as follows:

1 Bacterial colonies with P hairs are scattered around the intestines and urethra and spread to the urethra.

2 By urinary reflux, the bacteria are retrograde in the urinary tract and bind to the corresponding receptors of the epithelial cells of the urinary tract, locally proliferating, producing inflammation.

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

an examination

Related inspection

Renal tract urethral irrigation test urine concentration test host mediation test intravenous pyelography

Laboratory inspection

Urine routine examination

Urine routine examination is the easiest and most reliable way to diagnose urinary tract infections. It is advisable to leave the first urine in the morning for testing. More than 5 (>5/HP) white blood cells per high power field are called pyuria. In addition to pyuria in acute urinary tract infections, white blood cell casts, bacteriuria, and sometimes hematuria or gross hematuria can be found, especially when infected with Brucella, Nocardia, actinomycetes, and Mycobacterium tuberculosis. Occasionally, microalbuminuria, if more proteinuria, suggests glomerular involvement.

It is worth mentioning that pyuria does not mean that there must be an infection in the urinary tract, because pyuria can be divided into infectious pyuria and aseptic pyuria. Aseptic pyuria can be seen in various tubulointerstitial nephritis. Tubulointerstitial nephritis has a wide range of causes. Common diseases include reactive tubulointerstitial nephritis (ie, tubulointerstitial nephritis caused by systemic infection), allergic tubulointerstitial nephritis (which can be caused by many drugs), and non-steroidal Anti-inflammatory drugs associated with nephropathy, heavy metal toxic nephropathy, radiation nephritis, reflux nephropathy and various idiopathic tubulointerstitial nephritis.

2. Urine bacterial culture

In the past, it was considered that the cleaned mid-stage urine culture colony count >100,000/ml had clinical significance, 100,000/ml, but only about 70% of Gram-positive bacteria caused urinary tract infections with counts of more than 100,000/ml, and 20% to 30% of patients have a colony count of only 1000 to 100,000 / ml, especially in most patients with lower urinary tract infection. The reasons for the low colony count are:

(1) Urinary urgency and other irritating symptoms make the urine stay in the bladder for too short time, which is not conducive to the reproduction of bacteria.

(2) It has been treated with antibiotics.

(3) The application of diuretics makes the bacteria difficult to grow and reproduce.

(4) Acidified urine is not conducive to bacterial growth and reproduction.

(5) There is urinary tract obstruction (such as stones and infection), and bacteriuria excretion is restricted.

(6) Extraluminal infection.

(7) The pathogen is an anaerobic bacterium and cannot be cultured in a conventional medium.

(8) Gram-positive bacteria have a slow division and a tendency to agglutinate, and colony counts tend to be low.

Therefore, the clinical symptoms are consistent with urinary tract infections, and when the urine colony count is between 1000 and 100,000/ml, urinary tract infections should also be considered.

3. Chemical detection method of bacteriuria

In the past, urine culture bacteria were positive and microscopic examination showed the presence of pyuria as a standard for diagnosing urinary tract infections. But considering that UTI is ubiquitous in all age groups, it also emphasizes the diagnosis and treatment of UTI in the home or clinic. There are four methods available as a rapid diagnostic tool for bacteriuria.

(1) Nitrate reduction method: The most commonly used method to date is the Griess nitrate reduction method. This test method is the most accurate for the first urine measurement in the morning, and it can also determine whether the infection is caused by Escherichia coli. However, it cannot be used to detect infections caused by Gram-positive bacteria and Pseudomonas. Since the residence time of urine in the bladder is necessary for bacterial reduction of nitrate, false negative results can occur when the diet lacks a certain amount of nitrate or diuretic.

Applying professional cheap test paper, combined with nitrate method and leukocyte esterase method, the results can be obtained within 2 minutes, which greatly improves the practical value of the method. This test has diagnostic value for more than 100,000 Escherichia coli in urine or pyuria, and the expected value of the negative test result is 97%. In the presence of gentamicin or cephalosporin in proteinuria and urine, false negative results can occur. The sensitivity of this test is reported to be 87%. The specificity is 67% (false positive results are usually caused by vaginal contamination). This method is more effective in screening urine samples in symptomatic patients than in asymptomatic patients.

(2) Triphenyltetrazolium chloride test: This test is ingesting a large amount of vitamin C or urine pH.

(3) Glucose oxidase method and peroxidase test: The principle of glucose oxidase method is that bacteria can consume a small amount of glucose present in non-diabetic human urine. The principle of peroxidase test is most urinary pathogens. This enzyme is present in the inflammatory cells of any disease. The accuracy of these two methods is much worse than the previous two methods.

(4) Immersion slide inspection method: This method is to apply agar on the surface of a plastic plate, and immerse the plate in the urine, drip the urine, and then incubate, usually agar coated with a selective effect on Gram-negative bacteria. On one side of the plate or slide, agar which has no selection for the growth of most bacteria including Gram-positive bacteria is applied to the other side of the plate or slide. After one night of incubation, the surface of both sides of the agar is visible. Many colonies can be compared to a standard colony map to estimate the amount of bacteria in the urine in a semi-quantitative manner. The positive tablets can also be used for strain identification and drug susceptibility testing. This technique is often used in outpatient or home screening.

(5) Semi-automatic method: There are three semi-automatic methods for UTI diagnosis.

1Bac-T-Screen method: This method first filters, stains, rinses, and then uses a colorimeter for colorimetric analysis. This technique can detect 10,000 bacteria/ml of bacteria in the urine. Its sensitivity is about 88%, but the specificity is only 66%. The disadvantage is that it can cause blockage of the instrument or its specificity due to the presence of other colored particulate matter in the urine.

2 Bioluminescence: ATP produced by bacteria can be detected by the bioluminescent reaction of firefly luciferin/luciferase, and the amount of bacteria ATP is used to reflect the number of bacteria. This method can check the threshold value of bacteria in urine is 10,000/ml, its sensitivity is about 97%, and the specificity is 70%-80%, which is most valuable for patients with urine-tested bacteria-negative. The negative expected value for this method is greater than 99%.

3 Electronic impedance particle counting method: This is a method independent of bacterial proliferation, which can detect the number of white blood cells separately. Although this method has a high false positive rate (20% to 25%), it is still a promising detection technology.

4. Location check of infection

Although the clinical manifestations of upper and lower urinary tract infections are similar, there are significant differences in response to treatment and types of pathogenic bacteria. Bladder infection is an infection of superficial mucosa in anatomical location, and antibiotics tend to reach high concentrations in this area. In contrast, a kidney infection (a male prostate infection) is an infection of a deep parenchymal tissue. Due to the influence of the biochemical environment of the organism, the natural defense ability of this tissue part is weakened, and the concentration of antibiotics that can reach this part is also limited. Because of the different anatomical locations of urinary tract infections, the types of antibiotics required to treat urinary tract infections vary. Kidney infections (and prostate infections) require a more potent or longer-lasting antibacterial treatment than bladder infections.

Because the clinical symptoms of 30% to 50% of patients with occult renal infection are mainly the following urinary tract, it is not possible to perform localization diagnosis based on clinical manifestations. There are several methods for locating urinary tract infections:

(1) bilateral ureteral intubation: bilateral ureteral intubation is the only diagnostic method that directly locates the infection. Although it is more invasive, it is still the most accurate compared with the location diagnosis method of all other infections.

(2) Urine culture method after bladder irrigation: The method of less damage is urine culture after bladder irrigation. The main disadvantage of this method is that it does not distinguish whether the kidney infection is unilateral or bilateral. However, compared to all non-invasive methods, it is easy to operate, safe, inexpensive, and does not require the help of a cystoscope professional. It has replaced ureteral intubation as a diagnostic method for infection.

This method is to insert the catheter into the bladder, and take the urine for the No. 0 specimen; then use 100ml of normal saline to add antibiotics (usually with neomycin or neomycin polymyxin) to rinse the bladder, then use 200ml physiological The bladder was rinsed with saline, and the last few drops of urine were collected for the No. 1 specimen after evacuation; samples Nos. 2 to 5 were collected every 15 min thereafter. The samples from 0 to 5 were cultured in bacteria, and the results were judged as follows:

The number of colonies in the 10th specimen was >100,000/ml, indicating that the patient had bacterial urine.

Specimens 21 to 5 were sterile, indicating a lower urinary tract infection.

The number of colonies of specimen No. 32 to No. 5 was >100/ml, and it was more than 10 times of the number of colonies of No.1 specimen, indicating that it was an upper urinary tract infection.

(3) Determination of urine concentration function: The function of renal medulla is evaluated by measuring the maximum urine concentration function, which can be used to distinguish between kidney and bladder infections. Infection of the renal medulla may result in a change in maximum urinary concentrating function. Inflammation of the acute or chronic tubulointerstitial often causes a decrease in urinary concentrating function, so the maximum urinary concentrating function can be applied to optimally evaluate it. The decrease in urinary concentrating function in pyelonephritis is caused by a metabolic disorder of the renal medullary prostaglandin associated with inflammation because it can be blocked by administration of indomethacin, an inhibitor of prostate synthase. Studies have confirmed that renal bacteriuria is associated with decreased urinary function, while cystic bacteriuria is not associated with this, and bilateral renal infections have significantly less urinary concentrating function than those with unilateral kidney infection. For those with unilateral kidney infection, they may show impaired urinary concentrating function on the damaged side, while normal urinary enrichment function is normal on the undamaged side. The recovery of urine concentration is related to whether the infection is eradicated. The disadvantage of this method of infection location diagnosis is that there is often overlap between bladder infection, unilateral kidney and patients with bilateral kidney infection. Therefore, this method is not classified as a routine inspection because of its inconvenience in operation.

(4) Urine enzyme test: the detection of urinary enzyme can reflect the inflammation of the small tube, and the infection of the renal medulla can cause renal medullary inflammation, and thus the urinary enzyme increases.

25% of patients with pyelonephritis have elevated urinary lactate dehydrogenase (LDH) activity, but have false negative results, and false positive results can also occur in hematuria and severe proteinuria. Urine has been found in patients with pyelonephritis. The -glucuronidase activity was significantly higher than that of the lower urinary tract infection. Urinary -glucuronidase activity in patients with intrarenal infection was slightly higher than in bladder infection. However, since this enzyme activity has considerable overlap in the above patients, this method does not have a diagnostic value for each patient. The determination of N-acetyl--D-glucosaminase (NAG enzyme) in renal tubular cells can also be used for the localization diagnosis of infection, and this method is considered to be promising. The level of urinary creatinine in patients with pyelonephritis was (906±236) mol/(h?mg), while the level of urinary creatinine in patients with lower urinary tract infection was (145±23) mol/(h?mg). The level of urinary creatinine in normal children was ( 151.6 ± 10) mol / (h? mg). When children with pyelonephritis are treated with antibiotics, the level of urinary NAG enzymes decreases. Regrettably, in other studies, there was a considerable overlap in the range of urinary NAG enzymes in patients with pyelonephritis and cystitis.

Therefore, although the detection of urinary tubular cell enzymes or antigens is promising for the diagnosis of UTI anatomy, the best detection method for infection localization needs further investigation.

(5) Detection of C-reactive protein: It has been reported that the serum C-reactive protein is detected by immunodiffusion technique, and the level of C-reactive protein in children with pyelonephritis is continuously elevated, while the level of C-reactive protein in patients with acute cystitis is normal. Dynamic observation of changes in C-reactive protein levels in patients with pyelonephritis can be used as an indicator of efficacy. However, its diagnosis is inconsistent with the location diagnosis of bladder irrigation. Since C-reactive protein levels can also be elevated in various other inflammatory states, false positives can occur, and there is no correlation between changes in the amount of C-reactive protein and the site of infection. According to our experience, this method is more sensitive to the location diagnosis of adult urinary tract infections.

(6) Detection of bacterial antibodies: Kidney infections are often accompanied by the synthesis of specific antibodies directed against pathogenic antigens. Many researchers have attempted to apply immunological techniques to solve the problem of localization diagnosis of UTI anatomy. Bacterial adhesion tests have found that serum levels of antibodies in patients with symptomatic acute pyelonephritis are elevated and their titers decrease with the effectiveness of the therapeutic response to antibiotics. The serum antibody level of patients with pyelonephritis with obvious symptoms is also elevated, while the serum antibody titer of patients with cystitis is normal. Some researchers have used ureteral intubation lectin antibody to detect infection. It is confirmed that the lectin antibody titer of kidney infection is significantly higher than that of bladder bacteriuria. However, antibody titers vary widely, and there is considerable overlap between the two groups of patients. Therefore, the diagnostic value of this serological method is also limited.

In recent years, the most widely used infection localization technique is the urine antibody-coated bacterial assay (ACB method). Immunofluorescence studies found that the bacteria-derived test was positive for bacteria derived from kidney infection, while the bacterial antibody-encapsulated test for lower urinary tract infection was negative. Although some problems have arisen with the further promotion of the application of the ACB method, the results have been further confirmed by other researchers. The following is a comprehensive evaluation of the current status of this method:

1 urine specimens are contaminated by vaginal or rectal flora, patients with nephrotic syndrome have a large amount of proteinuria, and infections involving the urethral epithelium (prostatitis, hemorrhagic cystitis, bladder tumor or bladder infection caused by intubation) A false positive can occur in the results of the examination.

2 16% to 38% of adult acute pyelonephritis and most children with acute pyelonephritis can have false negative ACB test results. The accuracy of ACB detection in patients with chronic pyelonephritis is 95%. This may be related to the first infection, when the bacteria invade the kidney for 10 to 15 days, the ACB test is only positive. For those who have repeated infections, because of the presence of antibody reactions in their bodies, the time required for the positive conversion of ACB test results is much shorter.

3 In women with acute simple UTI, the positive rate of ACB is different in different patient populations. These differences may be related to the ease of treatment and the length of the symptoms and the length of treatment.

4ACB-positive populations are heterogeneous in response to single-dose antibiotic therapy. 50% to 60% of ACB-positive acute simple UTI women are effective for this treatment, whereas approximately 95% of ACB-negative acute simple UTI women are effective for this treatment.

In summary, the ACB test is not a routine examination for the diagnosis of urinary tract infection. Therefore, efforts continue to be made to find a better, non-invasive UTI positioning diagnostic method.

Film degree exam

1. Imaging examination

The main purpose of the UTI imaging examination is to determine whether the patient has an abnormality in the urinary tract that requires medical or surgical treatment. This type of examination is particularly beneficial for the diagnosis of children and adult male patients. For women, there are more controversies about how to apply these methods properly.

The basic principles of UTI imaging diagnostic examination:

(1) Inpatients with suspected obstructive bacterial pyelonephritis, especially those with poor response to appropriate treatment, need to undergo excretory urography or ultrasound to rule out the possibility of urinary tract obstruction. For septic shock, the above examination is urgent. If the abscess pressure of these patients cannot be relieved by drainage and the obstruction is relieved, it is usually impossible for patients to receive effective treatment.

(2) For children who are first or again UTI, especially age.

The above method is not ideal because the subject has a negative result of 60% to 90%, and the cost is relatively high, and children younger are not suitable for radiation and bladder intubation. However, there is no other technology for the diagnosis of high-risk urinary tract anaesthesia in children, especially the non-invasive infection location diagnosis technology has little diagnostic value for this group of patients.

(3) Most adult male UTI has abnormalities in urinary tract anatomy, the most common is bladder neck obstruction caused by benign prostatic hyperplasia. Therefore, in the anatomical location diagnosis, the prostate should be examined in detail before considering whether to perform excretory urography, or urinary tract ultrasound after emptying, which should be seriously considered for all male UTI patients.

(4) For the first time UTI female patients, most people think that imaging examination is not possible, but there are many controversies about the treatment of infection recurrence. For women with recurrent UTI, most scholars first disapprove of routine cystoscopy, while imaging and urological examinations show only 5% of patients with abnormal urinary tract structure, and the results of this test are for patients. Clinical treatment has no guiding significance. Therefore, routine anatomical diagnosis of recurrent UTI women is not advocated. This is not to say that these tests are meaningless for some patients. Rather, choose those women who have indications for anatomical examinations, including those that are ineffective for treatment or soon after treatment, persistent hematuria, urea-decomposing bacterial infections, persistent inflammatory symptoms such as night sweats, or may have Obstructive symptoms, although given adequate antibacterial therapy, patients with persistent low back pain or lower abdominal pain. It is generally beneficial to perform imaging and ultrasound examinations for those who do not respond to antibiotics.

2. Renal angiography

Because acute urinary tract infection itself is prone to vesicoureteral reflux, intravenous or retrograde pyelography should be performed 4 to 8 weeks after infection is eliminated. Acute pyelonephritis and uncomplicated recurrent urinary tract infection do not advocate routine pyelography. . For patients with chronic or long-term treatment, urinary tract plain film, intravenous pyelography, retrograde pyelography, retrograde ureter ureterography, or occlusion, stones, ureteral stricture or compression, renal ptosis, urinary innate congenital Sexual malformation and vesicoureteral reflux phenomenon.

In addition, you can also understand the shape and function of renal pelvis and renal pelvis, which can be differentiated from kidney tuberculosis and kidney tumors. The renal pelvis of chronic pyelonephritis is slightly dilated or sputum-like, with scar deformity. In the case of renal insufficiency, 2 times or 3 times dose of iodine contrast agent should be used for rapid intravenous injection, and multiple imaging can be used to achieve satisfactory results. Renal angiography can show that the small blood vessels of chronic pyelonephritis have varying degrees of distortion.

3. Nuclide kidney diagram examination

Can understand the renal function, urinary tract obstruction, vesicoureteral reflux and bladder residual urine. The renal pattern of acute pyelonephritis is characterized by a peak shift, the secretory segment is delayed by 0.5-1.0 min, and the excretion segment is slow. The slope of the secretory segment of chronic pyelonephritis is reduced, the peak is blunt or widened and moved backward, and the excretion segment begins. Time delay, parabolic. However, the above changes have no obvious specificity.

4. Ultrasound examination

It is the most widely used and easiest method to detect urinary tract dysplasia, congenital malformation, polycystic kidney, renal artery stenosis caused by uneven kidney size, stones, severe hydronephrosis, tumor and prostate diseases, etc. .

Differential diagnosis

Differential diagnosis of complicated urinary tract infections:

1. Upper urinary tract structure and functional damage: normal urination activity is caused by the spinal reflex center and sympathetic, parasympathetic, and body nerves. The bladder urethral dysfunction caused by damage to the central nervous system or peripheral nerves that control urinary function is called nerve. The original bladder. According to the detrusor function, it is divided into two categories: 1 detrusor hyperreflexia; 2 detrusor no reflection. Neurogenic bladder urethral dysfunction is a type of dysfunction of the bladder and/or urethra caused by neuropathy or damage, often accompanied by a coordinated disorder of bladder and urethral function. Neurogenic bladder and urethral dysfunction produces complex urination symptoms, and poor urination or urinary retention is one of the most common symptoms. The resulting urinary tract complications are the leading cause of death in patients.

2, urinary tract infection: urinary tract infection referred to as urine sensation, is caused by bacteria directly invade the urinary tract caused by inflammation. Infection can involve the upper and lower urinary tract, and the difficulty of positioning is collectively referred to as urinary sensation. Clinically divided into acute and chronic. The former is acutely ill, and the symptoms are more common and easy to diagnose, but the symptoms in infancy can be atypical and the diagnosis is difficult. Chronic and recurrent infections can cause kidney damage. Repeated infection in children, often accompanied by abnormal urinary structure, should carefully find the cause, relieve congenital obstruction, prevent kidney damage and scar formation. Urinary tract infection is a common disease in childhood, mainly caused by E. coli, followed by infections such as bacilli, gas-producing bacilli and para-E. coli, and a few are caused by Staphylococcus aureus.

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