Urinary tract infection

Introduction Urinary tract infection, referred to as urinary sensation, is inflammation caused by bacteria directly invading the urinary tract. 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.

Cause

Pay attention to the history of diabetes, renal trauma, urinary surgery and instrument examination, and whether there is colitis or constipation. Women pay attention to pregnancy and birth history, incidence and pregnancy, menstruation, and gynecological diseases such as pelvic inflammatory disease.

Urinary tract infection is a general term for diseases such as pyelonephritis, cystitis, and urethritis caused by bacteria. It belongs to the category of "lean disease" and "closed" of Chinese medicine. Generally, low back pain, frequent urination, urgency, and dysuria are the main clinical features. Chinese medicine believes that this disease is caused by hot and humid bet, invading the kidney and bladder, and causing adverse effects of lower coke gasification. There are more children than adults, more women than men, and easy to recurrent. 80% of pathogenic bacteria causing urinary inflammation are Escherichia coli, Proteus, and Streptococcus faecalis in the intestine. Acute simple urinary tract infections are caused by a pathogen, chronic, recurrent infections, may have congenital urinary tract abnormalities, about 1/2 to 1/3 of patients have bladder, ureteral reflux, or stones, Chronic renal insufficiency embolism.

an examination

Related inspection

Renal function test urine sediment urine routine

1. In addition to general urine routine examination, urinary sediment smear Gram stain for bacterial examination, if necessary, 1h urine cell discharge rate determination (method: emptying the bladder, collecting 3h clean urine, calculate 1h urine white blood cells and non-squamous The number of epithelial cells. Judgment: 300,000 has diagnostic significance). This method is more accurate than the 12h urine sediment counting method.

2. Clean mid-stage urinary bacteria culture, colony count and drug sensitivity determination, Gram-negative bacilli colony count 100,000 / ml have diagnostic significance, 10,000 ~ 100,000 / m1 is suspicious, 10,000 / ml are there Diagnostic significance. Infection should be considered when the Gram-positive cocci colony count is 100-10000/ml.

3. Special culture and inspection: For the detection of pathogenic bacteria in conventional bacteria and fungal culture, high-permeability culture (0.3M sucrose medium) can be used to exclude L-type bacterial infection; anaerobic culture is used to exclude anaerobic Bacterial infection. Check for viruses, mycoplasmas, and saprophytic parasites when necessary.

4. Renal function test: including glomerular filtration rate measurement and renal tubular concentration function, acidification function test, chronic cases should be checked for blood and urine potassium, sodium, chlorine, calcium, phosphorus, magnesium, pH, arterial blood gas analysis.

5. Repeated episodes of routine double-B-ultrasound examination: as appropriate, intravenous pyelography or retrograde urography, if necessary, CT examination. Women should undergo gynecological examinations and pelvic venography should be performed if necessary to exclude the presence of predisposing factors.

6. Diagnostic criteria: According to the location of urinary tract infection, it is often divided into upper and lower urinary tract infections. Upper urinary tract infection refers to pyelonephritis, which can be divided into acute and chronic pyelonephritis according to clinical features. Pyelonephritis may be associated with a lower urinary tract infection, while lower urinary tract infections are often present separately.

Differential diagnosis

Differential diagnosis

1, asymptomatic bacteriuria: also known as occult bacteriuria, refers to patients with true bacterial urine, and no clinical symptoms of urinary tract infection. Asymptomatic bacteriuria is common in women. Clinically, there are often no signs and symptoms of urinary tract infections. Urine routine examinations are not obvious, only bacterial urine. The disease can evolve from symptomatic urinary tract infections. Most of the pathogenic bacteria are Escherichia coli. The bacteria can come from the kidneys or the bladder, so cases with persistent bacterial urine need to be further located and examined for anatomical abnormalities in the urinary system, giving appropriate treatment.

2, urethral syndrome: also known as aseptic urinary frequency - urinary discomfort syndrome. Patients with intermittent or persistent urinary frequency, urgency, urinary pain symptoms, often with frequent urination as the main performance. Mostly women, but no urine in multiple urine cultures. The cause is not clear, but some people believe that it is related to nylon pants, gynecological inflammation, excessive anxiety, abnormal urethral dynamics and other factors. Acute urethral syndrome is often seen clinically. Sometimes, the secretion of estrogen is reduced in middle-aged women, the mucus secreted by the vaginal and urethral mucosa is reduced, and the vaginal and urethral mucosa are dried up. The local resistance is reduced and the urinary tract infection is easily caused. There is also a feeling of urinary discomfort when there is no urinary tract infection, and it is negative for repeated urinary sediment and urine culture. In this case, a small dose of nylestriol is administered, while wearing loose cotton underwear has a significant improvement in symptoms. In addition, the diagnosis of this disease should also exclude urinary tuberculosis, anaerobic bacteria, fungi, gonococcal, mycoplasma, chlamydia infection.

3, occult glomerulonephritis: the disease is mainly hematuria or simple proteinuria. However, some patients will be accompanied by white blood cell urine, but after the corresponding anti-inflammatory treatment, red blood cell urine and proteinuria persist. Kidney biopsy can be used for identification if necessary.

4, kidney tuberculosis: renal tuberculosis with hematuria as the main performance, accompanied by obvious symptoms of bladder irritation, easily misdiagnosed as urinary tract infection. However, if the patient undergoes active anti-inflammatory treatment, there are still frequent urination, urinary discomfort or abnormal urine sediment. It is necessary to attach great importance to the presence or absence of renal tuberculosis, and carefully check whether there is tuberculosis or pelvic tuberculosis, and also perform skin OT test, blood tuberculosis antibody. Check, urine sediment smear to find acid-fast bacilli and tuberculosis culture, if positive, should be diagnosed as kidney tuberculosis.

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