Urinary Tract Infection (UTI)

The renal system is composed of 2 kidneys, 2 ureters, a bladder, and a urethra. These structures function to filter blood and excrete urine, which contains waste products of metabolism. Varying conditions such as infections, cysts, solid masses, ischemia, and mechanical obstruction can affect the renal system. Evaluation of diseases rely on imaging methods such as radiography, ultrasonography, CT, and MRI. Some of these are also used to guide tissue sampling (e.g., renal biopsy).

An infection is the proliferation of microorganisms within tissues, body cavities, or spaces, which induces an immune response and overwhelms the body’s natural defenses. In surgical patients, these infections are frequently caused by the translocation of commensal organisms into deeper tissues, combined with the impairment of host defenses due to surgical injury or stress. Infections commonly identified in patients after surgery include surgical site infections, catheter-associated infections, and ventilator-associated infections. Infection subtypes can be prevented, diagnosed, or treated using several strategies. The mainstays of treatment in surgical patients involve local control of the infection as well as targeted antibiotic therapy.

Pyelonephritis is infection affecting the renal pelvis and the renal parenchyma. This condition arises mostly as a complication of bladder infection that ascends to the upper urinary tract. Pyelonephritis can be acute or chronic (which results from persistent or chronic infections). Typical acute symptoms are flank pain, fever, and nausea with vomiting. The chronic type depends on the underlying pathology. The diagnosis is established via clinical presentation, supported by laboratory findings (in blood and urine). Imaging studies are performed if severe illness is noted or there is no response to initial treatment (antibiotics). CT is the study of choice, given its ability to detect renal abnormalities associated with the infection, including the extent of the disease. Perinephric abscess is an infection involving the perinephric space between the kidney and Gerota’s fascia. Perinephric abscess can be an extension from pyelonephritis or from hematogenous spread of a systemic infection. The diagnosis is established via CT scan. The treatment includes antibiotics, with abscess drainage (which is both diagnostic and therapeutic).

Urinary tract infections (UTIs) represent a wide spectrum of diseases, from self-limiting simple cystitis to severe pyelonephritis that can result in sepsis and death. Urinary tract infections are most commonly caused by Escherichia coli, but may also be caused by other bacteria and fungi. Depending on the location of the infection, patients can present with dysuria, urinary urgency, increased urinary frequency, suprapubic pain, and fever. Urinalysis and urine culture along with the clinical presentation help in the diagnosis of UTIs. Management options include oral or IV antibiotics such as trimethoprim-sulfamethoxazole, nitrofurantoin, and ceftriaxone. In certain instances, further workup may be needed to determine the underlying conditions that predispose an individual to UTIs.