Editing Urinary Tract Infections (section)

===== Diagnosis and Evaluation =====

====== History and Physical Exam ======
* The clinical spectrum ranges from gram-negative sepsis to cystitis with mild flank pain.
* '''<span style="color:#ff0000">History'''
**'''<span style="color:#ff0000">Signs and Symptoms'''
***'''<span style="color:#ff0000">Upper tract signs (3):'''
***#'''<span style="color:#ff0000">Abrupt onset of chills'''
***#'''<span style="color:#ff0000">Fever'''
***#'''<span style="color:#ff0000">Unilateral or bilateral flank or costovertebral angle pain and/or tenderness'''
***'''<span style="color:#ff0000">Often accompanied by LUTS such as (3):'''
***#'''<span style="color:#ff0000">Dysuria'''
***#'''<span style="color:#ff0000">Increased urinary frequency'''
***#'''<span style="color:#ff0000">Urgency'''
* '''<span style="color:#ff0000">Physical Exam'''
** '''<span style="color:#ff0000">Tenderness to deep palpation in the costovertebral angle'''

====== Labs ======
* '''<span style="color:#ff0000">CBC'''
** May have leukocytosis with a predominance of neutrophils.
* '''<span style="color:#ff0000">Urinalysis'''
** Usually reveals numerous WBCs, often in clumps, and bacterial rods or chains of cocci.
** '''The presence of large amounts of granular or leukocyte casts in the urinary sediment is suggestive of acute pyelonephritis.'''
* '''<span style="color:#ff0000">Urine cultures'''
** '''Usually positive'''
*** '''≈20% of patients have''' urine cultures with < 105 cfu/mL and therefore '''negative results on Gram staining of the urine'''
* '''<span style="color:#ff0000">Blood cultures'''
** '''<span style="color:#ff0000">Should not be routinely obtained for the evaluation of uncomplicated pyelonephritis in females.'''
*** '''Positive in ≈25% of cases of uncomplicated pyelonephritis in females and the majority replicate the urine culture and do not influence decisions regarding therapy.'''
** '''Should be performed in males and females with systemic toxicity or in those requiring hospitalization or with risk factors such as pregnancy'''
'''Imaging'''
* '''In patients with presumed uncomplicated pyelonephritis who will be managed as outpatients, initial radiologic evaluation can usually be deferred.'''
** However, if there is any reason to suspect a problem or if the patient will not have reasonable access to imaging if there should be no change in condition, renal US can rule out stones or obstruction.
* '''In patients with known or suspected complicated pyelonephritis, CT provides excellent assessment of the status of the urinary tract and the severity and extent of the infection.'''
*'''Renal US and CT are commonly used to evaluate patients initially for complicated UTIs or factors or to reevaluate patients who do not respond after 72 hours of therapy'''