the urinary tract epithelium
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Week 10 Discussion
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Week Ten Discussion
Urinary tract infections (UTI) are inflammation of any part of the urinary tract epithelium. The locations can include the urethra, prostate, bladder, ureter, or kidney (Huether & McCance, 2017). UTIs are one of the most common bacterial infection, affecting an estimated 150 million people around the world each year (Mireles, Walker, Caparon, & Hultgren, 2015). About $3.5 billion per year is spent on office time, tests, treatment, and missed work in the United States alone (Mireles et al., 2015).
Upper and Lower UTIs
UTIs can affect both the upper and lower urinary tracts. A lower UTI is inflammation of the urethra and/or bladder. Acute cystitis (inflammation of the bladder) is the most common site of a UTI (Huether & McCance, 2017). The most common causes of cystitis are E. coli, Staphylococcus saprophyticus (Huether & McCance, 2017). According to Mireles et al. (2015), a UTI usually starts with contamination of the urethra by the uropathogen from the gut, then move into the bladder. The subsequent inflammation causes the mucosa to be hyperemic, and possible hemorrhage, pus formation, and sloughing in prolonged infections (Huether & McCance, 2017). Some may be asymptomatic. However, common symptoms of cystitis are frequency, urgency, dysuria, low back pain, and suprapubic pain (Huether & McCance, 2017).
Acute pyelonephritis is an infection of the upper urinary tract (ureters, renal pelvis, and/or interstitial). The most common causes of pyelonephritis are urinary obstruction and urine reflux (Huether & McCance, 2017). The most common pathogens include E. coli, Proteus, and Pseudomonas (Huether & McCance, 2017). The microorganisms overcome host immune surveillance and ascend the ureters to the kidney(s) (Mireles et al., 2015). Inflammation causes infiltration of white blood cells, renal edema, and purulent urine, resulting in fever, chills, and flank pain (Huether & McCance, 2017). Patients may also experience symptoms of lower UTI symptoms, as well.
Patient Factors
Gender is a significant factor with UTIs. Adult women are 30 times more likely to develop a UTI than men are (Tan & Chelbicki, 2016). Up to 50% of women develop a UTI in their lifetime (Huether & McCance, 2017). Women are more at risk because the urethra is shorter and near the anus (Huether & McCance, 2017). At-risk women include sexually active, pregnant, antibiotic usage, postmenopausal, and spermicide users (Huether & McCance, 2017).
Age is also a factor with UTI risk. UTI increases with age among both men and women. Because of aging, sensitivity to infection, and comorbidities, older adults are more at risk for UTI (Alpay, Aykin, Korkmaz, Gulduren & Caglan, 2018). There can be increased difficulty diagnosing a UTI in the elderly because they may demonstrate vague symptoms, incontinence, confusion, nausea, and abdominal pain (Alpay et al., 2018). Healthcare providers should be aware of changes in urine character such as odor and cloudiness, that may point to a UTI (Alpay et al., 2018).
Diagnosis
Diagnosis of cystitis can be made by a urine culture of microorganisms with 10,000/ml or more from urine (Huether & McCance, 2017). Urine dipstick that is positive for leukocyte esterase or nitrate reductase is also useful for diagnosis in uncomplicated UTI (Huether & McCance, 2017). Diagnosis can even be made without an office visit or tests with women with no other risk factors of complicated UTI (Huether & McCance, 2017). Uncomplicated cystitis usually requires three to seven days of treatment with antibiotics, whereas complicated cystitis requires about one to two weeks of treatment (Huether & McCance, 2017). Differentiating acute cystitis and acute pyelonephritis can be difficult. Urine culture, urinalysis, signs and symptoms, and the presence of white blood cell casts can assist in the diagnosis of pyelonephritis. Uncomplicated pyelonephritis two to three weeks of antibiotic therapy, with follow-up urine cultures one and four weeks after treatment if symptoms come back (Huether & McCance, 2017).
References
Alpay, Y., Aykin, N., Korkmaz, P., Gulduren, H.M., & Caglan, F.C. (2018). Urinary tract
infections in the geriatric patients. Pakistan Journal of Medical Sciences, 34(1), 67-
72. doi: 10.12669/pjms.341.14013
Huether, S.E., & McCance, K.L. (2017). Understanding pathophysiology (6th ed.). St. Louis,
MO: Mosby.
Mireles, A.L., Walker, J.N., Caparon, M., & Hultgren, S. (2015). Urinary tract infections:
Epidemiology, mechanisms of infection and treatment options. Nature Reviews Microbiology, 13(5), 269-284. doi: 10.1038/nrmicro3432
Tan, C.W., & Chelbicki, M.P. (2016). Urinary tract infections in adults. Singapore Medical
Journal, 57(9), 485-490. doi: 10.11622/smedj.2016153
