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Acute Pyelonephritis II: Diagnostic Studies and Management01:28

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Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
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Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such...
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The pathophysiology of urinary tract infections (UTIs) encompasses several progressive stages, beginning with bacterial colonization and culminating in potential systemic complications if untreated. UTIs are primarily initiated by bacteria, such as Escherichia coli, which often originate from the gastrointestinal tract and migrate to the urinary system through the periurethral area. This migration can occur via several routes, including improper hygiene practices, sexual activity, or...
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Urinary tract infections (UTIs) impact various parts of the urinary system, including the kidneys, ureters, bladder, and urethra. These infections are generally bacterial, with Escherichia coli being the most common causative agent, often originating from the gastrointestinal tract. However, other bacteria, such as Staphylococcus saprophyticus, Klebsiella pneumoniae, and Proteus mirabilis, are also known to cause UTIs. The type, location, and underlying complexity of the UTI guide both...
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A healthcare provider can diagnose a urinary tract infection (UTI) through several methods:Medical History and Symptoms: The provider will take a detailed medical history and ask about symptoms such as frequent urination, burning sensation during urination, and lower abdominal pain.Urinalysis: A clean-catch urine sample is collected in a sterile container and tested for the presence of bacteria, white blood cells (leukocytes), nitrites, blood, and protein. The presence of leukocytes and...
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The genitourinary system is critical to maintaining fluid balance, waste elimination, and reproductive function. Nurses play a vital role in assessing this system, beginning with a thorough health history. This process involves gathering patient information, identifying risk factors, and recognizing symptoms of genitourinary disorders. Early detection is vital for timely interventions and management.1. Gathering Patient InformationA complete health history includes the patient’s personal,...
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Sex effects in pyelonephritis.

Clayton D Albracht1, Teri N Hreha1, David A Hunstad2,3

  • 1Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8208, St. Louis, MO, 63110, USA.

Pediatric Nephrology (Berlin, Germany)
|February 11, 2020
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Summary

Urinary tract infections (UTIs) impact both sexes, with unique risk factors and outcomes in males. Research highlights sex differences in immune responses and the potential role of androgens in UTI severity.

Keywords:
Innate immunityKidneyRenal fibrosisSex differencesUrinary tract infection

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Area of Science:

  • Urology
  • Immunology
  • Pediatrics

Background:

  • Urinary tract infections (UTIs) are commonly viewed as a female condition, but affect all ages and sexes.
  • While pyelonephritis is more frequent in women, it presents higher morbidity in men.
  • In young infants, males are more commonly affected by UTIs than females, with risk factors including posterior urethral valves and uncircumcised status.

Purpose of the Study:

  • To investigate sex differences in urinary tract infection (UTI) pathogenesis and immune responses.
  • To explore the influence of sex hormones, particularly androgens, on UTI outcomes.
  • To identify specific risk factors contributing to UTI incidence in male infants.

Main Methods:

  • Analysis of epidemiological data on UTI incidence and outcomes across different sexes and age groups.
  • Utilization of mouse models to study innate immune responses to UTI and the effects of androgens.
  • Examination of potential hormonal influences, such as the postnatal testosterone surge in male infants.

Main Results:

  • Mouse models reveal sex-based differences in innate immune responses to UTI.
  • Male mice and androgen-treated female mice exhibit worse outcomes in experimental pyelonephritis.
  • Androgen exposure may suppress the innate immune control of urinary tract infections, with potential non-hormonal sex effects also implicated.

Conclusions:

  • Sex and sex hormones significantly influence UTI pathogenesis and immune responses.
  • Androgen exposure may exacerbate UTI severity by modulating innate immunity.
  • Further research in contemporary models is needed to fully elucidate sex-specific effects on UTIs.