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Urinary tract infection: bacteria can affect the kidneys and require treatment

Urinary tract infection: bacteria can affect the kidneys and require treatment

The condition we commonly call a urinary tract infection, in fact, represents an infectious process where bacteria grow somewhere in the urinary tract (kidneys, ureter, bladder and urethra). In fact, bacteria enter the urinary tract from the urethra and begin to multiply in the bladder. These bacteria can stay only in the bladder or progress in the urinary tract until you reach the kidney. Therefore, although it appears that urinary infections always appear in the kidneys or affect them, this statement is not correct.

Urinary infections can occur in the lower urinary tract (bladder and urethra) or upper or upper (urinary) urinary tract. The pictures that involve the bladder are the known cystitis and the pictures that involve the kidneys are called pyelonephritis.

Cystitis is most often caused by a type of bacteria from the gastrointestinal tract, called Escherichia coli , and urethritis may also be due to bacteria coming from the gastrointestinal tract, but because the urethra in women is closer to the vagina, some infections such as herpes, gonorrhea and chlamydia infection can lead to urethritis. In order to have an idea of ​​the frequency of the two conditions, acute pyelonephritis occurs in frequency about 18 times lower than the cystitis pictures, which is important, since the clinical picture of pyelonephritis is generally more severe and requires, in many cases, patient hospitalization.

There are some gender-related differences in the frequency of urinary tract infections. In general, in the first year of life, urinary infections occur more frequently in boys due to congenital malformations, such as in the posterior urethral valve. Since the pre-school age and in adulthood, women usually present more episodes of urinary tract infection than men.

It is known that among women the peak occurrence of urinary infections occurs at the onset of sexual activity, during gestation or after menopause, so that studies indicate that in about 40% of women there will be at least one episode of urinary tract infection throughout life. The factors that explain the greater propensity of women to this disease are shorter urethra, greater proximity of the anus to the vaginal vestibule and urethra, and use, for example, of spermicidal gel that alters the region's acidity and vaginal flora. side, among men, some beneficial factors are described that would protect them from developing this picture, being they the greater length of the urethra, greater urinary flow and the antibacterial factor prostate. There is also, although controversial, the fact that circumcision would reduce the risk of infection because there is no binding of the bacteria to the foreskin. However, from the fifth or sixth decade of life, some conditions may favor urinary tract infections, such as changes in the prostate gland and the need for bladder catheterization, which would favor the migration of bacteria.

Urinary infections can be classified as uncomplicated and complicated, and among uncomplicated infections is, for example, cystitis. In this situation, both the structure and functionality of the urinary tract are normal, and there is therefore no impairment of the kidneys. Among complicated infections, we can use as an example pyelonephritis, that is, the infection involving the kidney. The occurrence of complicated acute pyelonephritis is greater among women, both in a non-hospital environment and in hospitalized patients.

There are a wide range of situations or diseases that are associated with complicated infections, such as those related to obstructive processes (such as benign prostatic hypertrophy, presence of tumors, renal calculi, ureteral strictures or narrowing, renal cysts, or presence of diverticula in the bladder), functional changes in the urinary tract (neurogenic bladder, vesicoureteral reflux, use of urethral catheter ) and metabolic changes (diabetes mellitus, renal failure, renal transplantation, etc.).

Treatment of urinary tract infections usually involves the use of an antibiotic that will be chosen according to the bacteria found in the tests that will be ordered.

Thus, in urinary tract obstructions, what happens is that urine is retained for more time in the bladder, leading to the growth of bacteria and, moreover, as the bladder distends itself through the accumulation of urine, the mucosa lining the bladder loses its ability to destroy bacteria.

To understand what occurs in the vesicoureteral reflux, it is good to remember which is the normal pathway that urine follows since its formation. Once produced in the kidneys, the urine passes through the ureter to be accumulated in the bladder and when we feel like urinating, that urine is eliminated to the outside environment by the urethra. When we urinate, the bladder empties and therefore there should be no residual volume (urine). However, when a frame of reflux occurs, we are indicating that the urine returns from the bladder to the ureter. In this situation there is persistence of residual volume of urine in the bladder which ultimately leads to the growth of bacteria. In addition to these situations, urinary infections can evolve with complications in the cases of recurrent infections, ie when three or more infections occur. year or when there is permanent kidney damage resulting from an acute or chronic pyelonephritis due to an untreated urinary tract infection.

Some factors are known to predispose to the appearance of urinary infections such as pregnancy, diseases such as diabetes mellitus and menopause .

Know Differentiating Symptoms

Some people believe that urinary tract infections always have symptoms. In these cases, changes in the urine test may be observed with the presence of large numbers of bacteria (asymptomatic bacteriuria), which especially in pregnant women, patients who will undergo urological procedures or probing, require antibiotic treatment. The most common symptoms we can mention are a strong and persistent urge to urinate, burning sensation when urinating, elimination of small amount of urine in each urination, sometimes the urine looks cloudy, it may appear reddish, with dark, indicative of loss of blood in the urine, and with strong odor, in addition to suprapubic pain. In men, rectal pain can occur.

In order to differentiate urinary tract infection in its different forms according to symptomatology, we can say that urethral infections (urethritis) usually present with burning sensation when urinating, cystitis usually present with pressure in the pelvic region, discomfort in the lower abdomen, frequent and painful urination, and pyelonephritis presents a more exuberant symptomatology with flank and lumbar pain, high fever, chills and tremors, nausea and vomiting. Therefore, as can be seen, urinary infections that affect the kidneys are richer in symptoms and, as said before, in general, need hospitalization for treatment.

Treatment options

Treatment of urinary tract infections in general treatment involves the use of an antibiotic that will be chosen according to the bacteria found in the tests that will be ordered.

In uncomplicated infections treatment may vary from one to three days but may be indicated for longer depending on each case. In addition to antibiotics, an analgesic can be prescribed to relieve the burning sensation on urination. In general, this medicine will stain orange urine. In addition, adequate hydration allows bacteria to be removed faster, reducing the possibility of proliferation.

Other measures that may be employed in the treatment of urinary tract infections involve longer cycles of antibiotic therapy (prophylaxis), or short-term treatments that symptoms begin, or for women after menopause, the use of vaginal creams with estrogens may decrease the risk of recurrent infections, and the use of cranberry products in some indications has shown protective effect.In the case of severe urinary tract infections, in general, the treatment is done in a hospital environment, with intravenous medication, the treatment time is variable, but around 14 to 21 days and the choice of antibiotic is based on the resistance profile of the bacteria, the patient's clinical condition and the severity of the infection.

The best medicine

Prevention is always the best option especially for women who usually have a higher incidence of urinary tract infections. Here are some recommendations:

Ingest Adequate amounts of fluids, especially water: Water helps to dilute urine and cause it to urinate more often throughout the day, thus, bacteria will be removed from the urinary tract before infection can settle.

After urinating and evacuating the hygiene should be done from front to back. This will prevent bacteria from the gastrointestinal tract (anal area) from spreading to the vagina and urethra

Emptying the bladder after intercourse will help remove possible bacteria

Avoid wearing tight clothing (pants) and deodorants or powdered products in the genital area. Such products may irritate the urethra and facilitate the migration of bacteria and their possible proliferation.


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