CLIN MX: According to Nelson there are 3 basic forms UTI

o Pyelo, Cys, ABU

o Pyelo,

which is a do affecting the tubuels, interstitium and pelvis

Usually presents with ssx sysystemic infection
It come in 2 forms: ACUTE (wc involves bac infection), CHRONIC (wc is
a more complex do, bac infection plays a dominant role but other
factors involved such as VUR or obstruction)
Other forms of renal parenchymal involvement are
ACUTE NEPHRONIA: localized infection involving >1 lobe that
represents either complication of pyelo or early of renal abscess
RENAL ABSCESS:occur following pyelo, usually 2 to primary
bacteremia of Staph
Cysstitis
Affects the UB
More localized, no fever
Causes sx of irritation DUF
ABU
Bacterial infection of the lower urinary tract may be completely
asymptomatic (asymptomatic bacteriuria) and most often
remains localized to the bladder without the development of
renal infection.
RISK FACTORS
o Complicated infections occur in patients who have metabolic, structural or
functional abnormalities of the urinary tract.
o Females, being a biologic factor, are more prone to UTI due to the proximity
of the bowel to their urethra
PATHO:
The urinary tract can be infected via haematogenous or lymphatic spread of
microorganisms, but the ascending route from the urethra is more common. Enteric
bacteria most often cause UTI due to the anatomic proximity of the bowel flora to the
urethra, particularly in women. This is clinically seen as the nitrituria and Gram (-)
rods in urinalysis which are usually associated with enteric bacteria.
Organisms from the bowel spreads to the perenium and, in women, colonize the
vaginal introitus and vagina. Once the vaginal introitus and periurethral area are
colonized, bacteria can readily gain entry into the urethra.
The most prevalent is uropathogen is E.coli. Its key virulence factor is the adhesin
which facilitates the adhesion to the urothelium. The most pathogenic strains of
E.coli have filamentous adhesins termed as p-pili or p-fimbriae. P pili is expressed by
almost all pyelonephritis E. coli isolates. The adhesion of the bacteria to the
uroepithelium allows the colonization and ascending infection.

Mucosal attachment and invasion also triggers a host immune response. The mucosal
cells release chemokines that attract neutrophils to the affected tissues. Recruited
neutrophils cross the mucosa and are released into the urine (pyuria).

If left untreated, bladder infections can ascend to the ureters. The fimbriae and
bacterial toxins released by the bacteria decreases the peristaltic action of the ureter,
thus allowing further ascent of the infection.
It could also then migrate to the kidneys, which prominently involves the renal pelvis,
causing pyelonephritis. The entire kidney is rarely involved; instead, patchy areas of

necrosis and scarring are found adjacent to normal tissue. This could be associated
with hematuria and lower back pain that were manifested in the patient.