URINARY TRACT INFECTION - Full extract 

Spiro's parents were obviously worried. They were used to him being bouncy, happy and eating well; his first six months had been a breeze. But for the last few weeks he was just not himself. He had also lost weight at his last two visits to the infant welfare centre. 

There was not much else to go on. He still looked quite a healthy baby. Examining him there was nothing unusual to find. There was no fever but his mother said that he had been a bit hot for a few days the previous week. She had put it down to a viral infection, although there had not been a runny nose or a cough. 

The cause of the problem was far from clear, so I explained to Spiro's parents that several tests were required. A paediatric urine collector bag was fitted and a routine blood test was arranged. Interestingly, Spiro's father said that his own brother had some sort of kidney problem when he was very young. 

The blood test was normal but the urine test showed a urinary tract infection. I started Spiro on a course of antibiotics and within a day he was as good as new. He also began to eat properly again. 

Because of the definite urinary tract infection I referred Spiro for a renal ultrasound and a bladder X-ray. The investigations showed that he has reflux of urine up both ureters when his bladder contracts to pass urine. This is a rather complex area, so I referred him to our paediatric urology specialist for assessment. 

The specialist suggested that we leave Spiro on antibiotics for the next year or so, and do occasional urine tests to see that there is no continuing infection. When reflux is persistent or severe, surgery may be required to reimplant the ureter into the wall of the bladder. However, the specialist is hopeful that in Spiro's case this may not be necessary.

The urinary tract is essentially a filtering and plumbing arrangement. On each side a kidney filters blood to produce urine, which flows down a narrow tube called a ureter into the bladder. After sitting in the bladder for a while, the urine then passes out a single smaller tube called the urethra to the outside. 

Anything that interferes with this drainage system leads to stasis or stagnation of the urine and subsequent infection... rather like leaves in the spouting. This might be a congenital problem with the bladder and ureters in a young child, a kidney stone in an adult, or perhaps prostate problems in an older man. 

Urinary infections are fairly common, especially lower urinary tract infections like cystitis. Often there is burning or stinging of the urine and urinary frequency. The urine may be quite offensive and sometimes contains blood. About 30% of women will be troubled by these distressing symptoms at some stage. By contrast, when less common infections like pyelonephritis occur in the upper part of the urinary tract, the person is usually quite sick...often with a high fever, back pain and shivers. This type of infection is far more likely to be associated with underlying abnormalities and follow-up investigations are always advised. 

Urinary infections are far more common in females, mainly because of the tiny distance from the urinary opening to the bladder. Contaminant bacteria from the bowel can more easily find their way into the bladder to cause infection. Likewise, the friction of sexual intercourse can also encourage bacteria into the bladder. This tendency can be reduced by emptying the bladder at least once after intercourse, and by drinking plenty of fluids. 

Childhood urinary tract infections are an area of special concern. They are often not obvious and can cause children to be chronically unwell. Sometimes the infection is due to an underlying urinary tract abnormality like reflux of the urine up the ureters to the kidneys. If these problems remain undiagnosed, irreparable damage to the kidneys can occur. When any child is shown to have a definite urinary infection, tests like renal ultrasounds are always advised to check that the whole urinary tract is structurally normal. 

Older patients can also be troubled with urinary infections. When an older patient becomes confused or vaguely unwell a urinary infection needs to be looked for and excluded. If an infection is demonstrated, further investigation with X-rays may be required to exclude structural drainage problems caused by urinary stones, tumours and the like. 

Collecting a reliable specimen of urine to test for infection is not as easy as it sounds. In older children and adults we rely on a clean-catch midstream specimen. In young infants, adhesive collecting bags or other measures may be required. The urine is carefully tested to see if bacteria grow from the specimen. Sensitivity tests are also done to check which antibiotic would be most effective in clearing the infection. 

Once the urinary infection is diagnosed, the treatment is usually quite straightforward...oral antibiotics, plenty of fluids, and sometimes alkalinizing drinks to take away urinary burning. More severe upper urinary tract infections might require hospitalization and intravenous antibiotics but they also respond well to treatment. Follow-up urine tests are then done to check that the infection has been completely cleared. Then comes the next step...to rule out any predisposing reason for the infection to have occurred in the first place. 

Health Tip:
* When a child or an elderly person becomes unwell and the cause is not obvious, think of a urinary tract infection. 

* With urinary tract infections it is important to rule out underlying structural abnormalities. This is of particular importance in young children.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001