Urinary Tract Infections (UTIs)

•    Cystitis (Lower UTI):

o    Symptoms: dysuria, frequency, urgency, suprapubic pain ± haematuria

o    Most common organisms: E. coli, Klebsiella, Proteus, Staphylococcus saprophyticus

o    Diagnosis:

    Urinalysis: leukocytes, nitrites (Gram-negative bacteria), ± blood

    Urine culture: if recurrent, male, or complicated infection

o    Treatment:

    Empirical antibiotics (e.g. nitrofurantoin, trimethoprim)

    Ensure adequate hydration

•    Acute Pyelonephritis (Upper UTI):

o    Symptoms: fever, chills, flank or loin pain, vomiting

o    Signs: costovertebral angle tenderness

o    Urinalysis: pyuria, white cell casts (diagnostic), bacteriuria, ± haematuria

o    Investigations:

    Blood cultures if febrile

    Imaging (e.g. ultrasound or CT) if atypical features, failure to improve

o    Treatment:

    Oral or IV antibiotics (e.g. ciprofloxacin, co-amoxiclav)

    Admit if septic, vomiting, or pregnant

Reflux Nephropathy

•    Definition: Renal parenchymal damage due to vesicoureteric reflux (VUR) and recurrent UTIs, especially in children

•    Pathophysiology:

o    Congenital VUR → retrograde urine flow during voiding → pyelonephritis → renal scarring

o    Leads to focal segmental glomerulosclerosis in advanced cases

•    Clinical Features:

o    Recurrent febrile UTIs in children

o    Asymptomatic hypertension in older children/adults

o    Proteinuria ± progressive CKD

•    Diagnosis:

o    Micturating cystourethrogram (MCUG): confirms VUR

o    DMSA scan: detects renal scarring

o    Renal ultrasound: small, scarred kidneys

•    Management:

o    Long-term antibiotic prophylaxis in selected cases

o    Surgical correction in severe or persistent reflux

o    Monitor BP and renal function

Renal Tuberculosis (TB)

•    Cause: Reactivation of haematogenous spread from primary TB (often pulmonary)

•    Clinical Features:

o    Sterile pyuria (WBCs in urine, but negative routine culture)

o    Haematuria, dysuria, frequency

o    Flank pain, low-grade fever, weight loss

o    May cause non-functioning kidney, calcifications, strictures

•    Investigations:

o    Early morning urine: 3 consecutive samples for acid-fast bacilli (AFB) and TB culture (Lowenstein–Jensen medium)

o    PCR for Mycobacterium tuberculosis may improve sensitivity

o    IVU or CT urogram: cavitation, strictures, calcification ("putty kidney")

•    Management:

o    Standard anti-TB therapy (e.g. RIPE: rifampicin, isoniazid, pyrazinamide, ethambutol)

o    Nephrectomy if severe damage/non-functioning kidney