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DIAGNOSIS :URINARY TRACT

INFECTION AND NEPHROLITHIASIS


• HISTORY
• PHYSICAL EXAMINATION
• URINALYSIS WITH MICROSCOPY (AND URINE
CULTURE IF EVIDENCE OF INFECTION).
• SERUM ELECTROLYTES, BUN, CREATININE, AND
CALCIUM
• COMPLETE BLOOD COUNT
• ABDOMINAL IMAGING
• STONE ANALYSIS (IF A SPECIMEN CAN BE
OBTAINED).
URINE ANALYSIS

Normal Findings Abnormal findings


• pH - 4.6 – 8.0 •pH – Alkaline
• Appearance- clear (Increases)
• Color – pale to • Appearance – cloudy
amber ,yellow • Color - deep amber
• Odor – aromatic • Odor – foul smelling
• Blood – none •Blood – maybe present
• Leukocyte esterase – •Leukocyte esterase -
none present
• WBC- absent •WBC- present
• Bacteria- absent •Bacteria- present
URINE CULTURE:
Cultures are indicated in the following situations:
– Complicated UTI including pyelonephritis
– UTI in past 3 weeks indicating possible
relapse or the
presence of symptoms for > 7 days
Recent hospitalization or catheterization
indicating
possible nosocomial infection
 – Transplant patients
– Prostatitis patients
– Pregnancy
 – Diabetes
REPORTING OF URINE CULTURE
 Count approximate no. of
colonies=Estimate the number of
bacteria,that is colony forming units
per ml of urine.
<10,000 organisms/ml,not
significant.
10,000-100,000,doubtful
significance.
 >100,000/ml,significant bacteuria
MOST COMMONLY USED QUANTITATIVE CRITERIA FOR UTI
• Symptomatic women
– >103 CFU bacteria/ml = most likely cause of the UTI

• Symptomatic men
– >103CFU bacteria/mL
• Catheterized patients
>103CFU bacteria/mL
• Asymptomatic individuals
– >105CFU bacteria/mL(IDSA recommends 2 urine
samples)
IMAGING MODALITIES FOR NEPHROLITHIASIS
Abdominal X-RAY
Intravenous pyelography / excretory
urography
ULTRASOUND
CT SCAN