Commonly missed as misdiagnosis of kidney stone or pyelonephritis vs musculoskeletal pain. Usually embolic (afib, cardiomyopathy, LV aneurysm, MV stenosis/prolapse, artificial valve) vs in-situ thrombosis (aneurysm, dissection). Presents as acute onset flank pain. Hematuria (32-72%), fever (10%). Creatinine usually normal. LDH very sensitive (usually >300). Diagnosis with CT with contrast. Tx: anticoagulation. Look for big picture – embolic syndrome. Needs likely TEE as well. (USC Rounds, 10/12/17).
6 UTI myths
- Cloudy/foul urine is usually an UTI. Cloudy/foul likely related to hydration status of patient; does not mean patient is having UTI.
- Positive bacteria means UTI. Asymptomatic bacteremia is common in all ages groups. Virtually 100% of indwelling catheters colonize within 2 weeks.
- Nitrite positive means UTI. Study showed in nursing home patients with both positive nitrite/leukocyte esterase, only 48% positive for true UTI.
- Pyuria means UTI. 6-10 WBC can be related to hydration status as well.
- AMS and bacteruria – can be observed for 1-2 days for possible resolution of AMS before treating (no realistic in my experience).
- Yeast/Candida in Urine with catheters needs treatment. Colonization. Very rare to cause symptoms. Isolation of candida in urine of noncatherized patients should raise concerns for vaginal or external contamination.