094. Urinary Tract Infections and Hematuria

Renal Infarctions

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

  1. Cloudy/foul urine is usually an UTI. Cloudy/foul likely related to hydration status of patient; does not mean patient is having UTI.
  2. Positive bacteria means UTI. Asymptomatic bacteremia is common in all ages groups. Virtually 100% of indwelling catheters colonize within 2 weeks.
  3. Nitrite positive means UTI. Study showed in nursing home patients with both positive nitrite/leukocyte esterase, only 48% positive for true UTI.
  4. Pyuria means UTI. 6-10 WBC can be related to hydration status as well.
  5. AMS and bacteruria – can be observed for 1-2 days for possible resolution of AMS before treating (no realistic in my experience).
  6. 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.
094. Urinary Tract Infections and Hematuria