Renal Question

mommatrauma, RN · Aug 5, 2005

I originally posted this question under dialysis but haven't gotten a response so I'll post it here.
How would one differentiate between a bladder infection vs a renal infection with just a urine sample? Not that it really matters, I assume the treatment is the same?

Clinical symptoms do not always correlate with site of infection bladder vs kidney or with the amount of bacteria involved. No test differentiates the difference between bladder infections and kidney infections. Treatment depends on whether its complicated vs uncomplicated infection or presence of pre-existing factors, ie. pregnancy, diabetes, recurrent UTI, or failed oral therapy...

http://www.acpmedicine.com/dxrx/dxrx0723.htm

pricklypear · Aug 5, 2005

Just to add that symptom-wise there can be some differences. Bladder or urinary tract infections will usually cause some burning on urination, feelings of urgency. If flank pain and/or fever begins to accompany the UTI symptoms it usually indicates kidney infection. I had that once after I thought I had gotten over a mild UTI, and I can tell you, it hurts like H***!! Felt like someone kicked me in the back. My doctor told me at the time that for UTIs the favored abx treatment is a sulfa drug or cipro. For nephritis, they move up to the cillins to hit it hard and avoid renal complications.

enfermeraSG · Aug 5, 2005

What about positive nitrites on the urine dipstick? I have heard some say that along with being symptomatic is enough to diagnose pyelo, others say it is only significant of an infection - not necessarily kidney. I am a nursing student right now, so this info would be valuable because I can just see an instructor drilling me on it! SG

1Tulip · Aug 5, 2005

What about positive nitrites on the urine dipstick? I have heard some say that along with being symptomatic is enough to diagnose pyelo, others say it is only significant of an infection - not necessarily kidney. I am a nursing student right now, so this info would be valuable because I can just see an instructor drilling me on it! SG

I cannot answer the question about the U/A-dipstick-nitrites-pyelo. But I can offer a suggestion for dealing with an instructor. When you use a product like this, check the literature that the manufacturer provides (or their website) and see if they address the question you have. Then, at the very least when the instructor "drills" you, you can say... "You know... I wondered about that. The manufacturer doesn't recommend the product for that, so I would be reluctant to rely on it for that purpose." (Or "The manufacturer claims that their product can make that distinction, but I'd like to think there would be additional assessment indicators to go by." or whatever.) The instructor may have you do some additional reading or send you to other sources, but at least you proved to her you were thinking. You'd get an A in my book for the day, even if your answer wasn't technically correct.

zacarias, ASN, RN · Aug 6, 2005

Enfermera, I've never heard that + nitrites being diagnostic of pyelo. But + nitrites does suggest bacterial infection somewhere in the urinary tract.

mommatrauma, RN · Aug 6, 2005

Enfermera, I've never heard that + nitrites being diagnostic of pyelo. But + nitrites does suggest bacterial infection somewhere in the urinary tract.

Agreed, if you use the link in my first post it does indicate that +Nitrites there is bacteria present, but can't differentiate where in the urinary system it is...Nitrites are 90% sensitive and 70% specific for infection...

enfermeraSG · Aug 6, 2005

Thanks! Great info here, and I read the site that Mommatrauma posted a link for and it really is good - clears things up. SG