URINARY TRACT INFECTIONS

Dr.Navaneethakrishnan PharmD.,
Assistant Professor
Department of Pharmacology
Introduction
 The urinary tract is normally sterile and so normal urine is sterile
Sterility is normally maintained by
 Free flow of urine
 The low pH (acidic)
 High osmotic pressure
 High NH3 content of urine
 Urethral length
 Ureterovesical and urethral sphincters
 Prostatic secretions (bacteriostatic) and the anti-bacterial antibodies
(by bladder mucus)
Infection occur mostly in lower UT rarely in upper UT / both
Mostly affects female (no prostate, pregnancy, short urethra)
 Urinary tract infection is defined as the presence of organisms in
the urinary tract along with the signs and symptoms of
inflammation.
 It is also defined as the presence of at least 1 lakh bacteria/ml of
urine not normal bacteria count is 1000/ml of urine.
 If the inflammatory conditions are confined to urethra and bladder,
then it is known as lower urinary tract infection and if it involves
the ureters and kidneys, then it is known as upper urinary tract
infection.
 Various urinary tract infection is include,
1. Ureteritis
2. Cystitis
3. Pyelitis
4. Pyelonephritis
1. Ureteritis
It is the inflammation of the ureters, mainly due to descending
infection.
2. Cystitis
It is the inflammation of the urinary bladder, which is more
common in females than in males. This is because, females have
shorter urethra and hence the microbes can easily enter into the
bladder.
3. Pyelitis
It is the inflammation of the renal pelvis and calyces, Which
occurs due to bacteria (Escherichia coli). It is more common in women
than in men.
4. Pyelonephritis
Inflammation of the kidneys which impairs their function.
1. Ureteritis

 Inflammation of urethra
 Classified into gonococcal and non gonococcal urethritis
 Urethritis often accompanied by cystitis in women and
prostatistis in men

Morphology
 Accumulation /aggregation of lymphocytes in the subepithelial
region – fine granular mucosal surface (ureteritis follicularis)
 At other times mucosa become sprinkled with fine cysts
uretritis cystica.
2. Cystitis
 Cystitis is a term that refers to urinary bladder inflammation

Morphology - Cystitis
 Hyperemia of mucosa
 Ulcerative cystitis – ulceration of large areas of the mucosa sometimes
seen
 Persistence of the infection leads to chronic cystitis

Morphology – chronic cystitis

 There is more extreme heaping up of infection gives rise to fibrous
thickening and consequently inelasticity of the bladder wall
 Follicular cystitis - aggregation of lymphocytes into lymphoid follicles
3. Pyelitis
It is the inflammation of the renal pelvis and calyces, Which occurs
due to bacteria (Escherichia coli) It is more common in women than in
men.

 Escherichia coli (E.Coli) – most common

Other organisms include

 Proteus
 Klebsiella
 Enterobacter
 Pseudomonas
 Staphylococci
4. Pyelonephritis
Pyelonephritis is a renal disorder affecting the tubules, interstitium
and renal pelvis
Acute Pyelonephritis is the commonest form of UTI which is caused by
bacterial infection

Occurs in two forms

Acute pyelonephritis
Chronic pyelonephritis

other factors (vesico-ureteral reflux, obstruction) are involved in

addition to bacterial infection.
Acute pyelonephritis:

Gross changes:
The kidneys are enlarged, swollen and the cut surface shows
yellow or white abscess with haemorrhagic lining.

Microscopic changes:
Patchy interstitial inflammation is seen with tubular
destruction due to accumulation of neutrophils
Chronic pyelonephritis:
It occurs due to repeated attacks of inflammation and scarring
Which leads to complete failure of the kidneys chronic
pyelonephritis is of two types.

Reflux nephropathy:
It occurs due to vesico-ureteral reflux.

Obstructive pyelonephritis:
Due to obstruction of urine outflow at different levels
Chronic pyelonephritis:

Gross changes:
Kidneys shrink and get constricted. weight of the kidneys also
decreases and they weigh less than 100 gram (normal weight is 135 to
150g). The surface of the kidney shows irregular scars.

Microscopic changes:
Inflammation is seen due to inflammatory infiltrate of lymphocytes,
plasma cells and macrophages. Kidney tubules, renal pelvis and calyces
Show dilatation and inflammatory reaction.
Aetiology
 Causative organisms of urinary tract infections (UTI) are E.coli,
Pseudomonas aeroginosa, Streptococcus faecalis, Staphylococcus
epidermis and Proteus mirabilis.
 Organisms which cause UTI in hospitals are E.coli, Streptococci and
Klebsiella.
 Sexual intercourse
 Sexually transmitted diseases like gonorrhoea causes urethritis.
 Having bubble bath, wearing tight fitting clothes or holding urine
for long time can cause the microorganism to enter into the bladder
or kidneys and cause UTI.
 Risk factors for developing UTI include, pregnancy, diabetes,
presence of tumour, stones or any foreign bodies in the urinary
tract.
Types of UTIs
Acute Infection :
Acute infection involves infection of the urinary bladder termed as
cystitis and urethra known as urethritis. This condition or infection is
collectively termed as cysto-urethritis.
Symptoms:
 Frequent micturition
 Dysuria (painful micturition)
 Pain in the perineum (region between the anus and urethral
opening)
 Loin pain (Loin is the region between thorax and pelvis)
 Chills, Fever and leukocytosis are seen when kidneys are also
involved.
Symptoms:

 Pyuria (presence of pus cells in urine)

 Significant bacteriuria (presence of bacteria in urine)
 Septicaemia occurs in pregnant women
 In patients on immunosuppressants and those suffering from
lynphoproliferative disorders.

If acute infections are not treated properly, then they may lead to
recurrent and chronic infection (pyelonephritis)
Chronic Infection :
Chronic infection involves infection of kidneys. It includes acute
pyelonephritis and chronic pyelonephritis. Acute pyelonephritis
involves acute infection of one or both kidneys along with lower
urinary tract.
The cause of chronic pyelonephritis is unclear as it may be due to
an infection while in some cases it may occur due to other reasons
also.
Symptoms:
 Polyuria (production of large volumes of urine)
 Weight loss
 Anaemia and hypertension, Pyuria
 Fever, vomiting and vague abdominal pain are seen in infants
and children
Pathophysiology of UTI

 The microorganisms gain access into the urinary tract by different

routes.
 By ascending pathway (urethra urinary bladder ureters kidney)
thus causing ascending infection.
 Through blood known as haematogenous or descending infection. It
occurs in bacteraemic illness wherein the organisms (Staphylococcus
aureus) affect the kidney.
 Through lymphatic route bacteria enters the rectum and then affects
the kidneys by an unknown mechanism.
Pathophysiology of Ascending Infection

 It is common in females (due to short urethra and secretion of

menopause hormones), diabetic patients, pregnant women and in
persons suffering from obstruction in the urinary tract.
 It is also seen during instrumentation (catheterization).

Step 1: Colonization of Bacteria

The bacteria gains access into the urethra from the colon.
Colonization of bacteria occurs in the urethra. This is facilitated by
adhesion of bacteria (by pili) to the uroepithelial surface.
Pathophysiology of Ascending Infection

Step 2: Transfer of Bacteria from urethra to urinary bladder

The bacteria then enters the urinary bladder by moving against the
flow of urine. This occurs during,
 Instrumentation (catheterisation or cystoscopy)
 Sexual intercourse
 Obstruction of urine outflow (due to which incomplete emptying of
bladder occurs and the microorganisms multiply in the retained
urine).
Pathophysiology of Ascending Infection
Step 3: Establishment of Bacteria in the bladder
From urinary bladder, the microorganisms enter the ureters. The
opening of the ureters into the bladder is closed due to the contraction of
bladder which occurs during micturition. This opening is known as
vesico-ureteral orifice.
In some cases, vesico-ureteral orifice does not close completely during
micturition, so urine enters the ureters from urinary bladder (urine flows
in opposite direction) which is known as vesico-ureteral reflux (VUR).
The microorganisms then enter the ureters and then kidneys. This is
called upper UTI. This results in pyelitis (inflammation of renal pelvis)
and pyelonephritis (inflammation of the kidney and pelvis).
Thankyou..