Asymptomatic bacteriuria: Difference between revisions

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==Differentiating Asymptomatic Bacteriuria From Other Diseases==
==Differentiating Asymptomatic Bacteriuria From Other Diseases==
Asymptomatic Bacteriuria must be differentiated from other diseases that might cause bacteriuria.
Asymptomatic Bacteriuria must be differentiated from other diseases that might cause bacteriuria.<ref name="WiseLongo2015">{{cite journal|last1=Wise|first1=Gilbert J.|last2=Longo|first2=Dan L.|last3=Schlegel|first3=Peter N.|title=Sterile Pyuria|journal=New England Journal of Medicine|volume=372|issue=11|year=2015|pages=1048–1054|issn=0028-4793|doi=10.1056/NEJMra1410052}}</ref><ref name="Stamm1983">{{cite journal|last1=Stamm|first1=Walter E.|title=Measurement of pyuria and its relation to bacteriuria|journal=The American Journal of Medicine|volume=75|issue=1|year=1983|pages=53–58|issn=00029343|doi=10.1016/0002-9343(83)90073-6}}</ref><ref name="GroahPerez-Losada2015">{{cite journal|last1=Groah|first1=Suzanne|last2=Perez-Losada|first2=Marcos|last3=Caldovic|first3=Ljubica|last4=Ljungberg|first4=Inger|last5=Sprague|first5=Bruce|last6=Castro-Nallar|first6=Eduardo|last7=Shah|first7=Neel|last8=Hsieh|first8=Michael|last9=Pohl|first9=Hans|title=MP20-08 PYURIA AND ASYMPTOMATIC BACTERIURIA IS ASSOCIATED WITH NOVEL AND SPECIFIC URINE MICROBIOMES|journal=The Journal of Urology|volume=193|issue=4|year=2015|pages=e226|issn=00225347|doi=10.1016/j.juro.2015.02.980}}</ref><ref name="ShaikhShope2016">{{cite journal|last1=Shaikh|first1=N.|last2=Shope|first2=T. R.|last3=Hoberman|first3=A.|last4=Vigliotti|first4=A.|last5=Kurs-Lasky|first5=M.|last6=Martin|first6=J. M.|title=Association Between Uropathogen and Pyuria|journal=PEDIATRICS|volume=138|issue=1|year=2016|pages=e20160087–e20160087|issn=0031-4005|doi=10.1542/peds.2016-0087}}</ref>
'''Differentiating the diseases that can cause pyuria:'''<ref name="WiseLongo2015">{{cite journal|last1=Wise|first1=Gilbert J.|last2=Longo|first2=Dan L.|last3=Schlegel|first3=Peter N.|title=Sterile Pyuria|journal=New England Journal of Medicine|volume=372|issue=11|year=2015|pages=1048–1054|issn=0028-4793|doi=10.1056/NEJMra1410052}}</ref><ref name="Stamm1983">{{cite journal|last1=Stamm|first1=Walter E.|title=Measurement of pyuria and its relation to bacteriuria|journal=The American Journal of Medicine|volume=75|issue=1|year=1983|pages=53–58|issn=00029343|doi=10.1016/0002-9343(83)90073-6}}</ref><ref name="GroahPerez-Losada2015">{{cite journal|last1=Groah|first1=Suzanne|last2=Perez-Losada|first2=Marcos|last3=Caldovic|first3=Ljubica|last4=Ljungberg|first4=Inger|last5=Sprague|first5=Bruce|last6=Castro-Nallar|first6=Eduardo|last7=Shah|first7=Neel|last8=Hsieh|first8=Michael|last9=Pohl|first9=Hans|title=MP20-08 PYURIA AND ASYMPTOMATIC BACTERIURIA IS ASSOCIATED WITH NOVEL AND SPECIFIC URINE MICROBIOMES|journal=The Journal of Urology|volume=193|issue=4|year=2015|pages=e226|issn=00225347|doi=10.1016/j.juro.2015.02.980}}</ref><ref name="ShaikhShope2016">{{cite journal|last1=Shaikh|first1=N.|last2=Shope|first2=T. R.|last3=Hoberman|first3=A.|last4=Vigliotti|first4=A.|last5=Kurs-Lasky|first5=M.|last6=Martin|first6=J. M.|title=Association Between Uropathogen and Pyuria|journal=PEDIATRICS|volume=138|issue=1|year=2016|pages=e20160087–e20160087|issn=0031-4005|doi=10.1542/peds.2016-0087}}</ref>
 
'''To review differential diagnosis of pyuria, click here.'''
'''To review differential diagnosis of pyuria, click [[Pyuria#Pyuria Differential Diagnosis|here]].'''
'''To review differential diagnosis of sterile pyuria, click here.'''
 
'''To review differential diagnosis of sterile pyuria, click [[Sterile pyuria differential diagnosis|here]].'''
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
|-
|-
! rowspan="16" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infectious diseases
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infectious diseases
! rowspan="14" align="center" style="background:#DCDCDC;" + |[[Urinary tract infection|UTI]]<ref name="pmid18061020">{{cite journal |vauthors=Neal DE |title=Complicated urinary tract infections |journal=Urol. Clin. North Am. |volume=35 |issue=1 |pages=13–22; v |date=February 2008 |pmid=18061020 |doi=10.1016/j.ucl.2007.09.010 |url=}}</ref>
! rowspan="4" align="center" style="background:#DCDCDC;" + |[[Urinary tract infection|UTI]]<ref name="pmid18061020">{{cite journal |vauthors=Neal DE |title=Complicated urinary tract infections |journal=Urol. Clin. North Am. |volume=35 |issue=1 |pages=13–22; v |date=February 2008 |pmid=18061020 |doi=10.1016/j.ucl.2007.09.010 |url=}}</ref>
! rowspan="3" align="center" style="background:#DCDCDC;" + |[[Bacteria|Bacterial]]
! rowspan="3" align="center" style="background:#DCDCDC;" + |[[Bacteria|Bacterial]]
! align="center" style="background:#DCDCDC;" + |[[Asymptomatic bacteriuria]]<ref name="Nicolle2014">{{cite journal|last1=Nicolle|first1=Lindsay E.|title=Asymptomatic bacteriuria|journal=Current Opinion in Infectious Diseases|volume=27|issue=1|year=2014|pages=90–96|issn=0951-7375|doi=10.1097/QCO.0000000000000019}}</ref><ref name="Nicolle2015">{{cite journal|last1=Nicolle|first1=Lindsay E.|title=Asymptomatic Bacteriuria and Bacterial Interference|journal=Microbiology Spectrum|volume=3|issue=5|year=2015|issn=2165-0497|doi=10.1128/microbiolspec.UTI-0001-2012}}</ref>
! align="center" style="background:#DCDCDC;" + |[[Asymptomatic bacteriuria]]<ref name="Nicolle2014">{{cite journal|last1=Nicolle|first1=Lindsay E.|title=Asymptomatic bacteriuria|journal=Current Opinion in Infectious Diseases|volume=27|issue=1|year=2014|pages=90–96|issn=0951-7375|doi=10.1097/QCO.0000000000000019}}</ref><ref name="Nicolle2015">{{cite journal|last1=Nicolle|first1=Lindsay E.|title=Asymptomatic Bacteriuria and Bacterial Interference|journal=Microbiology Spectrum|volume=3|issue=5|year=2015|issn=2165-0497|doi=10.1128/microbiolspec.UTI-0001-2012}}</ref>
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| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Urine|urinalysis]]
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Urine|urinalysis]]
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Virus|Viral]]<ref name="pmid23816478">{{cite journal |vauthors=Aboumohamed A, Flechner SM, Chiesa-Vottero A, Srinivas TR, Mossad SB |title=Disseminated adenoviral infection masquerading as lower urinary tract voiding dysfunction in a kidney transplant recipient |journal=Clin. Nephrol. |volume=82 |issue=5 |pages=332–6 |date=November 2014 |pmid=23816478 |doi=10.5414/CN107977 |url=}}</ref><ref name="pmid25667584">{{cite journal |vauthors=Santiago-Rodriguez TM, Ly M, Bonilla N, Pride DT |title=The human urine virome in association with urinary tract infections |journal=Front Microbiol |volume=6 |issue= |pages=14 |date=2015 |pmid=25667584 |pmc=4304238 |doi=10.3389/fmicb.2015.00014 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |PCR viral load
| align="left" style="background:#F5F5F5;" + |
* Increased risk in immunosuppressed [[Kidney transplantation|kidney transplant]] patients
*[[Cytomegalovirus infection|CMV]], [[Epstein Barr virus|EBV]], [[BK virus]], [[Adenoviridae|adenovirus]] might be seen
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Tuberculosis]]<ref name="pmid26123266">{{cite journal |vauthors=Altiparmak MR, Trabulus S, Balkan II, Yalin SF, Denizli N, Aslan G, Doruk HE, Engin A, Tekin R, Birengel S, Cetin BD, Arslan F, Turhan V, Mert A |title=Urinary tuberculosis: a cohort of 79 adult cases |journal=Ren Fail |volume=37 |issue=7 |pages=1157–63 |date=August 2015 |pmid=26123266 |doi=10.3109/0886022X.2015.1057460 |url=}}</ref><ref name="pmid27865246">{{cite journal |vauthors=Verma AK, Mishra AK, Kumar M, Kant S, Singh A, Singh A |title=Renal tuberculosis presenting as acute pyelonephritis - A rarity |journal=Indian J Tuberc |volume=63 |issue=3 |pages=210–213 |date=July 2016 |pmid=27865246 |doi=10.1016/j.ijtb.2015.07.010 |url=}}</ref><ref name="pmid23303798">{{cite journal |vauthors=Daher Ede F, da Silva GB, Barros EJ |title=Renal tuberculosis in the modern era |journal=Am. J. Trop. Med. Hyg. |volume=88 |issue=1 |pages=54–64 |date=January 2013 |pmid=23303798 |pmc=3541747 |doi=10.4269/ajtmh.2013.12-0413 |url=}}</ref><ref name="pmid28784884">{{cite journal |vauthors=Czapka M, Shukla S, Slosar-Cheah M |title=Urine trouble: genitourinary tuberculosis and subsequent DRESS syndrome |journal=BMJ Case Rep |volume=2017 |issue= |pages= |date=August 2017 |pmid=28784884 |doi=10.1136/bcr-2017-220440 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Positive mycobacterial urine culture
| align="left" style="background:#F5F5F5;" + |
*[[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |[[Tuberculosis|Pulmonary TB]] on chest CT
| align="center" style="background:#F5F5F5;" + |Urine mycobacterial [[Polymerase chain reaction|PCR]]
| align="left" style="background:#F5F5F5;" + |
*Past history of [[Tuberculosis|pulmonary TB]]
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Fungal]]<ref name="pmid22025959">{{cite journal |vauthors=Kim J, Kim DS, Lee YS, Choi NG |title=Fungal urinary tract infection in burn patients with long-term foley catheterization |journal=Korean J Urol |volume=52 |issue=9 |pages=626–31 |date=September 2011 |pmid=22025959 |pmc=3198237 |doi=10.4111/kju.2011.52.9.626 |url=}}</ref><ref name="pmid11980593">{{cite journal |vauthors=Carvalho M, Guimarães CM, Mayer JR, Bordignon GP, Queiroz-Telles F |title=Hospital-associated funguria: analysis of risk factors, clinical presentation and outcome |journal=Braz J Infect Dis |volume=5 |issue=6 |pages=313–8 |date=December 2001 |pmid=11980593 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | + after several weeks of follow up
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |[[Hydronephrosis]] on ultrasound
| align="center" style="background:#F5F5F5;" + |[[Urine culture]]
| align="left" style="background:#F5F5F5;" + |
*Increased risk in patients with long−term foley [[Catheter|catheters]]
*[[Candidiasis|Candida]] as the most prevalent fungus
|-
! rowspan="7" align="center" style="background:#DCDCDC;" + |[[Sexually transmitted disease|STD]]
! align="center" style="background:#DCDCDC;" + |[[Chlamydia]]<ref name="MatthewsBonigal1990">{{cite journal|last1=Matthews|first1=R.S.|last2=Bonigal|first2=S.D.|last3=Wise|first3=R.|title=Sterile pyuria and Chlamydia trachomatis|journal=The Lancet|volume=336|issue=8711|year=1990|pages=385|issn=01406736|doi=10.1016/0140-6736(90)91936-5}}</ref><ref name="pmid8733337">{{cite journal |vauthors=Tayal SC, Pattman RS |title=Sterile pyuria: consider chlamydial infection |journal=Br J Clin Pract |volume=50 |issue=3 |pages=166–7 |date=1996 |pmid=8733337 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic [[Causes of pelvic pain|pelvic pain]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="left" style="background:#F5F5F5;" + |
*[[Tenderness (medicine)|Abdominal tenderness]]
*[[Adnexa|Adnexal]] motion [[tenderness]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |[[Polymerase chain reaction|PCR]]
| align="left" style="background:#F5F5F5;" + |
*Females might have concurrent chlamydial [[cervicitis]]
*Must be considered in young, sexually active males
|-
! align="center" style="background:#DCDCDC;" + |[[Gonococcus]]<ref name="pmid6799059">{{cite journal |vauthors=Clarke M, Maskell R |title=Gonorrhoea presenting as "sterile" pyuria |journal=Br Med J (Clin Res Ed) |volume=283 |issue=6305 |pages=1546 |date=December 1981 |pmid=6799059 |pmc=1507898 |doi= |url=}}</ref><ref name="pmid9389943">{{cite journal |vauthors=Jephcott AE |title=Microbiological diagnosis of gonorrhoea |journal=Genitourin Med |volume=73 |issue=4 |pages=245–52 |date=August 1997 |pmid=9389943 |pmc=1195851 |doi= |url=}}</ref><ref name="pmid26063863">{{cite journal |vauthors=Tomas ME, Getman D, Donskey CJ, Hecker MT |title=Overdiagnosis of Urinary Tract Infection and Underdiagnosis of Sexually Transmitted Infection in Adult Women Presenting to an Emergency Department |journal=J. Clin. Microbiol. |volume=53 |issue=8 |pages=2686–92 |date=August 2015 |pmid=26063863 |pmc=4508438 |doi=10.1128/JCM.00670-15 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic [[Causes of pelvic pain|pelvic pain]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="left" style="background:#F5F5F5;" + |
*[[Tenderness (medicine)|Abdominal tenderness]]
*[[Adnexa|Adnexal]] motion [[tenderness]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
High false negative result
| align="left" style="background:#F5F5F5;" + |
*Intracellular gram−negative [[Diplococcus|diplococci]] on [[Gram staining|gram stain]]
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |[[Nucleic acid amplification technique|Nucleic acid amplification]] testing (NAAT)
| align="left" style="background:#F5F5F5;" + |
*Females might have concurrent cervical [[Gonorrhea|gonococcal infection]]
*Must be considered in young, sexually active males
|-
! align="center" style="background:#DCDCDC;" + |[[Ureaplasma urealyticum]]<ref name="pmid18614434">{{cite journal |vauthors=Nassar FA, Abu-Elamreen FH, Shubair ME, Sharif FA |title=Detection of Chlamydia trachomatis and Mycoplasma hominis, genitalium and Ureaplasma urealyticum by polymerase chain reaction in patients with sterile pyuria |journal=Adv Med Sci |volume=53 |issue=1 |pages=80–6 |date=2008 |pmid=18614434 |doi=10.2478/v10039-008-0020-1 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
*Gram stain −
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |[[Polymerase chain reaction|PCR]]
| align="left" style="background:#F5F5F5;" + |
*Associated with complications of pregnancy
|-
! align="center" style="background:#DCDCDC;" + |[[Herpes simplex virus]]<ref name="pmid16926356">{{cite journal |vauthors=Xu F, Sternberg MR, Kottiri BJ, McQuillan GM, Lee FK, Nahmias AJ, Berman SM, Markowitz LE |title=Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States |journal=JAMA |volume=296 |issue=8 |pages=964–73 |date=August 2006 |pmid=16926356 |doi=10.1001/jama.296.8.964 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="left" style="background:#F5F5F5;" + |
*Painful [[Genital ulcer|genital ulcers]]
*Tender local inguinal [[lymphadenopathy]]
*Acute [[urinary retention]]
*Loss of sacral sensation
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Viral culture +
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Polymerase chain reaction|PCR]]
| align="left" style="background:#F5F5F5;" + |
*Associated with extragenital complications, like [[Meningitis|aseptic meningitis]]
*High risk of recurrence 
|-
! align="center" style="background:#DCDCDC;" + |[[Herpes zoster]]<ref name="ChenHsueh2002">{{cite journal|last1=Chen|first1=Po-Hong|last2=Hsueh|first2=Hsiu-Fang|last3=Hong|first3=Chang-Zern|title=Herpes zoster–associated voiding dysfunction: A retrospective study and literature review|journal=Archives of Physical Medicine and Rehabilitation|volume=83|issue=11|year=2002|pages=1624–1628|issn=00039993|doi=10.1053/apmr.2002.34602}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="left" style="background:#F5F5F5;" + |
*[[Rash]]
*Acute [[neuritis]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
* [[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Polymerase chain reaction|PCR]]
| align="left" style="background:#F5F5F5;" + |
*Associated with lumbosacral [[dermatome]] involvement
|-
! align="center" style="background:#DCDCDC;" + |[[Human papillomavirus|HPV]]<ref name="pmid16819332">{{cite journal |vauthors=Guo CC, Fine SW, Epstein JI |title=Noninvasive squamous lesions in the urinary bladder: a clinicopathologic analysis of 29 cases |journal=Am. J. Surg. Pathol. |volume=30 |issue=7 |pages=883–91 |date=July 2006 |pmid=16819332 |doi=10.1097/01.pas.0000213283.20166.5a |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Genital warts|Genital wart]]
*[[Cancer|Cancerous]] lesions of the [[Sex organ|genitalia]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Polymerase chain reaction|PCR]]
| align="center" style="background:#F5F5F5;" + |
*Associated with [[Bladder cancer|bladder carcinoma]]
*Prevented by [[HPV Vaccine|HPV vaccination]]
|-
! align="center" style="background:#DCDCDC;" + |[[Human Immunodeficiency Virus (HIV)|HIV]]<ref name="pmid20338962">{{cite journal |vauthors=Parkhie SM, Fine DM, Lucas GM, Atta MG |title=Characteristics of patients with HIV and biopsy-proven acute interstitial nephritis |journal=Clin J Am Soc Nephrol |volume=5 |issue=5 |pages=798–804 |date=May 2010 |pmid=20338962 |pmc=2863972 |doi=10.2215/CJN.08211109 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*Painful mucocutaneous ulceration
*[[Lymphadenopathy]]
*[[Meningitis|Aseptic meningitis]] 
*[[Diarrhea]]
*[[Weight loss]]
| align="center" style="background:#F5F5F5;" + |
*[[Leukopenia]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Combination antigen/antibody immunoassay + PCR [[Human Immunodeficiency Virus (HIV)|HIV]] viral load test
| align="center" style="background:#F5F5F5;" + |
*Might be gone to chronic [[Human Immunodeficiency Virus (HIV)|HIV]] infection with or without evidence of the [[Immunodeficiency|acquired immunodeficiency syndrome]] ([[HIV AIDS|AIDS]])
*Associated with acute [[interstitial nephritis]]
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Prostatitis]]<ref name="pmid23519458">{{cite journal |vauthors=Wagenlehner FM, Pilatz A, Bschleipfer T, Diemer T, Linn T, Meinhardt A, Schagdarsurengin U, Dansranjavin T, Schuppe HC, Weidner W |title=Bacterial prostatitis |journal=World J Urol |volume=31 |issue=4 |pages=711–6 |date=August 2013 |pmid=23519458 |doi=10.1007/s00345-013-1055-x |url=}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Prostatitis]]<ref name="pmid23519458">{{cite journal |vauthors=Wagenlehner FM, Pilatz A, Bschleipfer T, Diemer T, Linn T, Meinhardt A, Schagdarsurengin U, Dansranjavin T, Schuppe HC, Weidner W |title=Bacterial prostatitis |journal=World J Urol |volume=31 |issue=4 |pages=711–6 |date=August 2013 |pmid=23519458 |doi=10.1007/s00345-013-1055-x |url=}}</ref>
Line 670: Line 420:
*Associated with [[reactive arthritis]]
*Associated with [[reactive arthritis]]
|-
|-
! colspan="3" align="center" style="background:#DCDCDC;" + |[[Appendicitis]]<ref name="pmid11343547">{{cite journal |vauthors=Lee SL, Walsh AJ, Ho HS |title=Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis |journal=Arch Surg |volume=136 |issue=5 |pages=556–62 |date=May 2001 |pmid=11343547 |doi= |url=}}</ref><ref name="pmid25345259">{{cite journal |vauthors=Mahattanobon S, Samphao S, Pruekprasert P |title=Clinical features of complicated acute appendicitis |journal=J Med Assoc Thai |volume=97 |issue=8 |pages=835–40 |date=August 2014 |pmid=25345259 |doi= |url=}}</ref>
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Non−infectious diseases
| align="center" style="background:#F5F5F5;" + |Right lower abdominal pain
! align="center" style="background:#DCDCDC;" + |[[Urinary tract|Urinary tract disorders]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*Right lower [[Tenderness (medicine)|abdominal tenderness]]
| align="center" style="background:#F5F5F5;" + |
*[[Leukocytosis]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*Urine [[specific gravity]] >1.020
| align="center" style="background:#F5F5F5;" + |Enlarged appendiceal diameter on CT scan or ultrasound
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |NA
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! colspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |N/V
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urgency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gross hematuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other PE
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Electrolytes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cell
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cast
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bacteriuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Culture
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other UA findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard for diagnosis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
! rowspan="19" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Non−infectious diseases
! rowspan="7" align="center" style="background:#DCDCDC;" + |[[Urinary tract|Urinary tract disorders]]
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Urinary catheter|Urinary catheterization]]<ref name="ForsterHaslam2017">{{cite journal|last1=Forster|first1=C.S.|last2=Haslam|first2=D.B.|last3=Jackson|first3=E.|last4=Goldstein|first4=S.L.|title=Utility of a routine urinalysis in children who require clean intermittent catheterization|journal=Journal of Pediatric Urology|volume=13|issue=5|year=2017|pages=488.e1–488.e5|issn=14775131|doi=10.1016/j.jpurol.2017.01.016}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Urinary catheter|Urinary catheterization]]<ref name="ForsterHaslam2017">{{cite journal|last1=Forster|first1=C.S.|last2=Haslam|first2=D.B.|last3=Jackson|first3=E.|last4=Goldstein|first4=S.L.|title=Utility of a routine urinalysis in children who require clean intermittent catheterization|journal=Journal of Pediatric Urology|volume=13|issue=5|year=2017|pages=488.e1–488.e5|issn=14775131|doi=10.1016/j.jpurol.2017.01.016}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
Line 742: Line 446:
*Predicting [[Urinary tract infection|UTI]] in children who required clean intermittent [[Catheter|catheterization]] by routine [[Urine|urinalysis]]
*Predicting [[Urinary tract infection|UTI]] in children who required clean intermittent [[Catheter|catheterization]] by routine [[Urine|urinalysis]]
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Urinary stone|Urinary tract stone]]<ref name="pmid23283137">{{cite journal |vauthors=Fwu CW, Eggers PW, Kimmel PL, Kusek JW, Kirkali Z |title=Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States |journal=Kidney Int. |volume=83 |issue=3 |pages=479–86 |date=March 2013 |pmid=23283137 |pmc=3587650 |doi=10.1038/ki.2012.419 |url=}}</ref><ref name="pmid26349951">{{cite journal |vauthors=Singh P, Enders FT, Vaughan LE, Bergstralh EJ, Knoedler JJ, Krambeck AE, Lieske JC, Rule AD |title=Stone Composition Among First-Time Symptomatic Kidney Stone Formers in the Community |journal=Mayo Clin. Proc. |volume=90 |issue=10 |pages=1356–65 |date=October 2015 |pmid=26349951 |pmc=4593754 |doi=10.1016/j.mayocp.2015.07.016 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Colicky pain
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
* [[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |Visible stone on [[Computed tomography|CT scan]]
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |
*Might cause renal obstruction
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Urinary tract neoplasm]]<ref name="pmid23664207">{{cite journal |vauthors=Azuma T, Nagase Y, Oshi M |title=Pyuria predicts poor prognosis in patients with non-muscle-invasive bladder cancer |journal=Clin Genitourin Cancer |volume=11 |issue=3 |pages=331–6 |date=September 2013 |pmid=23664207 |doi=10.1016/j.clgc.2013.04.002 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
* [[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |Visible [[tumor]] on [[Computed tomography|CT scan]]
| align="center" style="background:#F5F5F5;" + |[[Cystoscopy]]  + [[biopsy]]
| align="center" style="background:#F5F5F5;" + |
*Associated with non−muscle−invasive [[bladder cancer]] (NMIBC)
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Fistulae|Urinary fistula]]<ref name="pmid25565512">{{cite journal |vauthors=Hampton BS, Kay A, Pilzek A |title=Urinary fistula and incontinence |journal=Semin. Reprod. Med. |volume=33 |issue=1 |pages=47–52 |date=January 2015 |pmid=25565512 |doi=10.1055/s-0034-1395279 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Urinary incontinence]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |[[Fistula]] on [[cystoscopy]] or [[IVP]]
| align="center" style="background:#F5F5F5;" + |Physical examination
| align="center" style="background:#F5F5F5;" + |
*History of recent surgery
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Interstitial cystitis]]<ref name="pmid22177158">{{cite journal |vauthors=Konkle KS, Berry SH, Elliott MN, Hilton L, Suttorp MJ, Clauw DJ, Clemens JQ |title=Comparison of an interstitial cystitis/bladder pain syndrome clinical cohort with symptomatic community women from the RAND Interstitial Cystitis Epidemiology study |journal=J. Urol. |volume=187 |issue=2 |pages=508–12 |date=February 2012 |pmid=22177158 |pmc=3894739 |doi=10.1016/j.juro.2011.10.040 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic bladder pain
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Tenderness (medicine)|Abdominal tenderness]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |Associated with other chronic pain syndromes
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Vesicoureteral reflux]]<ref name="pmid24012582">{{cite journal |vauthors=Hubert KC, Kokorowski PJ, Huang L, Prasad MM, Rosoklija I, Retik AB, Nelson CP |title=New contralateral vesicoureteral reflux after unilateral ureteral reimplantation: predictive factors and clinical outcomes |journal=J. Urol. |volume=191 |issue=2 |pages=451–7 |date=February 2014 |pmid=24012582 |pmc=4123205 |doi=10.1016/j.juro.2013.08.076 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Oliguria]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |Imaging
| align="center" style="background:#F5F5F5;" + |
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Hydronephrosis]]<ref name="pmid26194290">{{cite journal |vauthors=Dancz CE, Walker D, Thomas D, Özel B |title=Prevalence of Hydronephrosis in Women With Advanced Pelvic Organ Prolapse |journal=Urology |volume=86 |issue=2 |pages=250–4 |date=August 2015 |pmid=26194290 |doi=10.1016/j.urology.2015.05.005 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Oliguria]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |Imaging
| align="center" style="background:#F5F5F5;" + |
|-
! rowspan="5" align="center" style="background:#DCDCDC;" + |[[Renal disease|Renal diseases]]
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Polycystic kidney disease|Polycystic kidney disease]]<ref name="pmid25186187">{{cite journal |vauthors=Paul BM, Vanden Heuvel GB |title=Kidney: polycystic kidney disease |journal=Wiley Interdiscip Rev Dev Biol |volume=3 |issue=6 |pages=465–87 |date=2014 |pmid=25186187 |pmc=4423807 |doi=10.1002/wdev.152 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + | Flank or [[back]] [[pain]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |
*[[Polyuria]]
*[[Nocturia]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Hypocitraturia]]
*[[Hyperuricemia]]
*[[Hyperoxaluria]]
*[[Urine|Low urine pH]]
*[[Microscopic hematuria]]
*[[Proteinuria]] <1 g/day
| align="center" style="background:#F5F5F5;" + |Multiple cysts on [[ultrasound]]
| align="center" style="background:#F5F5F5;" + |Imaging
| align="center" style="background:#F5F5F5;" + |
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Renal vein thrombosis]]<ref name="pmid18158362">{{cite journal |vauthors=Mahmoodi BK, ten Kate MK, Waanders F, Veeger NJ, Brouwer JL, Vogt L, Navis G, van der Meer J |title=High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome: results from a large retrospective cohort study |journal=Circulation |volume=117 |issue=2 |pages=224–30 |date=January 2008 |pmid=18158362 |doi=10.1161/CIRCULATIONAHA.107.716951 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Flank pain
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl or ↑
| align="center" style="background:#F5F5F5;" + |
*Might be asymptomatic
*Signs of [[Acute kidney injury|acute renal failure]]
| align="center" style="background:#F5F5F5;" + |
*[[Leukocytosis]]
| align="center" style="background:#F5F5F5;" + |
*[[Hyperkalemia]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Proteinuria]]
*[[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |[[Thrombosis]] on CT scan
| align="center" style="background:#F5F5F5;" + |Renal [[venography]]
| align="center" style="background:#F5F5F5;" + |
*Increased risk in [[nephrotic syndrome]] and [[Thrombophilia|hypercoagulable state]]
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Interstitial nephritis]]<ref name="pmid25079860">{{cite journal |vauthors=Raghavan R, Eknoyan G |title=Acute interstitial nephritis - a reappraisal and update |journal=Clin. Nephrol. |volume=82 |issue=3 |pages=149–62 |date=September 2014 |pmid=25079860 |pmc=4928030 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |[[Low back pain|Lower back pain]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl or ↑
| align="center" style="background:#F5F5F5;" + |
*[[Rash]]
*[[Weight loss]]
*[[Oliguria]]
| align="center" style="background:#F5F5F5;" + |
*[[Eosinophilia]]
| align="center" style="background:#F5F5F5;" + |
*[[Hyperkalemia]]
*[[Isosthenuria]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Proteinuria]]
*[[Eosinophiluria]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Urine|urinalysis]]
| align="center" style="background:#F5F5F5;" + |
*Associated with [[medications]], particularly [[Antibiotic|antibiotics]]
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[IgA nephropathy]]<ref name="pmid24861083">{{cite journal |vauthors=Roberts IS |title=Pathology of IgA nephropathy |journal=Nat Rev Nephrol |volume=10 |issue=8 |pages=445–54 |date=August 2014 |pmid=24861083 |doi=10.1038/nrneph.2014.92 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl or ↑
| align="center" style="background:#F5F5F5;" + |
*Might be asymptomatic
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Proteinuria]]
*[[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |[[Biopsy]]
| align="center" style="background:#F5F5F5;" + |
*History of [[Acute viral nasopharyngitis (common cold)|upper respiratory infection]]
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Kidney transplantation|Renal transplant rejection]]<ref name="pmid29789350">{{cite journal |vauthors=Martin-Moreno PL, Tripathi S, Chandraker A |title=Regulatory T Cells and Kidney Transplantation |journal=Clin J Am Soc Nephrol |volume= |issue= |pages= |date=May 2018 |pmid=29789350 |doi=10.2215/CJN.01750218 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Flank pain
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |
*Might be asymptomatic
*[[Oliguria]]
| align="center" style="background:#F5F5F5;" + |
*[[Leukocytosis]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Proteinuria]]
*[[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |Increased graft size on ultrasound
| align="center" style="background:#F5F5F5;" + |Renal allograft [[biopsy]]
| align="center" style="background:#F5F5F5;" + |
*Acute rise in the [[Creatinine|serum creatinine]]
*History of [[Organ transplant|transplant]]
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! colspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |N/V
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urgency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gross hematuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other PE
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Electrolytes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cell
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cast
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bacteriuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Culture
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other UA findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard for diagnosis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
! rowspan="4" align="center" style="background:#DCDCDC;" + |[[Systemic disease]]
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Diabetic nephropathy]]<ref name="pmid24983394">{{cite journal |vauthors=Bjornstad P, Cherney D, Maahs DM |title=Early diabetic nephropathy in type 1 diabetes: new insights |journal=Curr Opin Endocrinol Diabetes Obes |volume=21 |issue=4 |pages=279–86 |date=August 2014 |pmid=24983394 |pmc=4138314 |doi=10.1097/MED.0000000000000074 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |
*Might be asymptomatic
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Albuminuria]]
*[[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + laboratory tests
| align="center" style="background:#F5F5F5;" + |
*History of [[retinopathy]] and [[neuropathy]]
*Slow and progressive [[Renal insufficiency|renal failure]]
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Lupus nephritis]]<ref name="SchwartzGoilav2014">{{cite journal|last1=Schwartz|first1=Noa|last2=Goilav|first2=Beatrice|last3=Putterman|first3=Chaim|title=The pathogenesis, diagnosis and treatment of lupus nephritis|journal=Current Opinion in Rheumatology|volume=26|issue=5|year=2014|pages=502–509|issn=1040-8711|doi=10.1097/BOR.0000000000000089}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |
*[[Rash]]
*[[Oral ulcer]]
*[[Arthritis]]
| align="center" style="background:#F5F5F5;" + |
*[[Pancytopenia]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Hematuria]]
*[[Proteinuria]]
| align="center" style="background:#F5F5F5;" + |Enlarged kidneys on CT scan
| align="center" style="background:#F5F5F5;" + |[[Biopsy]]
| align="center" style="background:#F5F5F5;" + |
* Abnormal results of specific serologic tests
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Sjögren's syndrome|Sjögren’s syndrome]]<ref name="de PaivaRocha2015">{{cite journal|last1=de Paiva|first1=Cintia S.|last2=Rocha|first2=Eduardo Melani|title=Sjögren syndrome|journal=Current Opinion in Ophthalmology|volume=26|issue=6|year=2015|pages=517–525|issn=1040-8738|doi=10.1097/ICU.0000000000000208}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |
*Dryness of all [[mucous membranes]] 
| align="center" style="background:#F5F5F5;" + |
*[[Pancytopenia]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Hematuria]]
*[[Proteinuria]]
| align="center" style="background:#F5F5F5;" + |Abnormal diffuse [[Adipose tissue|fat tissue]] deposition and diffuse punctate [[calcification]] on parotid gland CT scan
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + laboratory tests
| align="center" style="background:#F5F5F5;" + |
* Abnormal results of specific serologic tests
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Kawasaki's disease]]<ref name="pmid14745638">{{cite journal |vauthors=Wirojanan J, Sopontammarak S, Vachvanichsanong P |title=Sterile pyuria in Kawasaki disease |journal=Pediatr. Nephrol. |volume=19 |issue=3 |pages=363 |date=March 2004 |pmid=14745638 |doi=10.1007/s00467-003-1394-8 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Rash]]
*[[Irritability]]
*[[Desquamation]] of skin and mucous membranes
| align="center" style="background:#F5F5F5;" + |
*[[Normocytic normochromic anemia]]
*[[Thrombocytosis]]
*[[Leukocytosis]]
| align="center" style="background:#F5F5F5;" + |
*[[Hyponatremia]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Vessels involvement on [[Angiogram|angiography]]
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |Associated with multiple organ involvement including [[heart]]
|-
! rowspan="2" align="center" style="background:#DCDCDC;" + |[[Medication]]/[[toxin]]
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Analgesic nephropathy]]<ref name="pmid28341428">{{cite journal |vauthors=Henderickx MMEL, Brits T, De Baets K, Seghers M, Maes P, Trouet D, De Wachter S, De Win G |title=Renal papillary necrosis in patients with sickle cell disease: How to recognize this 'forgotten' diagnosis |journal=J Pediatr Urol |volume=13 |issue=3 |pages=250–256 |date=June 2017 |pmid=28341428 |doi=10.1016/j.jpurol.2017.01.020 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Flank pain
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |
*Chronic [[headache]]
*[[Low back pain]]
| align="center" style="background:#F5F5F5;" + |
*[[Eosinophilia]]
| align="center" style="background:#F5F5F5;" + |
*[[Hyperkalemia]]
*[[Isosthenuria]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Proteinuria]]
*[[Eosinophiluria]]
| align="center" style="background:#F5F5F5;" + |Renal impairment on CT scan
| align="center" style="background:#F5F5F5;" + |Imaging
| align="center" style="background:#F5F5F5;" + |
*Characterized by [[Renal papillary necrosis|papillary necrosis]] and chronic [[interstitial nephritis]]
*Caused by the chronic use of [[analgesic]] agents
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Contrast induced nephropathy|Contrast−induced nephropathy]]<ref name="PatschanBuschmann2018">{{cite journal|last1=Patschan|first1=D.|last2=Buschmann|first2=I.|last3=Ritter|first3=O.|title=Contrast-Induced Nephropathy: Update on the Use of Crystalloids and Pharmacological Measures|journal=International Journal of Nephrology|volume=2018|year=2018|pages=1–8|issn=2090-214X|doi=10.1155/2018/5727309}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Oliguria]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Hyperkalemia]]
*[[Acidosis]]
*[[Hyperphosphatemia]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
* [[Fractional sodium excretion]] (FENa) <1%
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + exclusion of other causes of AKI
| align="center" style="background:#F5F5F5;" + |
*Associated with reversible type of [[acute kidney injury]]
*Acute increase in the [[Creatinine|serum creatinine]]
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
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[[Category:Up-To-Date]]
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[[Category:Primary care]]

Latest revision as of 20:31, 29 July 2020



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To view the Urinary Tract Infections main page click here.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2], Abdurahman Khalil, M.D. [3], Sadaf Sharfaei M.D.[4]

Overview

Urine is normally sterile. Asymptomatic bacteriuria is a condition in which a significant number of bacteria appear in the urine, without the presence of typical symptoms of a urinary tract infection. Presence of >10 leukocytes/mm³ is considered as pyuria but not asymptomatic bacteriuria unless the number exceeds ≥105 colony forming units(cfu)/mL. There are two main pathogenesis that might be responsible for asymptomatic bacteriuria which include microbial virulence and host factors. Escherichia coli is the single most common cause of asymptomatic bacteriuria. Asymptomatic bacteriuria is more common in elderly and its prevalence increase with age. Asymptomatic bacteriuria has been slightly more common in black population. Asymptomatic bacteriuria has risk factors similar to symptomatic bacteriuria such as pregnancy, aging, diabetes mellitus, sexual intercourse, using diaphragm plus spermicide, BPH, renal stones, or patients with spinal cord injuries, hemodialysis, indwelling urethral catheters, genitourinary abnormalities. Screening for asymptomatic subjects is considered if bacteriuria is associated with preventable adverse outcomes such as symptomatic urinary infection, progression to chronic kidney disease or hypertension, development of urinary tract cancer, and decreased duration of survival. If left untreated asymptomatic bacteriuria normally cures on its own and active treatment is not required except in those who are pregnant, require renal transplantation or are supposed to undergo a urinary tract procedure. In patients who acquire asymptomatic bacteriuria early in their pregnancy, there is a minute chance of issues related to pregnancy like low birth weight etc or pyelonephritis. Most cases resolve postpartum. The diagnosis of bacteriuria in an asymptomatic individual is based on the culture results of urine collected in a manner that minimizes the possibility of contamination and limits the period between sampling and testing the specimen to avoid false positivity due to bacterial growth. Treatment is not required in otherwise healthy individuals unless it is associated with a urinary tract infection. Conditions that might require the asymptomatic bacteriuria to be treated are pregnancy, before transurethral prostatic resection, and renal transplant follow-up.

Historical Perspective

Classification

According to the Infectious Disease Society of America (IDSA), asymptomatic bacteriuria is defined as the presence of ≥105 cfu/mL of bacteria in clean catch urine specimen of an asymptomatic person with respect to symptoms urinary tract infection. By definition, one positive sample is enough to confirm asymptomatic bacteriuria in men, whereas in women two consecutive samples with same organism are required to diagnose asymptomatic bacteriuria. In men or women who are catheterized and are asymptomatic, identification of ≥102 cfu/mL of a single organism in the catheterized specimen is defined as asymptomatic bacteriuria. The prevalence of bacteriuria is more in sexually active women (4.6%) as compared to sexually inactive women (0.7%) or men.

Pathophysiology

Microbial Virulence

  • Asymptomatic bacteriuria may also be due to the decreased virulence of some strains that gather in the bladder but do not cause a symptomatic appearance. Some strains isolated from patients with asymptomatic bacteriuria in the setting of spinal cord injury have decreased capability of causing hemolysis.[5][6]

Host Factors

Causes

Most common organism

Common Causes Less Common Causes GU abnormalities & Hospitalization Long Term Catheterisation[13][14]
Enterococcus[15] Chromobacterium violaceum[16] E.coli[13][17] Pseudomonas aeruginosa
Enterobacteriaceae[18] Staphylococci[19] Proteus mirabilis[13][20] P. mirabilis
Klebsiella[21] Gardnerella vaginalis[22][23] Providencia stuartii
Pseudomonas aeruginosa[24] Elizabethkingia meningoseptica[25] Morganella morganii
Group B Streptococcus[26][27]

Differentiating Asymptomatic Bacteriuria From Other Diseases

Asymptomatic Bacteriuria must be differentiated from other diseases that might cause bacteriuria.[28][29][30][31]

To review differential diagnosis of pyuria, click here.

To review differential diagnosis of sterile pyuria, click here.

Category Disease Clinical manifestations Para−clinical findings Gold standard for diagnosis Associated findings
Symptoms Physical examination
Lab Findings Imaging
Pain Fever N/V Urinary symptoms BP Other CBC Electrolytes Urinalysis
Dysuria Frequency Urgency Gross hematuria Cell Cast Bacteriuria Culture Other
Infectious diseases UTI[32] Bacterial Asymptomatic bacteriuria[33][34] Nl Nl Nl ± + NA NA Urinalysis
  • Increased risk in pregnancy
  • Must be treated prior to an invasive urologic procedure
Cystitis[35] + + + Nl Nl Nl + + + NA Urinalysis NA
Pyelonephritis[36] + + + + + + Nl Nl + WBC cast + + NA Clinical manifestation + urinalysis NA
Prostatitis[37]  Pelvic or perineal pain + + + + + Nl or ↑
  • Dribbling of urine
  • Firm and tender prostate
Nl + ± + NA Clinical manifestation + urinalysis
  • Increased risk of bacteremia, prostatic abscess, and metastatic infection
  • Might be acute or chronic infection
Balanitis[38] Penile pain + + + + Nl
  • Pruritus
  • Erythematous lesions on the glans and/or the foreskin
Nl Nl + ± NA NA Clinical manifestation
Non−infectious diseases Urinary tract disorders Urinary catheterization[39] + + Nl Nl + + + Clinical manifestation + urinalysis
Disease Pain Fever N/V Dysuria Frequency Urgency Gross hematuria BP Other PE CBC Electrolytes Cell Cast Bacteriuria Culture Other UA findings Imaging Gold standard for diagnosis Associated findings

Epidemiology and Demographics

Prevalance

Age

  • Asymptomatic bacteriuria is more common in elderly and its prevalence increase with age.[42][43]
  • The prevalence of asymptomatic bacteriuria in women greater than 80 years old is >20%.[44][45]
  • The prevalence of asymptomatic bacteriuria in men greater than 75 year old is 6-15%.[46]
  • Asymptomatic bacteriuria is present in 3-5% of the women population between 38-60 years of age. It was identified in 5% of women in universities and 6% of women in groups related to health maintenance organisations.[47][48]

Gender

  • Asymptomatic bacteriuria is more prevalent in females as compared to males.
  • Asymptomatic bacteriuria is rare among healthy men.[49][50]

Race

  • Asymptomatic bacteriuria has been slightly more common in black population.[51]

Risk Factors

Asymptomatic bacteriuria has risk factors similar to symptomatic bacteriuria. Some of these include:[52][53]

General Risk Factors

Disease Conditions

Screening

Screening for asymptomatic subjects is considered if bacteriuria is associated with preventable adverse outcomes such as symptomatic urinary infection, progression to chronic kidney disease or hypertension, development of urinary tract cancer, and decreased duration of survival.[61]

Individuals requiring screening

The following should be screened for asymptomatic bacteriuria:[62][63]

Catheter Associated Asymptomatic Bacteriuria

It is not recommended to screen for or treat asymptomatic bacteriuria or fungiuria for short or long term catheters, exceptions are catheterized pregnant women and women with persistent bacteriuria 48 hours after removal of the urethral catheter. Prophylaxis can also be used also with patients undergoing urological procedures.[64][65]

Natural History, Complications, and Prognosis

Natural History

Complications

Asymptomatic bacteriuria rarely leads to complications. These may include:

Prognosis

Asymptomatic bacteriuria has a good prognosis and completely resolves with treatment.[75]

Diagnosis

Diagnostic Study of Choice

The diagnosis of bacteriuria in an asymptomatic individual is based on the culture results of urine collected in a manner that minimizes the possibility of contamination and limits the period between sampling and testing the specimen to avoid false positivity due to bacterial growth.

The quantitative definition for significant bacteriuria is:[76]

  • For asymptomatic women, bacteriuria is defined as 2 consecutive voided urine specimens with isolation of the same bacterial strain in quantitative counts of ≥105 CFU/mL.

History and Symptoms

Patients with asymptomatic bacteriuria are asymptomatic.

Physical Examination

Patients with asymptomatic bacteriuria appear completely normal.

Laboratory Findings

Electrocardiogram

There are no ECG findings associated with asymptomatic bacteriuria.

X-ray

There are no x-ray findings associated with asymptomatic bacteriuria.

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with asymptomatic bacteriuria.

CT scan

There are no CT scan findings associated with asymptomatic bacteriuria.

MRI

There are no MRI findings associated with asymptomatic bacteriuria.

Other Imaging Findings

There are no other imaging findings associated with asymptomatic bacteriuria.

Other Diagnostic Studies

There are no other diagnostic studies associated with asymptomatic bacteriuria.

Treatment

Medical Therapy

Treatment is not required in otherwise healthy individuals unless it is associated with a urinary tract infection. Some other conditions that might require the asymptomatic bacteriuria to be treated are:[87][88][89][63][90][91]

Asymptomatic bacteriuria treatment

  • 1. Empiric antimicrobial therapy
  • Treatment of asymptomatic bacteriuria is not recommended for the following persons:
  • 2. Specific considerations
  • 2.1 Women, pregnant
  • 2.2 Patients with indwelling urethral catheters
  • Screening for or treatment of asymptomatic bacteriuria in patients with indwelling urethral catheters is not recommended.
  • Note (1): Antimicrobial treatment of asymptomatic women with catheter-acquired bacteriuria that persists 48 hours after catheter removal may be considered.
  • 2.3 Urologic interventions
  • 2.4 Renal transplant
  • 2.5 Catheter Associated Asymptomatic Bacteriuria

Followup

  • A large proportion of women with asymptomatic bacteriuria in pregnancy have a recurrence after a short duration of therapy and for this reason a followup is done one week after completing the therapy and then monthly until the birth due to a higher chance of recurrence.[97]

Surgery

Surgical intervention is not recommended for the management of asymptomatic bacteriuria.

Primary Prevention

Primary preventive measure for asymptomatic bacteriuria include:[98][99]

Secondary Prevention

Secondary preventive measures for asymptomatic bacteriuria include:

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