Urinary Tract Infection (UTI) is a common bacterial infection affecting the urinary system, including the urethra (urethritis), bladder (cystitis), and kidneys (pyelonephritis). Accurate urine examination is critical for diagnosis, prognosis, and treatment.
I. Understanding UTI – Etiology and Pathophysiology
🔹 Common Causative Organisms
- Gram-negative bacteria: Escherichia coli (80-85%), Klebsiella pneumoniae, Proteus mirabilis
- Gram-positive bacteria: Enterococcus faecalis, Staphylococcus saprophyticus
- Fungal UTI: Candida species (especially in immunocompromised patients)
🔹 Pathophysiology
- Ascending Infection – Bacteria from the perineal region enter through the urethra and reach the bladder (most common).
- Hematogenous Spread – Rare, occurs in bacteremia or endocarditis.
- Risk Factors – Diabetes, catheterization, pregnancy, kidney stones, immunosuppression.
🔹 Types of UTI
| Type | Description | Symptoms |
|---|---|---|
| Uncomplicated UTI | Infection in a structurally normal urinary tract | Dysuria, frequency, urgency, suprapubic pain |
| Complicated UTI | UTI in patients with underlying pathology (stones, obstruction, diabetes) | Severe symptoms, fever, flank pain |
| Recurrent UTI | ≥2 infections in 6 months or ≥3 infections in 1 year | Persistent UTI symptoms despite treatment |
| Pyelonephritis | Kidney infection, ascending from lower UTI | Fever, chills, flank pain, nausea, vomiting |
II. Clinical Features of UTI
🔹 Common Symptoms
✔ Burning sensation during urination (dysuria)
✔ Frequent urination (polyuria)
✔ Urgency to urinate
✔ Lower abdominal or suprapubic pain
✔ Cloudy, foul-smelling urine
✔ Fever, chills (pyelonephritis)
🔹 Signs in Physical Examination
✔ Suprapubic tenderness (cystitis)
✔ Costovertebral angle (CVA) tenderness (pyelonephritis)
✔ Fever, tachycardia (severe UTI)
III. Urine Examination in UTI
A comprehensive urine analysis confirms UTI diagnosis and guides treatment.
A. Physical Examination of Urine
| Parameter | Findings in UTI | Clinical Significance |
|---|---|---|
| Color | Cloudy, yellow | Indicates infection and pyuria |
| Odor | Foul-smelling | Bacterial metabolism products |
| Clarity | Turbid | Pus cells and bacteria present |
| Specific Gravity | Normal or high (>1.020) | Dehydration in severe cases |
B. Chemical Urinalysis (Dipstick Test) in UTI
| Test | Expected Findings in UTI | Clinical Significance |
|---|---|---|
| Leukocyte Esterase | Positive | Indicates WBCs in urine (infection) |
| Nitrites | Positive | Indicates bacterial UTI (Gram-negative bacteria) |
| Protein | Mildly elevated | Due to inflammation in urinary tract |
| pH | Alkaline (>7.5) | Seen in Proteus infection (urease-producing bacteria) |
| Blood (Hematuria) | Present (microscopic or gross) | Due to inflammation or trauma |
C. Microscopic Urinalysis in UTI
| Finding | Expected in UTI? | Clinical Correlation |
|---|---|---|
| WBCs (Pyuria) | >10 WBCs/hpf | Strong evidence of infection |
| RBCs (Hematuria) | Present | Inflammation, cystitis, trauma |
| Bacteria | Seen in large numbers | Confirms infection |
| Casts | WBC casts in pyelonephritis | Suggests kidney involvement |
| Epithelial Cells | Few | Contamination if excessive |
D. Urine Culture & Sensitivity Test
- Gold standard test for UTI diagnosis
- Used to identify causative bacteria and determine antibiotic susceptibility
- Colony count > 10⁵ CFU/mL = Significant UTI
| Bacteria | Commonly Used Antibiotics |
|---|---|
| E. coli | Nitrofurantoin, Fosfomycin, Ciprofloxacin |
| Klebsiella | Ceftriaxone, Carbapenems |
| Proteus | Trimethoprim-Sulfamethoxazole |
| Enterococcus | Ampicillin, Vancomycin (if resistant) |
IV. Ayurvedic Perspective on UTI (Mutrakrichra – Dysuria)
A. Ayurvedic Classification of Mutrakrichra
| Type | Dosha Involved | Symptoms | Modern Correlation |
|---|---|---|---|
| Vataja Mutrakrichra | Vata | Dryness, pain during urination, interrupted flow | Urethral stricture, neurogenic bladder |
| Pittaja Mutrakrichra | Pitta | Burning micturition, fever, yellow urine | UTI, cystitis |
| Kaphaja Mutrakrichra | Kapha | Sticky urine, heaviness, cloudy urine | Chronic UTI, prostatitis |
| Sannipataja Mutrakrichra | Vata-Pitta-Kapha | Mixed symptoms, severe infection | Pyelonephritis, complicated UTI |
V. Advanced Interpretation – UTI in Special Cases
A. UTI in Diabetes (Diabetic Cystopathy)
- Urine Findings: Glucose in urine (glycosuria), recurrent UTIs
- Complication: Diabetic neuropathy → Bladder dysfunction
- Management: Tight glycemic control, antibiotics
B. UTI in Pregnancy
- Risk: Increased due to progesterone-induced urinary stasis
- Complication: Pyelonephritis, preterm labor
- Safe Antibiotics: Cephalexin, Amoxicillin
C. Recurrent UTI in Women
- Causes: Short urethra, postmenopausal changes, sexual activity
- Preventive Strategies: Hydration, cranberry juice, probiotics