Distinguishing cystitis from pyelonephritis at the bedside

What it is

UTI is set out as two sides, cystitis and acute pyelonephritis, and the three lines that separate them are the symptoms and signs, the investigation, and the treatment. In a patient with dysuria the character of the patient is key in the diagnosis: in the young female, cystitis, pyelonephritis and vaginitis; in the perimenopause female, estrogen deficiency changes; in the male, STI and urinary stones; and in the child, UTI and vesicoureteral reflex.

How it presents

Cystitis gives dysuria, increased frequency, urgency, and retropubic or suprapubic abdominal pain.

Acute pyelonephritis gives the same as cystitis plus systemic symptoms: spiking fever and chills, anorexia, nausea and vomiting, and loin pain or tenderness.

How it is diagnosed

For cystitis: urine microscopy with WBC above 7, where nitrate and bacteria cells are supportive, with or without urine culture.

For acute pyelonephritis: urine microscopy and urine culture. Imaging with contrast CT is only indicated if the patient is septic, if urinary obstruction is suspected, or if the patient does not respond to appropriate therapy within 48 to 72 hours.