Obstructed infected kidney and renal decompression

What it is

An infected kidney behind an obstruction is not a urinary tract infection that antibiotic alone will fix. Any complicated UTI must rule out obstruction, and relief of obstruction is a priority in addition to antibiotic. Left alone it ends in urosepsis.

Postrenal azotemia is due to outflow obstruction from stones, BPH, neoplasia or congenital anomalies, and it develops only with bilateral obstruction or in a solitary kidney.

Causes and risk

An uncomplicated UTI occurs in healthy asymptomatic, non-pregnant women with no history of urinary tract abnormalities, and not posted for any urological procedure. Everything outside that is complicated, and complicated means an increased chance of treatment failure.

By patient characteristics:

• Male sex
• Postmenopausal
• Pregnant
• Presence of hospital-acquired urinary tract infection
• Symptoms present for seven or more days before presentation

By medical conditions: diabetes mellitus and immunocompromised status.

By urologic conditions:

• History of childhood or recurrent urinary tract infections
• Indwelling catheter
• Neurogenic bladder
• Polycystic kidney disease
• Recent urologic instrumentation
• Renal transplant
• Urolithiasis
• Urologic obstruction
• Urologic stents

Some experts consider three of these groups uncomplicated after all: healthy postmenopausal women, patients with well-controlled diabetes, and patients with recurrent cystitis that responds to treatment.