Clinical signs:

– Lower back pain or acute or hyperacute pelvic (renal colic).

– Hematuria with or without “sand” in the urine, with or without evacuation of a calculation.

– Urinary Cap: red blood cells with or without leukocytes.

– Secondary infections may develop: then manifested by cystitis or pyelonephritis.

Treatment:

– Increase fluid intake: 3-4 liters / day

– Analgesics:

• moderate forms

PO diclofenac 150 mg / day in 3 divided doses for 3 days associated with hyoscine butylbromide PO: 30 to 60 mg / day in 3 divided doses for 3 days

• renal colic

IM diclofenac 75 mg / injection, 2 times / day for up to 2 days then change to oral hyoscine butylbromide IM: 10 to 20 mg / injection to be repeated every 8 hours depending on the clinical course

– In case of infection: antibiotic treatment as for pyelonephritis, whose effectiveness is conditioned by the elimination of the calculation.

Acute Cystitis

Cystitis is an infection of the bladder and urethra, mainly affecting women and in children, girls from the age of 2 years.The causative organism is Escherichia coli in 70-95% of cases. Other possible germs are Proteus mirabilis,Enterococcus, Klebsiella sp and in young women, S. saprophyticus.

Clinical signs:

– Burns / pain on urination and urinary frequency (frequent transmission of small amounts of urine); in children crying when urinating; bladder weakness a child continent.

AND

– No fever (or low fever) and low back pain; absence of signs and systemic symptoms in children.

Always remove pyelonephritis.

Of burning on urination are insufficient in themselves to make the diagnosis. In the presence of an abnormal vaginal discharge.

Laboratory:

– Urine dipstick:

The presence of nitrites (witness the presence of enterobacteria) and leukocytes (inflammatory witnessed a phenomenon).

• A negative test for both nitrites and leukocytes excludes a urinary tract infection.

• A positive test for nitrite and / or leukocytes confirms clinical diagnosis.

– Review cytobacteriological / urine culture (urine culture): If the test dipstick is positive, it is recommended to perform a urine culture, if available, to confirm the infection and identify the causative organism, especially in the children and pregnant women.

In the absence of urine culture, a positive result for leukocytes and / or nitrite in a patient with a typical clinical cystitis enough to prescribe an empiric antibiotic treatment.

Note: regardless of the results, in areas where urinary schistosomiasis is endemic, gross hematuria or the detection of blood in urine to the strip should be suspected schistosomiasis, especially among children 5 to 15 years, although concomitant UTI is also possible.

Treatment:

Cystitis in girls ≥ 2 years:

cefixime PO: 8 mg / kg / day once daily for 3 days or amoxicillin / clavulanic acid PO: 45 to 50 mg / kg / day in 2 divided doses for 3 days.

Cystitis in young women outside of pregnancy:

– If the dipstick is positive for nitrites and leukocytes: fosfomycin-trometamol PO: 3 g single dose or ciprofloxacinPO: 500 mg / day in 2 divided doses for 3 days or nitrofurantoin PO (except in patients with a deficit G6PD): 300 mg / day in 3 divided doses for 5 days

– If the strip is positive for leukocytes but negative for nitrites, infection with S. saprophyticus is possible. Fosfomycin is ineffective on this germ.

Use ciprofloxacin or nitrofurantoin, as-above.

– Whatever the antibiotic administered, symptoms may persist for 2-3 days after treatment, even if it is effective.

– In case of treatment failure (or for recurrent cystitis ie d> 3-4 episodes / year.), Ciprofloxacin PO: 1 g / day in 2 divided doses for 5 days

– In case of recurrent cystitis, consider bladder stones, urinary schistosomiasis, urinary tuberculosis, gonorrhea (examine the partner).

Cystitis in pregnant or lactating women:

fosfomycin-trometamol PO as above or cefixime PO: 400 mg / day in 2 divided doses for 5 days or nitrofurantoinPO (except during the last month of pregnancy, the first month of breastfeeding, and in case of deficit G6PD): 300 mg / day in 3 divided doses for 5 to 7 days

Acute Pyelonephritis

Pyelonephritis is an infection of the renal parenchyma, potentially severe, especially in pregnant women, newborns and infants. The germs are the same as for cystitis.

Clinical signs:

Newborns and infants:

– The symptoms are not specific: fever, irritability, vomiting, refusal to eat. The abdomen may be tender to palpation.The absence of fever does not exclude the diagnosis; conversely, the only sign may be an isolated fever without obvious cause.

– The table can be severe in newborns include fever or hypothermia, impaired general state of consciousness, gray complexion, signs of shock.

In practice, a urinary tract infection should be suspected in unexplained fever or infection or sepsis syndrome without particular call point.

Older children and adults:

– Signs of cystitis (burning / pain on urination and urinary frequency, etc.)

AND

– Fever> 38.5 ° C and back pain (often unilateral) or abdominal

Laboratory:

See cystitis.

Treatment:

– Antibiotic therapy in children

• Children less than a month

cefotaxime IV: 150 mg / kg / day in 3 injections for 10 days or ampicillin IV: 200 mg / kg / day in 3 injections for 10 days + gentamicin IM or IV: 5 mg / kg / once daily during 5 days

• Children over one month ceftriaxone IM or IV 50 mg / kg / once daily until clinical improvement (minimum 3 days), then take oral treatment to complete 10 days of treatment with amoxicillin / acid clavulanic PO: 45 to 50 mg / kg / day in 2 divided doses or cefixime PO: 8 mg / kg / once daily (in children ³ 3 months).

– Antibiotic therapy in adults

• In the absence of ciprofloxacin PO severity signs: 1 to 1.5 g / day in 2 or 3 doses for 7 days or cefixime PO: 400 mg / day in 2 divided doses for 10 days

• In the presence of severity signs (vomiting, patient seen late) or if the terrain is unfavorable ceftriaxone IM (eg malnutrition, associated pathology..): 1 g / once daily for 3 days minimum, and then take over by with oral cefiximePO: 400 mg / day in 2 divided doses to complete 10 to 14 days of treatment (up to 21 days according to clinical response) + gentamicin IM: 3 to 6 mg / kg / once daily for 3 days in sepsis or failing:

ampicillin IV: 8 g / day in 3 injections for at least 3 days + gentamicin IM: 3 to 6 mg / kg / once daily for 3 days, then take oral treatment with amoxicillin PO: 4 g / day in 2 divided doses to complete 10 to 14 days of treatment

– Treatment of fever and pain (use paracetamol to NSAIDs).

– Although hydrate the patient (1.5 liters of water per day for adults), especially in children (risk of dehydration); treat dehydration if present.

– In severe cases, management of septic shock.